Lower your pressure
study to determine the effect and durability of home BP telemonitoring with pharmacist case management in patients representative of the range of comorbidity and hypertension severity in typical primary care practices.
The randomised clinical trial included 450 adults with uncontrolled BP recruited from 14,692 patients with electronic medical records across 16 primary care clinics in an integrated health system in Minneapolis-St Paul, with 12 months of intervention and six months of post-intervention follow-up.
Eight clinics were randomised to provide usual care to patients (222 patients) and eight clinics were randomised to provide a telemonitoring intervention (228 patients).
Intervention patients received home BP telemonitors and transmitted BP data to pharmacists who adjusted antihypertensive therapy accordingly.
The primary measured outcome was control of systolic BP to less than 140mm Hg and diastolic BP to less than 90mm Hg (less than 130/80mm Hg in patients with diabetes or chronic kidney disease) at six and 12 months. Secondary outcomes were change in BP, patient satisfaction and BP control at 18 months (six months after intervention stopped).
Among the 380 patients attending both the six- and 12-month visits, the proportions of patients with controlled BP at both visits were 57.2% in the telemonitoring intervention group and 30% in the usual care group.
At 18 months, BP was controlled in 71.8% of the telemonitoring intervention group and 57.1% of the usual care group.
Among the 362 patients attending all clinic visits at six, 12, and 18 months, the proportions of patients with controlled BP at all vis- its were 50.9% in the telemonitoring intervention group and 21.3% in the usual care group.
“Self-efficacy questions indicated telemonitoring intervention patients were substantially more confident than usual care patients that they could communicate with their healthcare team, integrate home BP monitoring in their weekly routine, follow their medication regimen and keep their BP under control.
“Telemonitoring intervention patients selfreported adding less salt to food than usual care patients at all time points, but other lifestyle factors did not differ,” the authors write.
“If these results are found to be cost-effective and durable during an even longer period, it should spur wider testing and dissemination of similar alternative models of care for managing hypertension and other chronic conditions.” — HealthNewsDigest.com