Summary
A recent study published in JAMA examined the benefits of adding nurse case management (NCM) to home blood pressure telemonitoring (HBPTM) to reduce systolic blood pressure in Black and Hispanic stroke survivors with uncontrolled hypertension and significant comorbidity,1 groups experiencing a disproportionate risk for recurrent stroke and associated mortality . Whereas HBPTM's efficacy compared to usual care has been established,2 the combination with nurse case management and comparative effectiveness in this demographic had not been previously studied.
The clinical trial randomized patients to HBPTM alone versus HBPTM combined with telephonic NCM.1 Patients in the HBPTM plus NCM group received 20 phone calls at regular intervals from trained nursing staff, who provided personalized education, support, and protocol reinforcement, including notifying their primary care physicians if blood pressure exceeded targets. Patients in the combined group had a relatively greater systolic blood pressure reduction than those in the HBPTM alone group at 12 months (-15.1 mmHg and -5.8 mmHg, respectively). There was no difference in the rate of recurrent stroke (4.0% in both groups) at 24 months.
The study underscores the potential of telehealth interventions in mitigating health disparities in vulnerable populations, highlighting the role of structured NCM in enhancing treatment adherence and reducing clinical inertia. However, significant proportions of patients in the combined intervention group still had inadequate blood pressure control, suggesting ongoing challenges in optimizing care for these groups.
Sources
1Ogedegbe G, Teresi JA, Williams SK, et al. Home blood pressure telemonitoring and nurse case management in Black and Hispanic patients with stroke: a randomized clinical trial. JAMA. 2024;332(1):41-50. doi:10.1001/jama.2024.6609.
2Duan Y, Xie Z, Dong F, etal. Effectiveness of home blood pressure telemonitoring: a systematic review and meta-analysis of randomised controlled studies. J Hum Hypertens. 2017;31(7):427-437. doi:10.1038/jhh.2016.99.
This summary was created with assistance from generative artificial intelligence (ChatGPT, 2024).