Results Summary

What was the research about?

Uncontrolled high blood pressure, or BP, causes more than 500,000 deaths each year in the United States. Medicine can help patients control their BP. But patients and doctors need better ways of managing BP to make sure that medicines work well for patients.

The research team did two studies comparing new clinic programs and technologies for patients to help control high BP:

  • Study 1 tested a program to improve the quality of BP care at clinics. The research team compared clinics using the program with staff coaching versus without staff coaching. They also compared clinics that did and didn’t use the program.
  • Study 2 compared patients who used a home BP monitor with and without a smartphone app.

What were the results?

Study 1. At six months, the percentage of patients whose BP was within the normal range didn’t differ between:

  • Clinics that used the program with and without coaching
  • Clinics that did and didn’t use the program

At clinics that used the program, the percentage of patient visits where staff documented rechecking a high BP measurement increased by up to 20 percent. Documentation didn’t change at clinics that didn’t use the program.

Study 2. At six months, BP decreased in patients who used the home BP monitor with and without the app; the two groups didn’t differ in how much their BP decreased. Across both groups, 70 percent of patients were very likely to recommend the BP monitor to a friend.

What did the research team do?

For both studies, the research team used electronic health record data from PCORnet®.

Study 1. The research team assigned 24 clinics in four states by chance to the program with or without coaching. All clinics had access to a website with training and reports about how the clinic was doing. For clinics with coaching, staff at the clinic led the program after receiving training from a coach. The coach had expertise in helping clinics improve care for people with high BP. Clinics without coaching followed a self-guided process for the program. The team also looked at data for 18 clinics that didn’t use the program.

Study 2. The research team assigned 2,101 patients with high BP by chance to use a home BP monitor with or without the app. The app reminded patients to check their BP, explained the results, and supported emailing results to others. Among patients, 64 percent were White, 22 percent were Black, 9 percent were Hispanic or Latinx, 1 percent were Asian, and 4 percent were more than one race. The average age was 58, and 57 percent were women.

Patients, doctors, and a nurse gave input during the study.

What were the limits of the study?

The research team didn’t track how well clinics followed the program. The studies didn’t use a standard way to measure BP, which may have affected results.

Future research could look at whether clinics follow the program.

How can people use the results?

Clinics can use the results when considering ways to manage high BP.

How this project fits under PCORI’s Research Priorities
The PCORnet® Study reported in this results summary was conducted using PCORnet®, the National Patient-Centered Clinical Research Network. PCORnet® is intended to improve the nation’s capacity to conduct health research, particularly comparative effectiveness research (CER), efficiently by creating a large, highly representative network for conducting clinical outcomes research. PCORnet® has been developed with funding from the Patient-Centered Outcomes Research Institute® (PCORI®).

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers requested additional information about how the researchers managed missing data, especially in the first two parts of the project. The researchers explained that the first two parts of the project focused on aggregate metrics that could account for patients who might not be fully involved in their health system and might be receiving their care elsewhere. Because the aggregate metrics themselves could not be missing, the researchers did not feel it was necessary to complete sensitivity analyses or otherwise account for missing data. The researchers did expand their discussion in the limitations section on the effect of missing data on the third part of the project, where they felt such discussion to be very relevant.
  • The reviewers asked the researchers to emphasize their findings regarding the continued disparity in hypertension control between White and Black patients, even after the intervention improved hypertension outcomes. The researchers added to the discussion of this finding in their results section.
  • The reviewers noted that treatment intensification was defined only as adding additional anti-hypertensive medications to a treatment regimen because the data available for tracking patients did not include sufficient information about medication dose to measure whether there were also dose effects on hypertension. The researchers acknowledged that the lack of information on medication dose in this case demonstrated a limitation of the common data model used by PCORnet.
  • The reviewers suggested that the researchers consider issues that might have affected their results in the study comparing two blood pressure home monitoring interventions. The researchers enumerated the issues that could affect interpretation of the study in their discussion, noting that the large drop in blood pressure could be due to regression to the mean, many patients with high blood pressure were taking no medications and there were low response rates from patients.

Conflict of Interest Disclosures

Project Information

Mark J. Pletcher, MD, MPH
University of California San Francisco
$6,834,984
10.25302/04.2023.PaCR.2017C28153
Using PCORnet to Compare Blood Pressure Control Strategies

Key Dates

April 2018
May 2024
2018
2023

Study Registration Information

Tags

Has Results
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: April 16, 2024