Only half of US adults have blood pressure levels that are controlled to recommended levels. Home blood pressure monitoring has previously been shown to be a useful adjunct to team-based care for hypertension, and home BP readings can predict cardiovascular risk more accurately than office BP measurements. Recent studies have suggested that a combined approach using telemedicine with nurse- or pharmacist-led care may be effective at improving blood pressure control, but these studies did not include follow-up.
In this randomised trial of 450 adults with uncontrolled BP in Minnesota, 12 months of intervention and 6 months of postintervention follow-up were performed. Patients from eight primary care clinics were randomised to provide usual care (n=222), and eight were randomised to provide a telemonitoring intervention (n=228). Intervention patients received home BP telemonitors and transmitted BP data to pharmacists who then adjusted antihypertensive pharmacotherapy accordingly. The main outcome measure was control of blood pressure to less than 140/90 (130/80 in patients with diabetes or chronic kidney disease) at six and twelve months.
The mean age of the 450 patients recruited was 61.1 years, with a mean systolic BP of 148mmHg and a mean diastolic of 85mmHg. 45% were female and 82% were white. When compared to patients in the usual care group, the mean change from baseline systolic BP was found to be lower in patients in the telemonitoring group at 6 (-10.7mm Hg),12 (-9.7mm Hg), and 18 (-6.6mm Hg) months follow-up (all P<0.05).
Telemonitoring of home BP, combined with pharmacist case management, led to better BP control than usual care during 12 months of intervention. The effects were seen to persist to 6 months of postintervention follow-up.
- Margolis L, Asche SE, Bergdall AR et al. Effect of Home Blood Pressure Telemonitoring and Pharmacist Management on Blood Pressure Control A Cluster Randomized Clinical Trial. JAMA 2013;310:46-56.