Blood Pressure

Grand Rounds March 27, 2026: Text Messaging and Video Stories to Support Hypertension Self-Management in Black Veterans: A Randomized Clinical Trial (Sarah L. Cutrona, MD, MPH)

Posted on by Sophia Ramirez

Speaker

Sarah L. Cutrona, MD, MPH
Acting Director, Center for Health Optimization and Implementation Research (CHOIR)
VA Bedford Healthcare System
Professor, Division of Health Informatics and Implementation Science
Department of Population and Quantitative Health Sciences
UMass Chan Medical School

Keywords

Blood Pressure; Hypertension; Self-Management; Video; Texting; Black Americans; Veterans

Key Points

  • Black Americans experience disproportionate morbidity and mortality due to hypertension (HTN). Simultaneously, self-management is made more difficult by differential rates of diagnosis and treatment titration; decreased access to, trust in, and engagement with the healthcare system; and cost, access, and environmental barriers. This study sought to improve HTN control and self-management among about 600 Black Veterans by supplementing a preexisting video story intervention with longitudinal texting support.
  • Those in the intervention arm watched 5 video stories featuring other Black Veterans, chose their preferred storyteller, and received educational and interactive messages aligned with that storyteller. Those in the control arm received only interactive messages. The researchers hypothesized that peer stories would promote participants’ emotional engagement with the messages via a parasocial relationship with the storyteller, enhancing self-efficacy, influencing health behaviors and ultimately improving HTN control.
  • While participants in both arms saw marginal improvements in systolic and diastolic blood pressure (BP), there was no significant difference in the BP change between the arms. The intervention saw high treatment fidelity (92%) and sustained engagement, with over 55% of participants responding to texts through the end of the 6-month period. The researchers concluded that the interactive text messages, which were present in both arms, were an effective way to maintain engagement in a multi-month study and may serve as a useful strategy for future longitudinal interventions supporting Black Veterans.

Discussion Themes

The control group was intentionally kept active – i.e., received educational texts – to isolate the specific impact of storytelling rather than just the impact of receiving text messages.

The intervention was shaped by direct feedback from veteran consultants, who provided guidance on tone, word choice, and structure to ensure the messages felt authentic.

Attendees noted that negative studies are vital for informing future research and that the intervention provided valuable moments of outreach to a population facing socioeconomic vulnerabilities and isolation.

Grand Rounds November 14, 2025: IMPACT-BP: A Community-Based Intervention for Sustainable Blood Pressure Control in Rural KwaZulu-Natal, South Africa (Mark Siedner, MD, MPH)

Posted on by Sophia Ramirez

Speaker

Mark Siedner, MD, MPH
Professor of Medicine, Harvard Medical School
Faculty, Africa Health Research Institute

Keywords

Hypertension; Blood Pressure; Community-Based; Implementation Science; Global Health

Key Points

  • Hypertension (HTN) is the leading preventable cause of death globally. Dr. Siedner’s research typically revolves around HIV, but he turned his attention to HTN after publishing a study on the convergence of infectious and non-communicable disease epidemics in rural South Africa. Unlike HIV, he noted, HTN control remains poor.
  • The overarching goals of the IMPACT-BP study were to determine causes for poor HTN control in rural South Africa; co-develop an intervention with partners and end-users to address those causes; and implement and evaluate a novel model of care to improve blood pressure (BP) and increase disease control rates.
  • They began by designing and determining the acceptability of and conducting a readiness assessment for a community-based hypertension control program. The decision to pursue a community-based care model was informed by decades of successful HIV care programs and innovative HTN care programs.
  • The program had 3 main elements: Patients monitored their BP at home; community health workers (CHWs) visited patients to collect data, address challenges, and deliver medicines; and nurses managed care remotely with mobile health tools and decision support. Program goals included enhancing patient efficacy and self-empowerment; decongesting clinics and decreasing wait times; and task-shifting away from overburdened nurses.
  • Once the program had been designed and assessed, the study team conducted a randomized trial to determine its effectiveness. The primary outcome was the change in systolic BP from enrollment to 6 months.
  • Participants were randomized to 3 arms: Standard of care; “CHW,” which included self-monitoring of BP, home visits and medicine delivery by CHWs, and remote management of BP by nurses; and “eCHW+,” which differed from the “CHW” arm in that BP readings were automatically sent to nurses and the CHWs were less involved.
  • Though the “eCHW+” arm was slightly more successful, the study team observed 8 – 10mm HG reductions in systolic BP and roughly 30% improvements in BP control in both intervention arms.
  • This was a multidimensional intervention that sought to address multiple barriers to care. The team faced many real-world challenges, including a community health worker labor dispute, persistent nationwide power outages, destructive weather, and a carjacking spree.
  • Next, the study team will estimate the fidelity, sustainability, acceptability, and cost-effectiveness of the program. Future directions may include an expansion to multimorbidity care; expansion of the model to urban settings; and transportability to the U.S.

Discussion Themes

When it comes to translating these lessons and insights for care coordination in a U.S. setting, a focus on convenience for healthcare workers and for patients will continue to be crucial.

Though eCHW+ arm was successful, participant feedback indicated that the human element was central to intervention acceptability. Participants felt they were getting a tremendous amount of support from their community health workers, and some expressed anger at the possibility of the intervention ending.

Dr. Siedner noted that he sees the success of the trial more as proof of principle that there are fundamental steps we can take to improve chronic disease care than the unveiling of a one-size-fits-all model.

With a trusted healthcare system and provider providing the right kind of health education, this study demonstrates that you can get people to engage in treatment of an asymptomatic disease.

Grand Rounds June 20, 2025: The BedMed Trials: Does the Timing of Blood Pressure Medication Matter? (Scott Garrison, MD, PhD, CCFP)

Posted on by Sophia Ramirez

Speaker

Scott Garrison MD, PhD, CCFP
Professor, University of Alberta, Department of Family Medicine
Director, Pragmatic Trials Collaborative

Keywords

Hypertension; Blood Pressure; Blood Pressure Medication; Medication Timing

Key Points

  • In 2010, the Monitorización Ambulatoria para Predicción de Eventos Cardiovasculares (MAPEC) trial found that hypertensive patients who took once-daily blood pressure (BP) medication at night, as opposed to in the morning, had a 61% reduction in major adverse cardiovascular events (MACE).
  • These results came with a credible rationale: BP is higher during the day than overnight, and overnight BP is a better predictor of cardiovascular events than daytime BP. Theoretically, patients taking BP medication at bedtime could preferentially lower overnight BP. But there were also good reasons to be skeptical of the results, and clinical guidelines remained unchanged.
  • To further investigate whether the timing of BP medication had an effect on MACE, Dr. Garrison and his team conducted 2 randomized controlled trials: BedMed and BedMed Frail. The former was conducted in a hypertensive primary care population; the latter in a hypertensive continuing care population. They conducted them separately, given the differing risks and benefits for the populations and the likely underrepresentation of frail or complex older patients in BedMed.
  • In the early stages, Dr. Garrison came across several unexpected challenges. There were restrictions around data access; regulations around billing for trial-related procedures in British Columbia; and the time it took to identify a data partner.
  • In both trials, the intervention group took a once-daily BP medication when getting ready for bed. In BedMed, the control took a once-daily BP medication upon waking up in the morning; in BedMed Frail, the control had no change in their existing routine (which typically meant taking their BP medication in the morning). Given the unique needs of the trial population, BedMed Frail utilized opt-out consenting.
  • The primary outcome for both trials was all-cause death or hospitalization/emergency department visit for stroke, acute coronary syndrome, or heart failure. In BedMed, they used an intent-to-treat analysis, with patients participating (via active or passive follow-up) in the study for a median of 4.6 years. In BedMed Frail, they used a modified intent-to-treat analysis, with patients participating for a median of 1.1 years due to high mortality in the study population.
  • The research team found that no additional cardiovascular benefit is conveyed from taking BP medication at bedtime. Conversely, their results concluded that these medications can be safely taken at bedtime, so patients should incorporate them into their routine whenever they are least likely to forget it.

Discussion Themes

Dr. Garrison noted that he was more confident in the negative result for the BedMed trial than for BedMed Frail, given that the adjusted hazard ratio of 0.88 and the unadjusted ratio of 0.93 in the latter. A 12% reduction in the outcome (which was largely driven by death) may still be meaningful to patients.

Designing a trial that was workflow-friendly for physicians was a top priority for the research team and was critical to obtaining buy-in for and executing this trial.

A major accomplishment of BedMed and BedMed Frail was developing a network of volunteer physicians and a data partner who would collaborate with the Pragmatic Trials Collaborative on future trials.