Machine Learning to Reduce Hypertension Treatment Clinical Inertia

Among individuals with an uncontrolled BP at the current visit, the objective of this study is to compare clinical management of hypertension with and without information from a machine learning algorithm on whether a patient will have uncontrolled blood pressure at their next follow up visit through a case-vignette study.

Study Overview

• Status: Not yet recruiting
• Conditions: Hypertension
• Intervention / Treatment: Other: Predicted uncontrolled BP status (yes/no) at follow up visit, derived using a machine learning algorithm

Detailed Description

Among adults with uncontrolled blood pressure (BP) at a clinic visit, clinical inertia is common. Clinical inertia is defined as a failure of providers to initiate or intensify treatment (i.e., adding medication or increasing dosage) when guidelines indicate doing so. Prior studies report that clinicians intensify antihypertensive medication treatment in less than 20% of visits where intensification would have been clinically recommended. Thus, patients who have uncontrolled BP may not receive timely therapy to control their BP. To address this issue, the investigators will use a randomized design to test the hypothesis that clinicians will be more likely to intensify the hypertensive regimen and/or assess nonadherence for patients with uncontrolled BP at the current visit when presented with information that a patient is predicted to have uncontrolled BP at the next visit by a machine learning algorithm.

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Gabriel Tajeu, DrPH; Phone Number: 2055312258; Email: gtajeu@uab.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria: practicing primary care clinicians who see patients (i.e., internal medicine, family medicine, attending physicians, nurse practitioners) will be eligible to participate -

Exclusion Criteria:

-

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: No Information from Machine Learning Algorithm; The investigators will create case vignettes to assess clinician hypertension management behavior, specifically antihypertensive medication intensification among individuals with uncontrolled blood pressure (BP). This arm will not include information from a machine learning algorithm designed to predict uncontrolled BP at a follow up visit.
Experimental: Information from Machine Learning Algorithm; The investigators will create case vignettes to assess clinician hypertension management behavior, specifically antihypertensive medication intensification among individuals with uncontrolled blood pressure (BP). This arm will include information from a machine learning algorithm designed to predict uncontrolled BP at a follow up visit about whether the algorithm predicts that the patient will have uncontrolled BP at the next visit.	Other: Predicted uncontrolled BP status (yes/no) at follow up visit, derived using a machine learning algorithm; The investigators have created a machine learning algorithm to predict uncontrolled blood pressure (BP) status (yes/no) at a follow up visit among adults with uncontrolled BP at their current visit. The investigators will determine whether adding this information to a vignette describing a patient will increase the likelihood that a clinician will intensify antihypertensive medication treatment.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Vignette #1 - antihypertensive medication treatment intensification	A clinical vignette of a patient with uncontrolled blood pressure will be presented to clinicians. They will then be asked to assess wether they would intensify antihypertensive medication treatment. This will be assessed using a 5-point Likert scale with scores ranging from 1 ("Strongly disagree") to 5 ("Strongly agree"). Likert scale scores will be compared between clinicians in the control and intervention group.	Immediately after clinical vignette
Vignette #2 - antihypertensive medication treatment intensification	A second clinical vignette of a patient with uncontrolled blood pressure will be presented to clinicians. They will then be asked to assess wether they would intensify antihypertensive medication treatment. This will be assessed using a 5-point Likert scale with scores ranging from 1 ("Strongly disagree") to 5 ("Strongly agree"). Likert scale scores will be compared between clinicians in the control and intervention group.	Immediately after clinical vignette
Vignette #3 - antihypertensive medication treatment intensification	A third clinical vignette of a patient with uncontrolled blood pressure will be presented to clinicians. They will then be asked to assess wether they would intensify antihypertensive medication treatment. This will be assessed using a 5-point Likert scale with scores ranging from 1 ("Strongly disagree") to 5 ("Strongly agree"). Likert scale scores will be compared between clinicians in the control and intervention group.	Immediately after clinical vignette

Collaborators and Investigators

• Sponsor: Temple University
• Investigators: Principal Investigator: Gabriel Tajeu, DrPH, University of Alabama at Birmingham

Study record dates

Study Major Dates

• Study Start (Estimated): April 25, 2025
• Primary Completion (Estimated): May 31, 2025
• Study Completion (Estimated): July 31, 2025

Study Registration Dates

• First Submitted: May 25, 2022
• First Submitted That Met QC Criteria: June 1, 2022
• First Posted (Actual): June 6, 2022

Study Record Updates

• Last Update Posted (Actual): April 10, 2025
• Last Update Submitted That Met QC Criteria: April 7, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: Machine learning; Uncontrolled blood pressure; Antihypertensive medication; Hypertension treatment; Clinical inertia
• Additional Relevant MeSH Terms: Vascular Diseases; Cardiovascular Diseases; Hypertension
• Other Study ID Numbers: K01HL151974 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No