A cluster-randomized study on the risk assessment and management program for home blood pressure monitoring in an older population with inadequate health literacy

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.