Division of Cardiovascular Medicine, Boston, Massachusetts, USA.
Department of Pharmacy Services, Boston, Massachusetts, USA.
Clin Cardiol. 2022 Dec;45(12):1147-1162. doi: 10.1002/clc.23919. Epub 2022 Sep 24.
Hypertension is the leading risk factor for death, affecting over one billion people worldwide, yet control rates are poor and stagnant. We developed a remote hypertension management program that leverages digitally transmitted home blood pressure (BP) measurements, algorithmic care pathways, and patient-navigator communications to aid patients in achieving guideline-directed BP goals.
Patients with uncontrolled hypertension are identified through provider referrals and electronic health record screening aided by population health managers within the Mass General Brigham (MGB) health system. Non-licensed patient navigators supervised by pharmacists, nurse practitioners, and physicians engage and educate patients. Patients receive cellular or Bluetooth-enabled BP devices with which they monitor and transmit scheduled home BP readings. Evidence-based medication changes are made according to a custom hypertension algorithm approved within a collaborative drug therapy management (CDTM) agreement with MGB and implemented by pharmacists. Using patient-specific characteristics, we developed different pathways to optimize medication regimens. The renin-angiotensin-aldosterone system-blocker pathway prescribed ARBs/ACE inhibitors first for patients with diabetes, impaired renal function, and microalbuminuria; the standard pathway started patients on calcium channel blockers. Regimens were escalated frequently, adding thiazide-type diuretics, and including beta blockers and mineralocorticoid receptor antagonists if needed.
We have developed an algorithmic approach for the remote management of hypertension with demonstrated success. A focus on algorithmic decision-making streamlines tasks and responsibilities, easing the potential for scalability of this model. As the backbone of our remote management program, this clinical algorithm can improve BP control and innovate the management of hypertension in large populations.
高血压是导致死亡的主要风险因素，影响着全球超过 10 亿人，但控制率却很差且停滞不前。我们开发了一种远程高血压管理程序，该程序利用数字传输的家庭血压（BP）测量、算法护理路径和患者导航员的沟通，帮助患者实现指南指导的 BP 目标。
通过提供者转介和电子健康记录筛查，在麻省总医院布里格姆（MGB）卫生系统内的人群健康经理的帮助下，确定未得到控制的高血压患者。非持牌患者导航员在药剂师、执业护士和医生的监督下，与患者接触并进行教育。患者使用带蜂窝或蓝牙功能的血压设备监测并传输预定的家庭 BP 读数。根据与 MGB 达成的合作药物治疗管理（CDTM）协议批准的定制高血压算法进行基于证据的药物调整，由药剂师执行。使用患者特定的特征，我们开发了不同的途径来优化药物治疗方案。对于患有糖尿病、肾功能受损和微量白蛋白尿的患者，我们首先开处方使用肾素-血管紧张素-醛固酮系统阻滞剂（ARB/ACE 抑制剂）；标准途径则首先为患者开钙通道阻滞剂。经常升级方案，添加噻嗪类利尿剂，并根据需要包括β受体阻滞剂和盐皮质激素受体拮抗剂。
我们已经开发出一种用于远程高血压管理的算法方法，并取得了成功。对算法决策的关注简化了任务和责任，为这种模式的潜在可扩展性提供了便利。作为我们远程管理程序的基础，该临床算法可以改善 BP 控制，并为大规模人群的高血压管理带来创新。
