Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, USA.
Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA.
Am J Hypertens. 2020 Apr 1;33(4):362-370. doi: 10.1093/ajh/hpz148.
Uncontrolled hypertension (HTN) is a leading modifiable stroke risk factor contributing to global stroke disparities. This study is unique in testing a transitional care model aimed at controlling HTN in black and Hispanic poststroke, home health patients, an understudied group.
A 3-arm randomized controlled trial design compared (i) usual home care (UHC), with (ii) UHC plus a 30-day nurse practitioner transitional care program, or (iii) UHC plus nurse practitioner plus a 60-day health coach program. The trial enrolled 495 black and Hispanic, English- and Spanish- speaking adults with uncontrolled systolic blood pressure (SBP ≥ 140 mm Hg) who had experienced a first-time or recurrent stroke or transient ischemic attack. The primary outcome was change in SBP from baseline to 3 and 12 months.
Mean participant age was 67; 57.0% were female; 69.7% were black, non-Hispanic; and 30.3% were Hispanic. Three-month follow-up retention was 87%; 12-month retention was 81%. SBP declined 9-10 mm Hg from baseline to 12 months across all groups; the greatest decrease occurred between baseline and 3 months. The interventions demonstrated no relative advantage compared to UHC.
The significant across-the-board SBP decreases suggest that UHC nurse/patient/physician interactions were the central component of SBP reduction and that additional efforts to lower recurrent stroke risk should test incremental improvements in usual care, not resource-intensive transitional care interventions. They also suggest the potential value of pragmatic home care programs as part of a broader strategy to overcome HTN treatment barriers and improve secondary stroke prevention globally.
Trial Number NCT01918891.
未控制的高血压（HTN）是导致全球卒中差异的主要可改变的卒中危险因素。本研究的独特之处在于测试了一种过渡性护理模式，旨在控制黑人及西班牙裔卒中后、家庭健康患者的 HTN，这是一个研究不足的群体。
采用 3 臂随机对照试验设计，比较（i）常规家庭护理（UHC），（ii）UHC 加 30 天执业护士过渡性护理计划，或（iii）UHC 加执业护士加 60 天健康教练计划。该试验纳入了 495 名未经控制的收缩压（SBP≥140mmHg）的首次或复发性卒中或短暂性脑缺血发作的黑人及西班牙裔、讲英语和西班牙语的成年患者。主要结局是从基线到 3 个月和 12 个月时 SBP 的变化。
平均参与者年龄为 67 岁；57.0%为女性；69.7%为非裔，非西班牙裔；30.3%为西班牙裔。3 个月随访的保留率为 87%；12 个月的保留率为 81%。所有组的 SBP 从基线到 12 个月下降了 9-10mmHg；最大降幅发生在基线到 3 个月之间。与 UHC 相比，这些干预措施没有显示出相对优势。
全面的 SBP 下降表明 UHC 护士/患者/医生的互动是 SBP 降低的核心组成部分，为了进一步降低复发性卒中风险，应该在常规护理的基础上测试增量改善，而不是资源密集型的过渡性护理干预。它们还表明，实用的家庭护理方案作为克服 HTN 治疗障碍和改善全球二级卒中预防的更广泛策略的潜在价值。
试验编号 NCT01918891。
