Abstract TU163: Self-Measured Blood Pressure Monitoring Programs: Who are they good for?

Abstract

Background: Self-Measured Blood Pressure (SMBP) Monitoring programs, which focus on teaching participants how to lower their BP through medication adherence and lifestyle changes, are an integral part of the Million Hearts initiative co-led by the Center for Disease Control and Prevention and Center for Medicare and Medicaid Services. Here, we used data from SMBP programs to cluster individuals with similar BP trajectories and compared participant characteristics across trajectory groups to determine whether certain subgroups were more likely to benefit from SMBP participation. Methods: We analyzed data from 101 participants with > 3 SMBP encounters at Family Health Centers in Louisville, Kentucky. In addition to standard SMBP activities, participants at the included locations were screened for unmet social needs and, with consent, were connected to community-based organizations to help resolve these needs. In analyses, we used group-based trajectory modeling (GBTM) to identify joint SBP and DBP trajectory groups. Iterative models were fit to arrive at a model which was the best fit to our data based on Bayesian Information Criteria. We assigned individuals to the trajectory group for which they had the highest posterior probability of group membership and compared participant characteristics across trajectory groups. Factors which appeared to differ by trajectory groups were added to the GBTM to formally test their association with trajectory group membership. Results: We identified 4 joint SBP and DBP trajectories ( Figure ). Three out of 4 groups (74.5%) had decreasing BP during the SMBP program while one group (Group 3; 25.5%) had stable elevated BP throughout. Qualitative comparisons of participant characteristics across groups indicated potential differences in several characteristics ( Table ). Upon adding these factors to the GBTM, housing insecurity, obesity, and tobacco use were significantly associated with trajectory group membership such that, compared to Group 1, individuals in Groups 2 and 4 were more likely to experience housing insecurity (p 2v1 =0.0888; p 4v1 =0.0067) and use tobacco (p 2v1 =0.0899; p 4v1 =0.0124); Group 2 participants were also less likely to have obesity (p=0.0230). Conclusions: SMBP programs can help many individuals with hypertension lower their BP. There was no defining characteristic of “non-responders,” although participants tended to be slightly older and possess greater ASCVD risk scores than those whose BP decreased over time.