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Kidney Week

Abstract: TH-PO1146

A Clinical Decision Support Intervention Results in a Clinically Significant Decrease in Mean Systolic Blood Pressure in a Pragmatic Clinical Trial in a Primary Care Setting

Session Information

  • Late-Breaking Posters
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

  • 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Samal, Lipika, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Kilgallon, John L., Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Lipsitz, Stuart R., Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Baer, Heather J, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Gannon, Michael P, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Dunk, Ryan, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Chay, Weng Ian, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Fay, Richard John, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Garabedian, Pamela, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Wu, Edward, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Bonventre, Joseph V., Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • McMahon, Gearoid M., Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Waikar, Sushrut S., Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States
  • Dykes, Patricia, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
Background

Patients with chronic kidney disease (CKD) and hypertension (HTN) are at high risk for kidney failure and cardiovascular morbidity and mortality. Although both CKD and uncontrolled HTN are not difficult to diagnose, both often go unrecognized by primary care physicians (PCPs).

Methods

We conducted a pragmatic, randomized controlled trial involving PCPs and their patients in an academic medical center. Individual PCPs were randomized to intervention or usual care. All adult patients with a visit to a PCP were eligible and those with evidence in the electronic health record of CKD and uncontrolled HTN were automatically enrolled. The intervention consisted of a clinical decision support (CDS) intervention that delivered anti-hypertensive treatment recommendations (renin-angiotensin-aldosterone system (RAAS) inhibitors or hydrochlorothiazide for those on maximal RAAS inhibition). The primary outcome was the change in mean systolic blood pressure (SBP) between baseline and 180 days compared between arms. A secondary outcome was orders placed for recommended anti-hypertensive medications.

Results

The study included 184 PCPs and 2026 patients. Patient mean age was 75.3 years; 60% were female, and 71% were White. 80% of patients had an SBP measurement at 180 days +/- 60 days. We observed a 2.9 mmHg greater reduction in SBP in patients in the CDS intervention arm compared to usual care (95% CI 1.27,4.53; p=0.005). PCPs also placed more orders for recommended anti-hypertensive medications in the intervention arm (Table 1; p<0.0001).

Conclusion

A CDS intervention resulted in a clinically significant decrease in mean systolic blood pressure in a pragmatic clinical trial in a primary care setting.

Table 1: Primary and Secondary Outcomes
Measurement VariableInterventionUsual Carep-value
Primary Outcome: Difference in SBP from baseline to 180 days
Change in SBP, mmHg (95% CI)-14.6 (-13.1, -16.0)-11.7 (-10.2, -13.1)0.005
Secondary Outcome
Any ACE, ARB, or HCTZ ordered, % (95% CI)24.1 (20.5, 27.7)10.2 (0.07, 13.8)<0.0001

SBP=Systolic Blood Pressure, CI=Confidence Interval, ACE=Angiotensin Converting Enzyme Inhibitor, ARB=Angiotensin Receptor Blocker, HCTZ=Hydrochlorothiazide

Funding

  • NIDDK Support