A cluster-randomized study on the Risk Assessment and Management Program for home blood pressure monitoring in an older population with inadequate health literacy

Sau Nga Fu, Man Chi Dao, Wan Luk, Margaret Choi Hing Lam, Irene Sau Fan Ho, Siu Keung Cheung, Carlos King Ho Wong, Bernard Man Yung Cheung, Sau Nga Fu, Man Chi Dao, Wan Luk, Margaret Choi Hing Lam, Irene Sau Fan Ho, Siu Keung Cheung, Carlos King Ho Wong, Bernard Man Yung Cheung

Abstract

The Risk Assessment and Management Program (RAMP) has successfully demonstrated a reduction of blood pressure (BP) and cardiovascular (CVD) risk of patients with hypertension. This study aimed to compare the blood pressure control rate of participants after attended RAMP group, with those attended RAMP individual from usual care. A prospective open cluster-randomized controlled trial was performed in five public primary care clinics. Patients with uncontrolled hypertension were recruited. RAMP group consisted of multi-disciplinary group education on knowledge of hypertension, lifestyle modification, and hands-on home blood pressure monitoring (HBPM) training. Each participant was given a branchial HBPM device. An individual face-to-face nurse follow-up was arranged 6 weeks later. Participants' office BP and clinical parameters were assessed at 6, 12, and 18 months. Three RAMP group and two RAMP-individual clusters recruited 152 and 139 participants, respectively. The mean age was 67.0 (SD 9.9) year. After 18 months of treatment, there was a significantly higher BP control rate in the RAMP-group participants than the RAMP-individual participants (78.9% vs 36.5%, P < .001). The systolic BP was reduced by 19.7 mm Hg (95% CI -22.03, -17.40, P < .001) and diastolic BP by 8.1 mm Hg (95% CI -9.66, -6.61, P < .001) in RAMP group while the RAMP individual demonstrated 9.3 mm Hg (95% CI -12.1, -6.4, P < .001) reduction in systolic BP without any significant difference in diastolic BP. The RAMP-group participants' body weight (BW) and body mass index(BMI) had no significant changes, while the RAMP-individual participants had a significant increase in BW and BMI. No adverse effect was reported.

Trial registration: ClinicalTrials.gov NCT02551393.

Keywords: blood pressure monitoring; cluster-randomized controlled trial; group education; hypertension; individual counseling; outpatient clinics; patient education; self-management; uncontrolled hypertension.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2020 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.

Figures

FIGURE 1
FIGURE 1
CONSORT diagram of the study
FIGURE 2
FIGURE 2
The blood pressure control rate in RAMP group and RAMP individual at 6, 12, and 18 mo
FIGURE 3
FIGURE 3
Subgroup analysis of BP control rate of participants with adequate and inadequate health literacy among RAMP group (RAMP‐G) and RAMP individual (RAMP‐I)
FIGURE 4
FIGURE 4
Systolic blood pressure and diastolic blood pressure over time in RAMP individual (CC) and RAMP group (IC)

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