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IIR 15-369 – HSR&D Study

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IIR 15-369
Self-management of blood pressure medication for hypertensive veterans
Dena Evette Rifkin MD MS
VA San Diego Healthcare System, San Diego, CA
San Diego, CA
Funding Period: August 2017 - July 2021

BACKGROUND/RATIONALE:
Recent literature from the UK (TASMINH2 and TASMIN-SR trials) have suggested that patient-driven self-management of blood pressure medications can be effective in achieving hypertension control, but questions remain as to how to apply these findings to a US population. The VA Healthcare System is an ideal system in which to test and customize this strategy for blood pressure treatment.

OBJECTIVE(S):
We propose to address the following simple and powerful clinical research question:
Is patient-initiated self-management of blood pressure medication using a pre-specified, generalizable dose escalation scheme clinically effective, safe, and acceptable to patients and clinicians, compared to usual care in controlling blood pressure in hypertensive Veterans?

METHODS:
We propose a 12-month randomized, controlled, non-blinded, single-center study
of patient-initiated self-management of blood pressure medication versus usual care with planned poststudy cohort follow-up via medical records. Participants in the intervention arm will be provided with home blood pressure monitoring tools and a self-management algorithm for changing their blood pressure medications as needed. Participants in the usual care arm will receive home monitoring
tools and typical hypertension care from the primary care provider. The primary blood pressure outcome measure for the study will be between-group change in in-clinic blood pressure. Acceptability, safety, patient-centered outcomes and adherence will be key secondary outcomes.

FINDINGS/RESULTS:
We have begun enrollment for this study.

IMPACT:
The health impacts of better systems for treatment of hypertension are significant, and self-monitoring and self-management of blood pressure medication is an important strategy that would empower Veterans to achieve better control of blood pressure. We are now recruiting participants to study this question.

PUBLICATIONS:
None at this time.


DRA: Health Systems
DRE: Treatment - Efficacy/Effectiveness Clinical Trial, TRL - Development
Keywords: Adherence, Outcomes - Patient, Patient Preferences, Patient Safety
MeSH Terms: none