Telemonitoring with pharmacist management improves blood pressure control
- Patients who got home blood pressuring telemonitoring with pharmacist management reduced their BP more than those receiving usual care up to 18 months, but did not sustain the benefit through longer follow-up to 54 months, a new study published online by JAMA Network shows.
- The researchers followed 326 patients with uncontrolled hypertension to see if 12-month benefits from home blood pressure monitoring observed in an earlier study could be sustained up to 54 months. The primary outcome and measures were change from baseline to 54 months in systolic and diastolic BP measured as the mean of three measurements obtained at each research clinic visit.
- Blood pressures were significantly lower in the treatment intervention group than in the control group from six months to 24 months — 12 months after the intervention ended. Beyond that point, BPs increased and by 54 months were similar to those for patients receiving usual care.
High blood pressure is a major cause of heart disease and stroke. Of the 75 million Americans who have hypertension, just over half (54%) have it under control, according to the Centers for Disease Control and Prevention. Data from the American Heart Association show that nearly 70% of people who experience a first heart attack, 77% who have a first stroke and 74% with congestive heart failure have blood pressure exceeding 140/90 mm Hg.
While patients in the treatment group had use of telemonitors during the study, they were not given home BP monitors after the trial period ended and the telemonitors were returned to the vendor, which likely contributed to the slide in healthy BP maintenance.
The findings suggest the intervention was effective up to 18 months and subsequent BP measurements in EHRs suggest a sustained benefit up to 24 months, the authors note.
"Such BP reductions of this magnitude and duration have the potential to result in clinically important effects on cardiovascular events, even if BP was not different at 54 months," they wrote. "Nevertheless, long-term maintenance of BP controls is likely to require continued monitoring and resumption of the intervention if BP increases."
With good outcomes, interventions such as this have the potential to spur development of new products and platforms and gain traction with doctors and health systems looking for ways to reduce cardiovascular disease and deaths.
A recent study by researchers at the University of Sydney in Australia showed that heart patients with smartphone applications that remind them when it's time to take their medication had greater adherence to drug regimens than patients who didn't have such apps.