Abstract WMP52: Shake, Rattle & Roll Trial - Effects on Blood Pressure Control and Therapy

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Abstract

Background: In Kaiser Permanente Northern California (KPNC), a setting where all members have similar access to healthcare and a very high overall rate of HTN control, blacks still had poorer BP control than whites. It has been suggested that greater difficulty in controlling BP and lifestyle differences may account for this difference. The “Shake, Rattle and Roll” (SRR) trial is named for: 1) “shake” the salt habit; 2) “rattle” the intensity of current BP management; and 3) adapt and “roll” out the interventions to other communities.

Methods: SRR is a pragmatic clustered randomized controlled trial. All PCPs at Kaiser Oakland and their panels of black patients were randomized, stratified by panel size, to one of 3 arms: 1) usual care (UC); or 2) enhanced monitoring (EM) of current KPNC BP management protocol; or 3) culturally tailored diet and lifestyle (LS) coaching focused on the DASH eating plan. Black patients from KPNC HTN registry with an identifying high BP reading ≥ 140/90 qualified to be recruited into SRR. The intervention period lasted 12 months. We assessed rates of BP control using the latest follow-up BP measurements between enrollment and 15 months post-enrollment. Data on demographics and anti-hypertensives were collected from participants’ EMRs.

Results: We cluster randomized 107 PCPs to one of 3 arms. There were 1185 enrolled in UC, and 318 in EM and 259 in LS. Median ages ranged from 63-65 years [Table]. Among those enrolled, BP control rates were higher in EM and LS than in UC (53% in UC, 69% in EM, and 71% in LS, p<0.001). However, a significant proportion of UC did not have a follow-up BP measurement during the trial period. There were also significant differences in anti-hypertensive usage across the 3 arms [Table].

Conclusions: Preliminarily, among those enrolled in SRR, EM and LS arms had better BP control than UC and there were differences in the types of anti-hypertensive therapy used. Further analyses of all aspects of BP management in SRR are under way.

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