Long-term effects on cardiovascular events of home blood pressure telemonitoring with pharmacist management in patients with uncontrolled hypertension [abstract]
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Background: Uncontrolled hypertension is a leading contributor to cardiovascular (CV) disease. We previously reported results of a cluster-randomized trial evaluating a 1-year home blood pressure telemonitoring and pharmacist management intervention, with significant reductions in blood pressure favoring the intervention group for 24 months. This analysis examined the intervention effect on CV events over 5 years of follow-up. Methods: The Hyperlink trial randomized 16 primary care clinics with 450 patients with uncontrolled hypertension to either telemonitoring intervention (TI, n=228) or usual care (UC, n=222). CV events and deaths were ascertained though self-reports and electronic health records. Medical records for all potential events were adjudicated by trained reviewers blinded to intervention assignment. The primary composite endpoint included nonfatal myocardial infarction (MI), nonfatal stroke, hospitalized heart failure (HF), and CV death. Coronary revascularization was included in a secondary composite endpoint. Generalized estimating equations with robust standard errors were used to test differences in CV incidence by treatment group. Marginal Cox models were used to estimate the hazard ratio for time to first event by treatment group. Both methods account for the cluster-randomized design. Results: There were 15 CV events (5 MI, 4 stroke, 5 HF, 1 CV death) among 10 patients in the TI group and 26 events (11 MI, 12 stroke, 3 HF) among 19 patients in the UC group. The incidence of the primary CV composite endpoint was 4.4% in the TI group vs 8.6% in the UC group (odds ratio: 0.49, 95% CI: 0.21–1.13, P=0.09). Including 2 coronary revascularizations in the TI group and 10 in the UC group, the incidence of the secondary CV composite endpoint was 5.3% in the TI group vs 10.4% in the UC group (odds ratio: 0.48, 95% CI: 0.22–1.08, P=0.08). In the time-to-first-event analysis for the primary outcome, hazard ratio was 0.50 (95% CI: 0.22–1.11, P=0.09). For the secondary endpoint including coronary revascularization, hazard ratio was 0.49 (95% CI: 0.23–1.04, P=0.06). Conclusion: The intervention lowered blood pressure and may have reduced CV events by 50% over 5 years, even in this small study. Cost-effectiveness estimates using microsimulation models will be presented.