July 10, 2013
More Home Monitoring/Pharmacy Management Needed
for BP Control

Minneapolis—A widely disseminated new study is calling for more use of pharmacist management to improve blood pressure control in patients with hypertension.

The study, published recently in the Journal of the American Medical Association, found that pharmacist management combined with home blood pressure (BP) telemonitoring resulted in improved hypertension control over a year, compared to usual care.

What’s even more significant, however, is that the blood pressure improvement was maintained for at least 6 months following the intervention, even in patients with more severe hypertension and other comorbidities, according to the report.

“Decades of research have shown that treatment of hypertension prevents cardiovascular events; and many well-tolerated, effective, and inexpensive drugs are readily available,” according to background in the article. “Although BP 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 comorbidities [other illnesses] and more severe hypertension.”

To determine the effect and durability of home BP telemonitoring with pharmacist case management in patients representative of typical primary care practices, Karen L. Margolis, MD, MPH, of the HealthPartners Institute for Education and Research, Minneapolis, and colleagues conducted a study including the range of comorbidity and hypertension severity. Included in the randomized clinical trial were 450 adults with uncontrolled BP, recruited from 14,692 patients with electronic medical records across 16 primary care clinics in an integrated health system in Minneapolis-St. Paul. Study subjects received 12 months of intervention and 6 months of postintervention follow-up.

While eight clinics were randomized to offer usual care to 222 patients, the other eight clinics were randomized to provide a telemonitoring intervention to 228 study subjects. Patients in the intervention group were given home BP telemonitors to transmit data to clinic-based pharmacists, who then adjusted antihypertensive therapy accordingly.

In the study, the primary measured outcome was control of systolic BP to less than 140 mmHg and diastolic BP to less than 90 mm Hg (<130/80 mmHg in patients with diabetes or chronic kidney disease) at 6 and 12 months. Researchers also looked at overall change in BP, patient satisfaction, and BP control at 18 months and 6 months beyond the intervention period.

Among the 380 patients attending both the 6- and 12-month visits, the proportions of patients with controlled BP at both visits were 57.2% in the telemonitoring intervention group compared to 30% in the usual care group. At 18 months, meanwhile, BP was controlled in 71.8% of the telemonitoring intervention group and 57.1% of the usual care group.

The difference was especially significant among the 362 patients attending all clinic visits at each measurement period—6, 12, and 18 months. BP was controlled in 50.9% in the telemonitoring intervention group and 21.3% in the usual care group.

“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 BP monitoring in their weekly routine, follow their medication regimen, and keep their BP under control,” the report notes. “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.”

Assuming that the results are found to be cost-effective and durable over the long term, authors suggest “wider testing and dissemination of similar alternative models of care for managing hypertension and other chronic conditions."

U.S. Pharmacist Social Connect