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Abstract: PO1783

Blood Pressure Control and Undiagnosed Hypertension: A Randomized Diagnostic Study Comparing Clinic, Home, and Kiosk Methods

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Hall, Yoshio N., University of Washington, Seattle, Washington, United States
  • Anderson, Melissa L., Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States
  • Green, Beverly B., Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States
Background

Undiagnosed hypertension is common and contributes to CKD and cardiovascular morbidity and mortality. We compared prevalence of blood pressure (BP) control and undiagnosed hypertension at 6 months according to different BP measurement methods.

Methods

BP CHECK was a randomized diagnostic study of 510 adults aged 18-85 without diagnosed hypertension or antihypertensive medications, with elevated BP in clinic and at baseline, conducted 2017-2019 in primary care centers of an integrated healthcare system. Randomization occurred into one of three diagnostic regimens: (1) Clinic BP (usual care), (2) Home BP (twice daily for 5 days), or (3) Kiosk BPs (triplicate BPs on 3 days). All participants completed ABPM at baseline. Primary outcomes were changes in systolic BP and diastolic BP; BP control and receipt of a new hypertension diagnosis at 6 months. We further examined whether changes in patient-reported outcomes relating to physical and psychological well-being and behavior were associated with BP control or a new hypertension diagnosis.

Results

Mean baseline BP was similar across groups (150/88 mmHg). Overall, 93% (472/510) of study participants completed the 6-month visit. All groups experienced a reduction in BP (mean reduction: systolic BP −11.5 mmHg, diastolic BP −5.5 mmHg) with no significant differences by randomization group. Among 323 participants with hypertension based on ABPM, 156 (48%) achieved BP control (<140/90 mmHg) and 130 (40%) had a new hypertension diagnosis recorded in the EHR at 6-months. Participants with undiagnosed hypertension at 6 months experienced significantly lower reductions in both systolic and diastolic BP, compared to individuals with a new hypertension diagnosis (difference in mean change SBP [95% CI], -5.1 mmHg [-7.8,-2.3], P<0.001; DBP -2.4 mmHg [-4.2, -0.5], P=0.01). Changes in patient-reported outcomes from baseline to 6 months were small, with no significant differences in body weight, intake of fruits/vegetables, or measures of physical health according to randomization group or presence of hypertension diagnosis.

Conclusion

Irrespective of BP measuring method, most participants with high BP on screening and ABPM diagnostic testing did not receive a hypertension diagnosis or adequate BP control. New strategies are needed to enhance uptake of BP diagnostic testing into clinical practice.

Funding

  • Other U.S. Government Support