MedicalResearch: What is the background for this study? What are the main findings?
Dr. Yi: Self-blood pressure monitoring has been shown to be an effective tool for improving blood pressure control, however most studies have only included white race participants. We were interested in assessing whether distribution of self-blood pressure monitors (intervention) would improve blood pressure and hypertension control over usual care (control) in a 9-month period in a predominantly Hispanic, uninsured population. Systolic blood pressure improved over time in both the intervention (n=409) and the control (n=419) arms by 14.7 mm Hg and 14.1 mm Hg, respectively, as did hypertension control; 39% of study participants overall achieved control at the end of follow-up. However there were no statistical differences between the outcomes in the intervention and usual care groups.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Yi: Results indicate that adults who are Hispanic and/or uninsured may experience additional barriers to achieving blood pressure control (i.e., prescription costs, lack of supports for lifestyle modification). From a big picture perspective, we also demonstrated the feasibility of conducting a randomized clinical trial in the electronic health record; screening, randomization and longitudinal data collection were conducted in the electronic health record. This design is within the new vein of the ‘randomized registry trial’ (Lauer & D’Agostino, 2013) that is an efficient use of resources and available data. We have further developed a toolkit for those interested in conducting similar trials on hypertension control, or on other health outcomes in the clinic setting through the electronic health record.
MedicalResearch What recommendations do you have for future research as a result of this study?
Dr. Yi: The findings of our study were similar to those found by the Agency for Healthcare Research and Quality (AHRQ) on the effectiveness of self-monitoring which was contemporaneously conducted. Ours and the AHRQ report point to the need for the verification of positive results in racially and ethnically diverse communities, particularly those with limited English proficiency and/or health literacy, or with barriers to lifestyle modification. As the nation’s minority and immigrant elderly populations continue to grow, verification of the evidence-base in our culturally diverse communities are a necessity.
MedicalResearch.com Interview with: Stella Yi, Ph.D., MPH (2015). Hispanic and Uninsured Adults May Experience Barriers To Blood Pressure Control