Peer Comparison Feedback for High Blood Pressure

Overseen By Shivan Mehta, MD,MBA,MSHP

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Pennsylvania

Must be taking: Anti-hypertensives

Disqualifiers: Frailty, Advanced illness, Renal disease, Pregnancy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new method of sending feedback to doctors to improve their management of high blood pressure. Researchers aim to determine if sharing Peer Comparison Messages with doctors enhances their engagement in treating patients with hypertension. The trial includes two groups: one will receive these messages, while the other will continue regular care without them. It seeks patients with recent high blood pressure readings, specifically those with blood pressure over 140/90. Patients with serious kidney issues or in end-of-life care are not eligible. As an unphased trial, this study offers patients a unique opportunity to contribute to innovative approaches in hypertension management.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems to focus on evaluating doctors' management of high blood pressure, so it's best to ask the trial coordinators for more details.

What prior data suggests that this peer comparison message is safe for hypertension management?

Research has shown that communication tools, such as messages comparing doctors' performance, safely assist in managing patients' high blood pressure. One study found that digital tools, like text messages, effectively lowered the systolic blood pressure without causing harm. These methods are generally well-received because they provide information rather than medication. To date, no serious side effects have been reported from these communication methods, making them a promising and safe way to help manage high blood pressure. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the peer comparison feedback approach for managing high blood pressure because it takes a unique path by using social motivation rather than medication. Unlike standard treatments like ACE inhibitors or beta-blockers that focus on physiological changes, this method leverages behavioral science to encourage healthier lifestyle choices. By comparing a patient's progress with peers, it aims to inspire better adherence to healthy habits, potentially leading to more sustainable blood pressure control. This innovative strategy might offer a complementary option to traditional methods, reducing reliance on medication and empowering patients to take charge of their health.

What evidence suggests that this peer comparison message is effective for hypertension management?

Research has shown that comparing patients' progress with their peers can help manage high blood pressure. In this trial, one group will receive peer comparison messages, while the control group will not receive these messages and will continue with usual care. Studies have found that digital tools, such as text messages, can lower systolic blood pressure, the top number in a blood pressure reading. These messages remind people to take their blood pressure medicine as prescribed. By informing doctors about how their patients' blood pressure compares to others, these messages can encourage more attentive care. Overall, using peer comparisons may lead to better management of high blood pressure and improved health outcomes. ^{6 7 8 9 10}

Who Is on the Research Team?

Shivan Mehta, MD,MBA,MSHP

Principal Investigator

University of Pennsylvania

Are You a Good Fit for This Trial?

This trial is for Primary Care Providers at Penn Medicine Lancaster with at least 30 patients who have high blood pressure. These patients must be aged 18-85 and have had a diagnosis of hypertension in the last two years. Excluded are providers with fewer than 30 such patients, those caring for patients with end stage renal disease, recent pregnancy, or indicators of end-of-life care.

Inclusion Criteria

My blood pressure was over 140/90 at my last doctor's visit within the year.

Primary Care Providers who have at least 30 patients with hypertension as determined by the HTN quality metric

Exclusion Criteria

I have not been in comfort or palliative care in the last year.

I am not over 65 with frailty or have had an advanced illness diagnosis in the past year.

Primary Care Providers includes providers with less than 30 patients in the HTN quality metric

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Primary Care Providers receive monthly peer comparison messages to improve hypertension management

6 months

Monthly feedback sessions

Control

Primary Care Providers continue with usual care and access hypertension control rates via EPIC dashboard

6 months

Follow-up

Participants are monitored for changes in hypertensive medication prescriptions and hypertension control percentage

6 months

What Are the Treatments Tested in This Trial?

Interventions

• Peer Comparison Message

Trial Overview The study tests if sending monthly peer comparison messages to doctors can improve how they manage high blood pressure. It looks at whether these messages encourage doctors to start or increase doses of blood pressure medications among their patients.

How Is the Trial Designed?

Group I: Intervention Experimental Treatment 1 Intervention

This group will receive peer comparison messages.

Group II: Control Active Control 1 Intervention

This group will not receive peer comparison messages and will continue with usual care.

Who Is Running the Clinical Trial?

University of Pennsylvania

Lead Sponsor

Trials

2,118

Recruited

45,270,000+

Published Research Related to This Trial

A peer support program involving Veterans of Foreign Wars posts in Wisconsin effectively trained 27 peer leaders over 18 months to promote self-management of hypertension, with 93% of participating posts remaining active throughout the study.

The program resulted in peer leaders gaining health knowledge and confidence, which enhanced health support among veterans, highlighting the potential of community-based initiatives in improving chronic disease management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preliminary description of the feasibility of using peer leaders to encourage hypertension self-management. Hayes, A., Morzinski, J., Ertl, K., et al.[2010]

A study from the Boston Collaborative Drug Surveillance Program found that while 'nuisance' adverse drug reactions (ADRs) from antihypertensive medications occur in 10 to 29% of patients, 'life-threatening' ADRs are very rare, occurring in less than 1%.

Clinicians should consider the potential severity and type of ADRs, along with patient compliance and education, when selecting antihypertensive therapies to ensure effective treatment and minimize negative impacts on patient adherence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse drug reactions during treatment of hypertension. Kellaway, GS.[2018]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10840260/

The effectiveness of short mobile phone text message ... Mobile phone text messages to support treatment adherence in adults with high blood pressure (SMS-Text Adherence Support [StAR]) a single-blind, ...

2. mhealth.jmir.org mhealth.jmir.org/2021/9/e24527

Effectiveness of Text Messaging Interventions on Blood ... In addition, a text messaging intervention has a potential effect on BP control; however, the dosage of a text messaging intervention has not ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8495578/

Effectiveness of Text Messaging Interventions on Blood ... The overall results showed that the text messaging intervention significantly reduced systolic BP (SBP) but not diastolic BP (DBP). There was no ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S258975002300002X

Effectiveness, reach, uptake, and feasibility of digital health ... This study aimed to compare the effectiveness of SMS, smartphone application, and website interventions on improving blood pressure in adults with hypertension

5. globalheartjournal.com globalheartjournal.com/articles/10.5334/gh.1103

Effectiveness and Acceptability of a Mobile Phone Text ... The COM-B model informed contextual co-designed text messages. Primary outcomes were change in BP and medication adherence at three months.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10485713/

Long-Term Results of a Digital Hypertension Self ... A strong relationship exists between rising SBP and DBP and increased risk of cardiovascular disease, including a 2-fold increased risk of death ...

7. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2788120

Clinician Decisions After Remote Notification of Elevated ... This cohort study uses data from a randomized clinical trial to assess the range of clinician responses to elevated blood pressure alerts ...

8. ahajournals.org ahajournals.org/doi/10.1161/JAHA.124.035381

Neighborhood Safety and Hypertension Risk: A Systematic ... Our findings suggest that unsafe neighborhoods may increase blood pressure and hypertension risk, warranting further research and interventions.

9. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8576089/

Improving the Management of Hypertension by Tackling ... Overall, only 46.5% of participants with hypertension were aware of their diagnosis, with the highest awareness among upper-middle income ...

10. researchgate.net researchgate.net/publication/353722491_Effectiveness_of_text_messaging_intervention_on_blood_pressure_control_among_patients_with_hypertension_A_meta-analysis_of_randomized_controlled_trials

Effectiveness of text messaging intervention on blood ... The overall results showed that the text messaging intervention significantly reduced systolic BP (SBP) but not diastolic BP (DBP). There was no ...