Reducing Hypertension in a Post-Stroke Black and Hispanic Homecare Population: Results of a Pragmatic Randomized Controlled Trial.Am J Hypertens 2019AJ
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.
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.
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.
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.