Leveraging Preexisting Cardiovascular Data to Improve the Detection and Treatment of Hypertension

Abstract

ImportanceHypertension is often underrecognized, leading to preventable morbidity and mortality. Tailored data systems combined with care augmented by trained nonphysicians have the potential to improve cardiovascular care.ObjectiveTo determine whether previously collected cardiovascular imaging data could be harnessed to improve the detection and treatment of hypertension through a system-level intervention.Design, Setting, and ParticipantsThe NOTIFY-LVH trial was a 2-arm, pragmatic randomized clinical trial conducted from March 2023 through June 2024 within the Mass General Brigham health care system, a multi-institutional network serving the greater Boston, Massachusetts, area. The study included individuals with a Mass General Brigham primary care affiliation who had left ventricular hypertrophy (LVH) on a prior echocardiogram, had no established cardiomyopathy diagnosis, and were not being treated with antihypertensive medications. Patients were followed for 12 months postintervention.InterventionPopulation health coordinators contacted clinicians of patients randomized to the intervention, notifying them of LVH and offering assistance with follow-up care. A clinical support pathway—including 24-hour ambulatory blood pressure monitoring or cardiology referrals—was provided to aid LVH evaluation.Main Outcomes and MeasuresThe primary outcome was the initiation of an antihypertensive medication. Secondary outcomes included new hypertension and cardiomyopathy diagnoses.ResultsA total of 648 patients were randomized—326 to the intervention and 322 to the control. Mean (SD) patient age was 59.4 (10.8) years and 248 patients (38.3%) were female. A total of 102 patients (15.7%) had a baseline diagnosis of hypertension and 109 patients (20.1%) had a mean outpatient blood pressure of 130/80 mm Hg or higher. Over 12 months, 53 patients (16.3%) in the intervention arm were prescribed an antihypertensive medication vs 16 patients (5.0%) in the control arm (adjusted odds ratio [OR], 3.76; 95% CI, 2.09-6.75; P < .001). Individuals in the intervention group were also more likely to be diagnosed with hypertension (adjusted OR, 4.43; 95% CI, 2.36-8.33; P < .001). Cardiomyopathy diagnoses did not significantly differ between groups.Conclusions and RelevanceIn the NOTIFY-LVH randomized clinical trial, a centralized population health coordinator–led notification and clinical support pathway for individuals with LVH on prior echocardiograms increased the initial treatment of hypertension. This work highlights the potential benefit of leveraging preexisting but potentially underutilized cardiovascular data to improve health care delivery through mechanisms augmenting the traditional ambulatory care system.Trial RegistrationClinicalTrials.gov Identifier: NCT05713916