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A home-based blood pressure telemonitoring system, along with pharmacist assistance, contributed toward better short- and long-term blood pressure (BP) control compared with usual care, researchers found.

Compared with usual care, patients receiving the at-home intervention had significant reductions in systolic blood pressure at months 6 (P<0.001), 12 (P<0.001), and 18 (P=0.004), according to Karen Margolis, MD, of the HealthPartners Institute for Education and Research in Minneapolis, Minn., and colleagues.

The proportion of patients in the intervention group with controlled blood pressure was significantly greater at 6 (P<0.001), 12 (P=0.005), and 18 months (P=0.003), they wrote online in the Journal of the American Medical Association.

The authors noted that high blood pressure is the most common chronic condition for which patients consult primary care physicians, affecting roughly 30% of U.S. adults. They also noted that in-home measurement of blood pressure may be more accurate than clinical measurements.

Recent studies have shown telemonitoring of blood pressure can avert under-reporting of high blood pressure readings at home, though those studies have not included a follow-up after the study intervention.

To help fill in the gaps in research, Margolis and colleagues designed a two-group, cluster randomized clinical trial that enrolled 450 adult patients with uncontrolled blood pressure and randomized them to the telemonitoring/pharmacist case management group (n=228) or usual care (n=222).

The usual care group had no change in BP management; they continued to work with their primary care physicians as usual.

Researchers defined controlled blood pressure as less than 140/90 mm/Hg or less than 130/80 mm/Hg in those with diabetes or chronic kidney disease

The intervention group had a 1-hour consultation that reviewed patient history, taught patients about hypertension, instructed them on how to use the blood pressure monitoring system, and provided an individualized home blood pressure goal of 5 mm/Hg lower than their clinical blood pressure goal.

Those in the home intervention were asked to transmit at least six measurements weekly (three in the morning, three in the evening). Their telemonitoring system relayed blood pressure data to pharmacists who could adjust antihypertensive treatment appropriately. They could also provide coaching on lifestyle changes and medication adherence.

The treatment group also had biweekly phone conversations with their pharmacist during the first 6 months until blood pressure control was maintained for 6 weeks. Following BP control, phone calls were reduced to monthly intervals.

The four doctoral pharmacists involved in the intervention were trained for 8 hours each on study protocol and were observed during two phone consultations.

The majority of patients were male (55%), white (82%), with a mean age of 61. More than half (54%) were obese. At baseline, participants had a mean systolic BP of 148 mm/Hg and a mean diastolic BP of 85 mm/Hg.

At both 6 and 12 months, the proportion of patients with controlled blood pressure was significantly higher in the at-home group than the control group (57.2% versus 30%, P=0.001).

The same held true for three time periods -- 6, 12, and 18 months (50.9% versus 21.3%, P=0.002).

The intervention group also saw significantly reduced systolic blood pressure versus usual care at months 6 (-10.7 mm/Hg), 12 (-9.7 mm/Hg) and 18 (-6.6 mm/Hg).

The same held true for diastolic blood pressure at months 6 (-6 mm/Hg) and 12 (-5.1 mm/Hg), with a trend for significance at month 18 (-3 mm/Hg).

Overall satisfaction was similar between groups, although the telemonitoring group reported better outcomes for clinicians listening carefully, explaining clearly, and respecting what the patient said.

The authors reported costs of $1,045 per patient over the 12 months of intervention, roughly half of which (48%) were spent for care management services, while the remainder were for telemonitoring.

"The study outcomes showed the clear benefit of introducing new technologies to blood pressure management and that associated costs should be assumed by health insurers, adding that the ease of care through this service and the improved outcomes can lead to reductions in cardiovascular events, which would ultimately save money," wrote David Magid, MD, of Kaiser Permanente Colorado Institute for Health Research in Denver, and Beverly Green, MD, of Group Health Research Institute in Seattle, Wash., in an accompanying editorial.

Margolis and colleagues noted limitations of the study included limited response to invitation to the study, a highly educated patient population with high incomes, and the attribution of outcomes to the intervention.

From the American Heart Association: