Abstract P267: A Pharmacist-Led, AHA Heart 360 Supported Home Blood Pressure Monitoring Program Improves Blood Control in Patients With Uncontrolled Hypertension

Abstract

Objective: Treating hypertension (HTN) reduces morbidity and mortality, yet blood pressure (BP) remains inadequately controlled in a large proportion of patients with HTN. The purpose of this study was to determine if a pharmacist-led home BP monitoring (HBPM) program supported by the American Heart Association's (AHA) Heart 360 website improves BP control for patients with uncontrolled HTN. Methods: This practical randomized controlled study was conducted at Kaiser Permanente Colorado. A total of 353 patients 18 to 85 years of age with uncontrolled HTN, receiving ≤ 3 antihypertensive medications, and with internet access were randomized to the Usual Care (UC, n=174) or the home BP monitoring (HBPM, n=179) group. All patients were seen in clinic at baseline and 6 months for BP measurements. The HBPM group used the AHA Heart 360 website to transmit home BP readings via the internet to clinical pharmacy specialists who made adjustments to patients' antihypertensive medications and/or ordered labs as necessary based on collaborative drug therapy management (CDTM) protocols. The primary endpoint was BP control at 6 months (<130/80 mm Hg for patients with diabetes or chronic kidney disease and <140/90 mm Hg for all others). The number of office, telephone, and email contacts was also compared between groups. Results: Six-month follow-up data were available on 245 patients (245 of 353 (70%)) (n=120 HBPM, n=125 UC). The mean age of the participants was 58 years; 61% were male. There were no significant differences in age or gender between groups. Baseline mean systolic BP was 149 mm Hg in the HBPM group and 145 mm Hg in the UC group (p = 0.08). Rates of 6-month BP control were significantly higher in the HBPM ((58%) 69 of 120) versus the UC group ((38%) 47 of 125) (p < 0.01). The 6-month decrease in systolic BP was larger in the HBPM group (-21 mm Hg) versus the UC group (-9 mm Hg) (p < 0.01). The adjusted relative likelihood of BP goal attainment was 1.5; 95% CI, 1.2 to 2.0. There were no significant differences between groups in the number of office visits; however telephone and email contacts were significantly higher in the HBPM group. Conclusion: A pharmacist-led, HBPM program supported by the AHA Heart 360 website improves BP control for patients with uncontrolled HTN compared to UC.