Correlates and Control of Blood Pressure Variability

Correlates and Control of Blood Pressure Variability

The purpose the research is to prospectively demonstrate agreement between EHR and ambulatory blood pressure monitor (ABPM) derived blood pressure variability (BPV), as well as the feasibility of reducing BPV using a data-driven pharmacotherapeutic approach. To this end, this is a feasibility study that will make use of the Cedars-Sinai Health System including the Medical Delivery Network and the clinics of all practitioners who use the same EHR.

The primary research procedures are: assessment of blood pressure variability (BPV) using ABPM compared to EHR derived values; and to assess feasibility of a data driven pharmacotherapy intervention to reduce BPV among high BPV patients. As part of an option sub-study, participants may wear a single lead ECG patch to record skin sympathetic nerve activity (SKNA), which has been previously correlated with changes in blood pressure.

Inclusion Criteria:

• Individuals 18 years old or older are included.
• Patients followed continuously at Cedars-Sinai for at least 5 years, defined as at least 1 outpatient visit with a Cedars-Sinai physician at which a blood pressure was measured each of the last 2 calendar years
• Patients with a PCP in the Cedars-Sinai Medical Group or faculty practice
• Patients on antihypertensive therapy other than a DPH-CCB or thiazide-like diuretic
• Patients in the highest decile of BPV based on extracted BP data from the EHR

Exclusion Criteria:

• Any records flagged "break the glass" or "research opt out."
• Pregnant or breastfeeding patients (due to guideline recommendations for specific medications for the treatment of hypertension during pregnancy and breastfeeding).