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Intervention helps improve and maintain better blood pressure control

Home blood pressure telemonitoring combined with pharmacist-led care was effective in improving hypertension management in patients with uncontrolled high blood pressure.

CHICAGO – July 2, 2013 – An intervention that consisted of home blood pressure telemonitoring with pharmacist management resulted in improvements in BP control and decreases in BP during 12 months, compared with usual care, and improvement in BP that was maintained for 6 months following the intervention, according to a study in the July 3 issue of The Journal of the American Medical Association.

High blood pressure is the most common chronic condition for which patients visit primary care physicians, affecting about 30 percent of U.S. adults, with estimated annual costs exceeding $50 billion. Decades of research have shown that treatment of hypertension prevents cardiovascular events; and many well-tolerated, effective, and inexpensive drugs are readily available. Although blood pressure control has improved during the past two decades, it is controlled to recommended levels in only about half of U.S. adults with hypertension.

Several recent studies suggest that a combined intervention of telemedicine with nurse or pharmacist led care may be effective for improving hypertension management, but none included post intervention follow-up. Also, previous studies excluded patients with other medical conditions (like diabetes, kidney disease, and heart disease) and more severe hypertension.

Karen Margolis, MD, MPH, director of clinical research at HealthPartners Institute for Education and Research, in Minneapolis, and colleagues conducted a study to determine the effect and durability of home blood pressure telemonitoring with pharmacist case management in patients representative of the range of other conditions and hypertension severity in typical primary care practices. The randomized clinical trial included 450 adults with uncontrolled blood pressure recruited from 14,692 patients with electronic medical records across 16 primary care clinics in the HealthPartners health system in Minneapolis-St. Paul, with 12 months of intervention and 6 months of post intervention follow-up.

Eight clinics were randomized to provide usual care to patients (n = 222) and eight clinics were randomized to provide a telemonitoring intervention (n = 228). Intervention patients received home blood pressure telemonitors and transmitted home blood pressure data to pharmacists who adjusted antihypertensive therapy accordingly over the telephone. The primary measured outcome was control of systolic blood pressure to less than 140 mm Hg and diastolic blood pressure to less than 90 mm Hg (<130/80 mm Hg in patients with diabetes or chronic kidney disease) at 6 and 12 months. Secondary outcomes were change in blood pressure, patient satisfaction, and blood pressure control at 18 months (6 months after intervention stopped).

Among the patients attending both the 6 and 12 month visits, about twice as many patients in the telemonitoring intervention group (57.2 percent) had controlled blood pressure at both visits as patients in the usual care group (30.0 percent). More than 70 percent of patients in the telemonitoring group had controlled blood pressure at each individual follow-up time point (6 months, 12 months and 18 months). At the 18-month visit, 6 months after the intervention ended, blood pressure control was greater in the telemonitoring intervention group (71.8 percent) than in the usual care group (57.1 percent).

“Self-efficacy questions indicated telemonitoring intervention patients were substantially more confident than usual care patients that they could communicate with their health care team, integrate home blood pressure monitoring in their weekly routine, follow their medication regimen, and keep their blood pressure under control. Telemonitoring intervention patients self-reported 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.”

JAMA. 2013;310(1):46-56. doi:10.1001/jama.2013.6549.

This study is supported by grant HL090965 from the National Heart, Lung, and Blood Institute. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.

HealthPartners Institute for Education and Research

HealthPartners Institute for Education and Research is a 501c(3) non-profit organization dedicated to improving health through discovery, the translation of research and health professional education. Our researchers are dedicated to conducting high-quality, public-domain health research, proposed and led by multidisciplinary teams of independent PhD- and MD-level investigators. Our health professional educators provide nationally accredited graduate medical education, continuing medical education and clinical simulation emphasizing the use of quality improvement and experiential learning.