Improving Blood Pressure in Colorado

Hypertension, or high blood pressure (BP), affects 65 million people or almost 1 out of every 4 adults in the U.S. Individuals who have normal BP at 55 years of age have a 90% lifetime risk for developing hypertension. The level of BP elevation is directly related to a person's subsequent risk for heart attack, heart failure, stroke, and kidney failure. In 2002, hypertension was the primary or contributing cause of death in 11% of US deaths and the cost of hypertension was estimated at $59.7 billion. The prevalence of sequelae of uncontrolled hypertension will increase as our population ages unless we develop better programs to control high BP. Hypertension is treatable. If you reduce a person's elevated BP, you reduce their risk of stroke by 30%, heart attack and others forms of coronary heart disease by 20%, congestive heart failure by 50%, and premature death by 10%.3 Despite the evidence supporting hypertension treatment, more than half of patients with hypertension have inadequate BP control.

We will improve hypertension control in Colorado by implementing a population-based intervention using interactive voice response (IVR) technology that will be delivered to patients in three healthcare systems across Colorado (Denver Health and Hospitals [DH], VA Colorado Healthcare System [VA], and Kaiser Permanente of Colorado [KPCO]). Together, these organizations serve over 1 million Coloradans. The IVR-based hypertension program will: 1) reach out to more patients using fewer resources than a traditional patient visit approach, 2) implement evidence based guidelines for therapy, 3) facilitate patients' acquisition of medications by allowing them to order and receive medications at home, and 4) enhance medication adherence using tailored educational and motivational messages. This program will not duplicate or supplant funding for existing programs, but will complement the existing programs which are based on traditional provider-patient encounters.

IVR is a computer-based telephone system that initiates outbound calls, receives inbound calls, and provides information and collects data from patients between office visits. An IVR system has three components: 1) a standard microcomputer, 2) hardware that interfaces with the telephone system to place calls, and 3) software that controls calling operations. Patients require only a telephone to participate in an IVR program. Over 95% of Coloradans have telephones. People are familiar with IVR applications such as systems used by airlines to provide flight information and by healthcare organizations to arrange clinic appointments and refill prescriptions.

*Detailed description of study procedures (duration, description of intervention, study measures, endpoints, specific aims, etc):

Study Visits (both study arms):