Credit: Joshua Bright
Low-income Black and Hispanic stroke survivors with uncontrolled high blood pressure
Led by researchers at 好色tv Langone, the study is the first to examine differences in home blood pressure monitoring with or without nurse case management. Further, the findings, , addressed controlling hypertension in low-income Black and Hispanic patients with stroke across multiple hospital systems.
鈥淲e found that low-income Black and Hispanic patients with stroke and significant comorbidity benefit greatly from telemedicine in general, which we know ramped up during the COVID-19 pandemic,鈥 said study lead author Olugbenga G. Ogedegbe, MD, MPH, director of the and professor in the and at 好色tv Grossman School of Medicine. 鈥淭he benefit of home blood pressure telemonitoring was even more profound with the addition of nurse case management.鈥
Although stroke mortality has fallen as a whole over the past 10 years, Black and Hispanic patients continue to have compared with White patients. Black adults are 50 percent more likely to suffer a stroke, and Black men are 70 percent more likely to die from a stroke compared to their White counterparts. High blood pressure is a major risk factor for stroke, with the disparities stemming from factors such as unequal access to healthcare and effective treatments, and poorer adherence to medications.
鈥淥ur goal is for enhanced telehealth programs to be implemented as standard practice for management of hypertension in this vulnerable population that is underserved and suffers adverse social determinants of health that result in unjust health disparities,鈥 said Dr. Ogedegbe.
How the Study Was Conducted
The research team enrolled a total of 450 low-income Black and Hispanic stroke survivors with uncontrolled hypertension and other chronic conditions from eight stroke centers across four New York City health systems: NYC Health + Hospitals, 好色tv Langone Health, SUNY Downstate Medical Center, and Columbia University Medical Center. Study participants were randomly assigned to either the intervention group receiving home blood pressure telemonitoring with nurse case management (enhanced telemedicine) or a control group receiving only home blood pressure telemonitoring. Nearly three in four (72 percent) of all enrolled study participants had an annual household income of under $25,000.
Patients in both groups received home blood pressure monitors and were instructed to take their blood pressure 12 times per week for one year. Readings were wirelessly transmitted to a web-based portal, and monthly reports were sent to providers. Any reading that fell outside of an acceptable range triggered a phone call to the patient from a clinician.
In addition to home blood pressure telemonitoring, patients in the intervention group also received 20 telephone counseling calls from trained nurse case managers over the course of the year. During the calls, the nurses educated patients about blood pressure, stroke symptoms, and lifestyle changes聽(including physical activity, weight loss, nutrition, and the importance of adhering to prescribed medications) that could lower blood pressure. Nurses also checked that patients were keeping up with home blood pressure monitoring, and addressed any challenges expressed by patients.
The two main outcomes were patients鈥 blood pressure after one year, and rate of recurrent stroke within two years. Both groups had a significant decline in systolic blood pressure after one year compared to baseline, with two and half times greater decline among patients in the intervention group. However, there was no difference in rate of recurrent stroke between the two groups at two years.
Only 4 percent of total patients enrolled in the study had another stroke within two years (nine patients in the intervention group and nine in the control group). Dr. Ogedegbe maintains that additional studies are needed to better understand long-term clinical outcomes, cost effectiveness, and generalizability of nurse case management enhanced telehealth programs.
鈥淥ur ongoing work shows the urgent need to reduce racial disparities in hypertension-related outcomes between communities of color and White patients,鈥 said , associate professor in the Departments of Population Health and Medicine, and the study鈥檚 senior author. 鈥淲e believe that telehealth programs to manage uncontrolled hypertension could play an important role in addressing structural inequities in care and substantially improve outcomes in Black and Hispanic stroke survivors.
In addition to Dr. Ogedegbe and Dr. Spruill, study co-authors from 好色tv Langone were Stephen K. Williams, MD, and Adebayo Ogunlade, MPH. Additional authors are Chigozirim Izeogu, MD, of McGovern Medical School at University of Texas Health Houston; Joseph P. Eimicke, MS, Jian Kong, MS, Stephanie A. Silver, MPH, Jeanne A. Teresi, EdD, PhD, Olajide Williams, MD, of Columbia University; Helen Valsamis, MD, and Susan W. Law, DO, Steven R. Levine, MD, of NYC Health + Hospitals; and Salina P. Waddy, MD, of the National Center for Advancing Translational Sciences.
The research was supported by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health (NIH), grant number U54 NS081765.
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