Department of Medicine, New York University School of Medicine, New York, New York 10016, USA.
J Am Geriatr Soc. 2010 Jun;58(6):1177-83. doi: 10.1111/j.1532-5415.2010.02874.x.
Uncontrolled hypertension in older adults is a common yet preventable threat to healthy aging. Improvements in blood pressure (BP) control and related health outcomes require innovative approaches that reach beyond the clinical environment. Keep on Track (KOT), a volunteer-run, community-based BP-monitoring program that aims to lower BP of community-dwelling older adults through senior center programming, is described and evaluated. KOT is based on a New York City (NYC) Department for the Aging program that has been in existence for more than 20 years and is evaluated in six senior centers in low- to middle-income neighborhoods in NYC. Program design includes monitoring sessions every other week to measure and record participant BP. BP education is provided using low-literacy materials, and medication adherence is encouraged. Over 6 months of observation, 244 participants enrolled (mean age 73). Of the 181 (74%) with hypertension at baseline, 92% were previously aware of their condition, 78% were treated, and 31% were controlled. BP control among the treated was 42%. Forty-three percent of enrollees (n=105) were multiple-visit participants who experienced on average a 3.9-mmHg reduction in systolic BP (SBP) between the first and last program visit (95% confidence interval (CI)=-7.6 to -0.1, P=.04). Participants with an initial SBP greater than 160 mmHg (n=20) experienced on average a 20.9-mmHg reduction in SBP (95% CI=-32.4 to -9.4, P<.001). Areas for program improvement include greater attention to peer counseling and timely communication with participants' healthcare providers. Volunteer-run, community-based BP monitoring in senior centers may provide an effective, replicable model for reducing BP in older adults.
老年人的未控制高血压是健康老龄化的一个常见但可预防的威胁。要改善血压（BP）控制和相关健康结果，需要创新的方法，超越临床环境。Keep on Track（KOT）是一个志愿者运营的社区血压监测项目，旨在通过老年人中心的项目来降低社区居住的老年人的血压，它的描述和评估如下。KOT 是基于纽约市（NYC）老龄化部门的一个项目，该项目已经存在了 20 多年，在纽约市低收入到中等收入社区的 6 个老年人中心进行评估。项目设计包括每两周进行一次监测会议，以测量和记录参与者的血压。使用低识字材料提供 BP 教育，并鼓励药物依从性。在 6 个月的观察期间，有 244 名参与者登记（平均年龄 73 岁）。在基线时有高血压的 181 名（74%）参与者中，92%的人之前知道自己的病情，78%的人接受了治疗，31%的人得到了控制。治疗组的血压控制率为 42%。43%的参与者（n=105）是多次就诊的参与者，他们在第一次和最后一次项目就诊之间平均收缩压（SBP）降低了 3.9mmHg（95%置信区间[CI]为-7.6 至-0.1，P=.04）。初始 SBP 大于 160mmHg 的参与者（n=20）平均 SBP 降低了 20.9mmHg（95%CI=-32.4 至-9.4，P<.001）。项目改进的领域包括更加关注朋辈咨询和及时与参与者的医疗保健提供者沟通。老年人中心的志愿者运营的社区血压监测可能为降低老年人的血压提供了一种有效、可复制的模式。
