Default BP Medication Intensification
| Status: | Completed |
|---|---|
| Conditions: | High Blood Pressure (Hypertension) |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 18 - 55 |
| Updated: | 4/2/2016 |
| Start Date: | November 2013 |
| End Date: | December 2015 |
| Contact: | Xiu Tang |
| Email: | xiu.tang@cshs.org |
| Phone: | 310-967-0697 |
Automatic Medication Increase Protocol in the Treatment of Elevated Blood Pressure
High blood pressure leads to heart attacks and strokes which can be prevented by blood
pressure-lowering medication. However, the current office-based prescription of one pill and
one dose at a time is ineffective. the investigators want to pilot-test a more effective
patient-centered treatment approach, where patients will receive a prescription with gradual
but automatic weekly increases of dose and number of pills. Patients will measure their
blood pressure with an iPhone compatible cuff, which transmits readings to the doctor or
pharmacist, who will stop escalation when the desired blood pressure level is reached. The
investigators hypothesize that the intervention will decrease the time to control blood
pressure and increase the overall rate of blood pressure control. Therefore, this new
treatment model could prevent heart attacks and strokes, and reduce healthcare costs.
pressure-lowering medication. However, the current office-based prescription of one pill and
one dose at a time is ineffective. the investigators want to pilot-test a more effective
patient-centered treatment approach, where patients will receive a prescription with gradual
but automatic weekly increases of dose and number of pills. Patients will measure their
blood pressure with an iPhone compatible cuff, which transmits readings to the doctor or
pharmacist, who will stop escalation when the desired blood pressure level is reached. The
investigators hypothesize that the intervention will decrease the time to control blood
pressure and increase the overall rate of blood pressure control. Therefore, this new
treatment model could prevent heart attacks and strokes, and reduce healthcare costs.
This is a pilot 2A trial of an innovative behavioral economics theory-based antidote for
physician inertia in the medical treatment of hypertension (HTN). In the current reactive
physician-centered model, blood pressure (BP) is measured and medical decisions are made in
the physician office; when deciding whether or not to prescribe new medication for a high
office BP reading, the physician's default behavior is inaction. The investigators propose
default medication intensification as a new patient-centered/pharmacist-assisted proactive
treatment model to eliminate physician inertia. For enrolled patients with office BP>155/95,
the physician will prescribe a one-month protocol that automatically escalates drug dose and
drug number each week. The pharmacist will fill the prescription in a blister pack to
simplify adherence. The patient will measure daily home BP with an iPhone cuff that
transmits the data electronically to the pharmacist, who will halt the protocol if goal home
BP<135/85 is achieved ahead of schedule. the investigators will pilot test the feasibility
and safety of self-monitoring plus the new automatic intensification protocol packaged in
blisters. Default medication intensification could revolutionize HTN treatment and reduce
healthcare costs.
physician inertia in the medical treatment of hypertension (HTN). In the current reactive
physician-centered model, blood pressure (BP) is measured and medical decisions are made in
the physician office; when deciding whether or not to prescribe new medication for a high
office BP reading, the physician's default behavior is inaction. The investigators propose
default medication intensification as a new patient-centered/pharmacist-assisted proactive
treatment model to eliminate physician inertia. For enrolled patients with office BP>155/95,
the physician will prescribe a one-month protocol that automatically escalates drug dose and
drug number each week. The pharmacist will fill the prescription in a blister pack to
simplify adherence. The patient will measure daily home BP with an iPhone cuff that
transmits the data electronically to the pharmacist, who will halt the protocol if goal home
BP<135/85 is achieved ahead of schedule. the investigators will pilot test the feasibility
and safety of self-monitoring plus the new automatic intensification protocol packaged in
blisters. Default medication intensification could revolutionize HTN treatment and reduce
healthcare costs.
Inclusion Criteria:
- 18 to 55 years old
- office BP of ≥160 mmHg systolic and ≥100 mmHg diastolic (treated or untreated) AND
<180 mmHg systolic.
Exclusion Criteria:
- chronic kidney disease
- symptomatic coronary artery disease
- congestive heart failure
- more than mild valvular heart disease
- Diabetes mellitus
- obstructive left ventricular hypertrophy
- severe electrolyte abnormalities
- multiple medication intolerances
- orthostatic hypotension
- cognitive impairment and mental disorders affecting ability to self-monitor BP
- patients who are unwilling to measure and transmit BP readings throughout the study
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