BP Phone Home: Telemonitoring Helps Control BP

A home telemonitoring intervention, including case management by pharmacists, led to significant and lasting reductions in BP, reports the Journal of the American Medical Association.

The HyperLink trial included 450 adults with uncontrolled BP, enrolled at 16 primary care clinics in an integrated health care system in Minneapolis/St Paul. One group of practices received the home telemonitoring intervention, in which patients were instructed to perform at least six BP measurements per week (three in the morning, three in the evening). The study pharmacists acted as case managers, adjusting antihypertensive therapy in response to the home BP readings. The control practices followed usual care.

The intervention and control groups were compared for rates of target BP below 140/90 mm Hg, or 130/80 mm Hg in patients with diabetes or chronic kidney disease. Assessment included 6 months of follow-up after the 12-month intervention period.

The mean age was 61 years, and 55 percent of patients were men. At baseline, the mean BP was 148/85 mm Hg, and patients were taking a mean of 1.5 antihypertensive drugs.

Home telemonitoring was associated with a significant increase in the number of patients meeting the criteria for BP control: 57.2 versus 30.0 percent at both 6 and 12 months. Six months after the intervention period, the rates were 71.8 and 57.1 percent, respectively.

The telemonitoring group had greater reductions in systolic BP, with differences of 16.7 mm Hg at 6 months, 9.7 mm Hg at 12 months, and 6.6 mm Hg at 18 months. The differences in diastolic BP were 6.0, 5.1, and 6.3 mm Hg, respectively. Telemonitoring was also associated with more intensified antihypertensive therapy, increased adherence to medications and sodium restriction, and some improvements in patient satisfaction. Safety was acceptable, although some patients at the lower BP target had hypotension-related events.

The HyperLink intervention, incorporating home BP monitoring and team-based care, reduced BP in patients with uncontrolled hypertension, compared with usual care. The intervention costs are estimated at $1350 per patient per year. The authors plan further evaluations of cost-effectiveness and long-term cost savings [Margolis KL, 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].