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HypertensionBP MAPNCT03818659

Improving BP Control in Diverse Populations Using BP MAP

A study testing Self-Guided M.A.P. BP Improvement Program and Full Support M.A.P. BP Improvement Program in people with Hypertension, run by University of California, San Francisco at 24 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

BP-MAP is a cluster randomized controlled trial (RCT) designed to compare the effectiveness of BP lowering from a clinic-based quality improvement program with Full Support (dedicated practice facilitation) vs. a Self-Guided version of the program. Read more about this study

Who is it for?
Ages 18 to 85 years
Conditions the study is for
Hypertension
What is being tested?
Self-Guided M.A.P. BP Improvement Program and Full Support M.A.P. BP Improvement Program
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,238,835 participants
Where
24 sitesUnited States
Study dates
1 Jul 2019to 30 Jun 2021
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

ACTIVE CLINICS

For inclusion as an Active Clinic in this study, clinics may participate must be able to identify:

  • A Site Champion who works at the clinic and who is willing to take primary responsibility for implementing the M.A.P. intervention
  • A Physician Champion who works at the clinic and who is willing to advocate actively for the M.A.P. intervention
  • A Practice Change Facilitator willing to attend a 1-day training and help guide implementation of the M.A.P intervention for Full Support sites, with the support of AMA staff (may be the Site Champion or Physician Champion, or a person with regional responsibilities who can support multiple sites)

Sites will be excluded if they:

  • Have implemented any high blood pressure quality improvement component from the M.A.P. BP improvement program as part of Target: BP or from the AMA or Target: BP websites
  • Are currently involved in an ongoing clinical trial or grant funded project related to high blood pressure or hypertension

USUAL CARE CLINICS:

Usual Care Clinics will include PCORnet Datamarts participating in BP TRACK, a concurrently-running BP Control Registry within PCORnet that will provide quarterly datamart-level estimates of BP control and other aggregate metrics relevant to BP control. All participating datamarts will be included, with the following exceptions:

  • Datamarts with any Active Clinics participating in BP MAP will be excluded
  • Datamarts that obscure dates via date-shifting will be excluded, as this will not allow for control of concurrent secular trends

PATIENTS

Within clinics (Active or Usual Care), patients will be eligible (and identified from the electronic health record) if they meet National Quality Forum BP Control Metric (NQF 0018) criteria:

  • Age 18-85 on the date of analysis
  • At least one outpatient encounter with a diagnosis of hypertension during the first six months of the measurement year (ending on the date of analysis)
  • No diagnosis or evidence of end-stage renal disease on or prior to the end of the measurement year
  • No pregnancy during the measurement year
  • No admission to an inpatient setting during the measurement year

Trial locations and contacts

24 sites in 1 country.

24 sites in 1 country

United States24 sites
  • Belle Chasse Community Health Center

    Belle Chasse, Louisiana, 70037

  • Public Health: Seattle & King County Eastgate Public Health Center

    Bellevue, Washington, 98007

  • Public Health: Seattle & King County Primary Care at Navos

    Burien, Washington, 98166

  • Daughters of Charity Carrollton

    Carrollton, Louisiana, 70118

  • St. Bernard Community Health Center

    Chalmette, Louisiana, 70043

  • Open Door Del Norte CHC

    Crescent City, California, 95531

  • Open Door Eureka Community Health & Wellness Center

    Eureka, California, 95501

  • Daughters of Charity Gretna

    Gretna, Louisiana, 70056

  • Daughters of Charity Kenner

    Kenner, Louisiana, 70065

  • Kenner Community Health Center

    Kenner, Louisiana, 70065

  • Cowlitz County Health Department Cowlitz County: North Beach Clinic

    Longview, Washington, 98632

  • QueensCare Echo Park Clinic

    Los Angeles, California, 90026

  • St Charles Community Health Center- Paul Maillard

    Luling, Louisiana, 70070

  • St. Charles Community Health Center

    Luling, Louisiana, 70070

  • Daughters of Charity Metairie

    Metairie, Louisiana, 70001

  • Daughters of Charity St. Cecilia

    New Orleans, Louisiana, 700117

  • Daughters of Charity Higgins

    New Orleans, Louisiana, 700126

  • Daughters of Charity New Orleans East

    New Orleans, Louisiana, 700127

  • Access Health Louisiana Primary Care at the Pythian

    New Orleans, Louisiana, 70112

  • Daughters of Charity Gentilly

    New Orleans, Louisiana, 70122

  • Waterfall CHC

    North Bend, Oregon, 97459

  • Monterey County Health Department Laurel Family Practice

    Salinas, California, 93906

  • Public Health: Seattle & King County Downtown Public Health Center

    Seattle, Washington, 98121

  • Tillamook CHC

    Tillamook, Oregon, 97141

Other trials in United States

About this study

Official title: Improving Blood Pressure Control in Diverse Populations by Measuring Accurately, Acting Rapidly, and Partnering With Patients

BP-MAP is a cluster randomized controlled trial (RCT) designed to compare the effectiveness of BP lowering from a clinic-based quality improvement program with Full Support (dedicated practice facilitation) vs. a Self-Guided version of the program. The American Medical Association (AMA) developed the framework for the interventions.

Read the detailed description

BP-MAP is a cluster randomized controlled trial (RCT) designed to compare the effectiveness of BP lowering from a clinic-based quality improvement program with Full Support (dedicated practice facilitation) vs. a Self-Guided version of the program. The American Medical Association (AMA) developed the framework for the interventions. The trial will be conducted within the National Patient-Centered Clinical Research Network (PCORnet) that enables distributed querying of electronic health record data in a common data model. The primary outcome will be change in clinic-level blood pressure (BP) control at 6 months. Secondary outcomes will include other blood pressure (BP) control metrics, other time points (12 and 18 months), and process measures such as BP measurement accuracy, medication intensification, and average systolic blood pressure (SBP) reduction after a medication intensification, and repeat visit within 4 weeks after a visit with elevated BP. The investigators hypothesize clinics randomized to the Full Support version will achieve a larger increase from baseline in the proportion of their hypertensive patients with controlled BP at 6 months as compared to clinics randomized to the Self-Guided version, and also as compared with usual care. The investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating "Usual Care" institutions in PCORnet. This study was submitted to the IRB at UCSF, determined to be quality improvement and exempt from further review.

Conditions
Hypertension
Being tested
Self-Guided M.A.P. BP Improvement Program, Full Support M.A.P. BP Improvement Program
Medical subject headings
Hypertension

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Self-Guided M.A.P. BP Improvement ProgramOther

    Active Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.

  • Full Support M.A.P. BP Improvement ProgramOther

    Active Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.

Study groups in NCT03818659
Study groupRoleWhat they receive
Self-GuidedActive comparatorActive Clinics randomized to the Self-Guided Arm will receive access to an AHA/AMA web platform that includes the posted M.A.P. materials and limited access to AMA Staff who are available to answer questions. The study team will facilitate access to staff by hosting a kick-off webinar for program participants that will include an orientation to the materials on the website, general advice and practical tips about what works for implementation, and time for answering questions and discussion with the group.
Receives: Other: Self-Guided M.A.P. BP Improvement Program
Full SupportExperimentalActive Clinics randomized to the Full Support Arm will receive online access to M.A.P. materials and orientation webinar and also a Practice Change Facilitator who will lead the health center clinical staff, site champions and physician leads at each clinic over the course of 6 months to support the implementation of the MAP Program. With support from an AMA "Improvement Advisor", the Practice Change Facilitators will perform a baseline assessment of current workflows and assess each domain of M.A.P. The goal of the Full Support program is to help care teams develop skills and sustainable workflows that are effective at attaining and maintaining high levels of BP control.
Receives: Other: Full Support M.A.P. BP Improvement Program
Usual CareNo interventionThe investigators will also conduct non-randomized comparisons of BP control in the Full Support and Self-Guided intervention arms to BP control in non-participating "Usual Care" institutions in PCORnet.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Blood Pressure Control, % of Patients

    The primary outcome will be clinic-level change in the proportion of patients with controlled BP from baseline to 6 months after the start of the intervention. BP control will be defined according to NQF 0018 as the percent of eligible patients (defined below) with SBP <140 mmHg and DBP < 90 mmHg, based on measurements obtained at the most recent ambulatory clinical encounter at baseline (using the lowest measures of SBP and DBP at that encounter) and similarly at the 6-month time point after initiation of the intervention.

    Measured: baseline and 6 months

Secondary outcomes (9)
  1. Change in Improvement in Blood Pressure, % of Patients

    This overall measure of BP improvement implements CMS065v4[ref], which defines BP improvement as either a reduction of 10 mmHg in SBP or achievement of SBP that is "adequately controlled" (SBP < 140 mmHg) in months 12 of the measurement period, among hypertensive patients not previously controlled.

    Measured: baseline and 12 months

  2. Change in Confirmatory Repeated Blood Pressure Measurement, % of Visits

    This process measure is designed to capture the practice of repeating a blood pressure measurement in the same visit when the first measurement done in clinic is high (SBP≥140 mmHg or DBP≥90 mmHg).

    Measured: baseline and 6 months

  3. Change in Medication Intensification, % of Visits

    This process measure captures the proportion of visits where BP is uncontrolled where a medication is ordered that is of a different class of medication than had previously been used. Note that this explicitly does not give credit for ordering a simple refill or medication dose increase, or use of a different medication in the same class.

    Measured: baseline and 6 months

  4. Change in Average Systolic Blood Pressure (SBP) Reduction After a Medication Intensification Visit, mmHg

    This continuous metric describes the change in SBP (+/- standard deviation) observed between a visit with a medication intensification to the subsequent visit occurring at least 10 days later.

    Measured: baseline and 6 months

  5. Change in Repeat Visit in 4 Weeks After a Visit With Elevated BP, % of Visits

    This process measure captures the proportion of persons who had uncontrolled HTN who made a subsequent visit within the following 4 weeks.

    Measured: baseline and 6 months

  6. Change in Use of Fixed Dose Combination Product Among Patients Taking 2 or More Classes of Medications, % of Patients

    Use of fixed dose combination medications helps with adherence, promotes rational combinations of medications, and increases likelihood of achieving BP control. This metric, which is limited to patients taking more than one medication class, describes the prevalence of fixed dose combination pill use.

    Measured: baseline and 6 months

  7. Change in Use of a CCB or Thiazide or Thiazide-like Diuretic Among African-American Patients on at Least One Medication, % of Patients

    Use of calcium channel blockers (CCB) OR a thiazide or thiazide-like diuretic medication classes is recommended to treat black or African American patients as first line monotherapy due to increased efficacy. This metric, which is limited to African-American patients with a diagnosis of hypertension taking at least one medication class, describes the prevalence of those receiving the recommended drug class.

    Measured: baseline and 6 months

  8. Change in Terminal Digit = Zero, % of Measurements

    Inappropriate rounding of blood pressure measurements (usually to zero) leads to measurement error and worse treatment decisions. This continuous metric is calculated for a clinic as the percent of measurements at that clinic (for hypertensive patients) where the terminal digit of the measurement is zero. A percent greater than 10% (if an automated BP monitor is used) or greater than 20% (if a manual BP monitor is used with recommended rounding to even digits) indicates evidence of inappropriate rounding. Unlike most of our metrics, lower is better, down to an ideal value of 10-20%, which would be expected if no rounding were occurring.

    For this study we calculated the change in this continuous metric for each clinic from baseline to 6 months, and then described the mean change across clinics by group. As with our other outcomes, the unit of analysis in the study is a clinic.

    Measured: baseline and 6 months

  9. Change in Blood Pressure Controlled to 2017 Guideline Goal, % of Patients

    This alternative overall measure of BP control is identical to Metric 1, except that attainment of BP Control is defined by SBP < 130 mmHg and DBP < 80 mmHg, as per the goal stated in the 2017 ACC/AHA Hypertension Guideline[ref]. Note that while the treatment threshold varies in the Guideline, depending on cardiovascular risk, the goal applies to all patients.

    Measured: baseline and 6 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Jan 2019
  2. Study start1 Jul 2019
  3. Primary completion28 Feb 2021
  4. Study completion30 Jun 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
1,238,835 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03818659
Sponsor's protocol ID
18-25890
Acronym
BP MAP
Status last verified
Feb 2025
First submitted
22 Jan 2019
Last updated
3 Mar 2025
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Fontil V, Modrow MF, Cooper-DeHoff RM, Wozniak G, Rakotz M, Todd J, Azar K, Murakami L, Sanders M, Chamberlain AM, O'Brien E, Lee A, Carton T, Pletcher MJ. Improvement in Blood Pressure Control in Safety Net Clinics Receiving 2 Versions of a Scalable Quality Improvement Intervention: BP MAP A Pragmatic Cluster Randomized Trial. J Am Heart Assoc. 2023 Feb 7;12(3):e024975. doi: 10.1161/JAHA.121.024975. Epub 2023 Jan 25.

    PubMed 36695297

Questions about this trial

What is this clinical trial studying?

A study testing Self-Guided M.A.P. BP Improvement Program and Full Support M.A.P. BP Improvement Program in people with Hypertension, run by University of California, San Francisco at 24 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 3 Mar 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 24 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 3 Mar 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Blood Pressure Control, % of Patients (time frame: baseline and 6 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03818659, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Mar 2025.

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