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Reducing Hypertension in a Post-Stroke Black and Hispanic Homecare Population: Results of a Pragmatic Randomized Controlled Trial.

Abstract

BACKGROUND

Uncontrolled hypertension (HTN) is a leading modifiable stroke risk factor contributing to global stroke disparities. This study is unique in testing a transitional care model aimed at controlling HTN in Black and Hispanic post-stroke, home health patients, an understudied group.

METHODS

A three-arm randomized controlled trial design compared: a) usual home care (UHC), with b) UHC plus a 30-day nurse practitioner transitional care program, or c) UHC plus nurse practitioner plus a 60-day health coach program. The trial enrolled 495 Black and Hispanic, English and Spanish speaking adults with uncontrolled systolic blood pressure (SBP ≥ 140 mmHg) who had experienced a first-time or recurrent stroke or transient ischemic attack. The primary outcome was change in SBP from baseline to 3 and 12 months.

RESULTS

Mean participant age was 67; 57.0% were female; 69.7% were Black, non-Hispanic; 30.3% Hispanic. Three-month follow-up retention was 87%; 12-month retention was 81%. SBP declined 9-10 mmHg from baseline to 12 months across all groups; the greatest decrease occurred between baseline and 3 months. The interventions demonstrated no relative advantage compared to usual home care.

CONCLUSION

The significant across-the-board SBP decreases suggest that UHC nurse/patient/physician interactions were the central component of SBP reduction and that additional efforts to lower recurrent stroke risk should test incremental improvements in usual care, not resource-intensive transitional care interventions. They also suggest the potential value of pragmatic homecare programs as part of a broader strategy to overcome HTN treatment barriers and improve secondary stroke prevention globally.

Authors+Show Affiliations

Center for Home Care Policy & Research, Visiting Nurse Service of New York.Center for Home Care Policy & Research, Visiting Nurse Service of New York.Center for Home Care Policy & Research, Visiting Nurse Service of New York.Center for Home Care Policy & Research, Visiting Nurse Service of New York.Center for Home Care Policy & Research, Visiting Nurse Service of New York.Center for Home Care Policy & Research, Visiting Nurse Service of New York.Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx.Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx.Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx. Columbia University Stroud Center at New York State Psychiatric Institute, New York.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31541606

Citation

Feldman, Penny H., et al. "Reducing Hypertension in a Post-Stroke Black and Hispanic Homecare Population: Results of a Pragmatic Randomized Controlled Trial." American Journal of Hypertension, 2019.
Feldman PH, McDonald MV, Trachtenberg M, et al. Reducing Hypertension in a Post-Stroke Black and Hispanic Homecare Population: Results of a Pragmatic Randomized Controlled Trial. Am J Hypertens. 2019.
Feldman, P. H., McDonald, M. V., Trachtenberg, M., Trifilio, M., Onorato, N., Sridharan, S., ... Teresi, J. (2019). Reducing Hypertension in a Post-Stroke Black and Hispanic Homecare Population: Results of a Pragmatic Randomized Controlled Trial. American Journal of Hypertension, doi:10.1093/ajh/hpz148.
Feldman PH, et al. Reducing Hypertension in a Post-Stroke Black and Hispanic Homecare Population: Results of a Pragmatic Randomized Controlled Trial. Am J Hypertens. 2019 Sep 21; PubMed PMID: 31541606.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reducing Hypertension in a Post-Stroke Black and Hispanic Homecare Population: Results of a Pragmatic Randomized Controlled Trial. AU - Feldman,Penny H, AU - McDonald,Margaret V, AU - Trachtenberg,Melissa, AU - Trifilio,Marygrace, AU - Onorato,Nicole, AU - Sridharan,Sridevi, AU - Silver,Stephanie, AU - Eimicke,Joseph, AU - Teresi,Jeanne, Y1 - 2019/09/21/ PY - 2019/05/15/received PY - 2019/9/22/entrez PY - 2019/9/22/pubmed PY - 2019/9/22/medline JF - American journal of hypertension JO - Am. J. Hypertens. N2 - BACKGROUND: Uncontrolled hypertension (HTN) is a leading modifiable stroke risk factor contributing to global stroke disparities. This study is unique in testing a transitional care model aimed at controlling HTN in Black and Hispanic post-stroke, home health patients, an understudied group. METHODS: A three-arm randomized controlled trial design compared: a) usual home care (UHC), with b) UHC plus a 30-day nurse practitioner transitional care program, or c) UHC plus nurse practitioner plus a 60-day health coach program. The trial enrolled 495 Black and Hispanic, English and Spanish speaking adults with uncontrolled systolic blood pressure (SBP ≥ 140 mmHg) who had experienced a first-time or recurrent stroke or transient ischemic attack. The primary outcome was change in SBP from baseline to 3 and 12 months. RESULTS: Mean participant age was 67; 57.0% were female; 69.7% were Black, non-Hispanic; 30.3% Hispanic. Three-month follow-up retention was 87%; 12-month retention was 81%. SBP declined 9-10 mmHg from baseline to 12 months across all groups; the greatest decrease occurred between baseline and 3 months. The interventions demonstrated no relative advantage compared to usual home care. CONCLUSION: The significant across-the-board SBP decreases suggest that UHC nurse/patient/physician interactions were the central component of SBP reduction and that additional efforts to lower recurrent stroke risk should test incremental improvements in usual care, not resource-intensive transitional care interventions. They also suggest the potential value of pragmatic homecare programs as part of a broader strategy to overcome HTN treatment barriers and improve secondary stroke prevention globally. SN - 1941-7225 UR - https://www.unboundmedicine.com/medline/citation/31541606/Reducing_Hypertension_in_a_Post-Stroke_Black_and_Hispanic_Homecare_Population:_Results_of_a_Pragmatic_Randomized_Controlled_Trial L2 - https://academic.oup.com/ajh/article-lookup/doi/10.1093/ajh/hpz148 DB - PRIME DP - Unbound Medicine ER -