OPTImizing Precision of Hypertension Care to Maximize Blood Pressure Control Pilot (OPTI-BP Pilot)
Condition: High Blood Pressure
MeSH terms: Hypertension
Study type: Interventional

Summary: 
      Hypertension (HTN) is a major risk factor for coronary heart disease (CHD), heart failure,
      kidney failure and stroke. Disparities in HTN prevalence, treatment and control in the US
      have persisted for decades. The prevalence of HTN is 44% among Blacks, which is among the
      highest rates in the world. Those in ethnic/racial, rural, socioeconomically disadvantaged
      and other medically underserved populations are known to have the worst blood pressure (BP)
      control. Awareness of, treatment for, and control of HTN is not optimal, and varies according
      to race, whereby BP is controlled in ~53% of non-Latino Whites, 42% of non-Latino Blacks and
      only 34% of Latinos. Fundamental underlying differences in the pathophysiology contribute to
      HTN among different race groups. The United States (US) 2014 HTN recommendations outline
      race-based pharmacotherapy care for HTN. However, these recommendations use race-based
      population assumptions for Whites and Blacks only, do not include Latino ethnicity and have
      no accompanying guidelines or tools for successful implementation, particularly in rural
      primary care practices where disparate populations are common. Moreover, these
      recommendations only apply to initial therapy and lack guidance on subsequent regimen
      selection. The Optimizing Precision of HTN Care to Maximize BP Control Pilot (OPTI-BP Pilot),
      will directly address a long known and growing health disparity concern in the US which
      includes higher rates of death from CHD and stroke among Blacks and the poorest rates of HTN
      control among Latinos. Utilizing a mixed methods approach, the overarching goal of OPTI-BP
      Pilot is to test, using a pragmatic trial design, a personalized, algorithmic-based HTN
      management approach focused on age, race, biomarker (plasma renin activity) and treatment
      factors. The investigators hypothesize that implementation of a precision-based approach to
      the care of HTN in the community will improve BP reduction and ultimately reduce risk for
      CHD, stroke and death among those most affected by HTN.OPTI-BP Pilot is significant because
      it will utilize an innovative, systematic, precision-focused HTN management approach in an
      underserved, diverse population where BP control is currently suboptimal and lays the
      infrastructure groundwork for broad implementation across all areas of the US to minimize HTN
      related disparities and improve HTN outcomes.
    

Detailed description: 
      The purpose of this research study is to develop pilot data to support a more precise way to
      treat high blood pressure based on an individual person's specific characteristics.
      Information from a blood test called plasma renin activity will be entered into an on-line
      app that may more precisely determine which medication should be used to treat high blood
      pressure than random selection. Renin is a substance in the body that is known to affect your
      blood pressure. By measuring plasma renin activity, and using that to select a blood pressure
      lowering medication it may help to more precisely select medications based on how an
      individual will respond.
    

Intervention name(s): HTN PRA App; Blood Sample
Intervention type(s): Other; Other
Intervention description(s): The HTN PRA App will be used to adjust standard of care medication dosages for high blood pressure drugs which may include: thiazide diuretic (water pill), usually called hydrochlorothiazide (HCTZ) or chlorthalidone, and an ACE inhibitor or an angiotensin receptor blocker.; Blood sample for plasma renin activity activity will be obtained at least once (at baseline) and if BP is not controlled after 1-3 months, an additional blood sample may be obtained.
Other intervention name(s): on-line app
Allocation: Non-Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Prevention