Home Blood Pressure Monitoring Group Research Articles

Efficacy of a Web-Based Home Blood Pressure Monitoring Program in Improving Predialysis Blood Pressure Control Among Patients Undergoing Hemodialysis: Randomized Controlled Trial.

Hypertension is highly prevalent among patients undergoing hemodialysis, with a significant proportion experiencing poorly controlled blood pressure (BP). Digital BP management in this population has been underused. This study aimed to explore the efficacy of a web-based home BP monitoring (HBPM) program in improving predialysis BP control and enhancing knowledge, perception, and adherence to HBPM among patients with hypertension undergoing hemodialysis. A multicenter, open-label, randomized controlled trial was conducted at 2 hemodialysis units. Patients were randomly allocated in a 1:1 ratio to either the web-based HBPM program as the intervention group or to usual care as the control group over a 6-month period. The primary outcomes were the predialysis BP control rate, defined as less than 140/90 mm Hg, and the predialysis systolic and diastolic BP, assessed from baseline to the 6-month follow-up. Secondary outcomes included patient knowledge, perception, and adherence to HBPM, evaluated using the HBPM Knowledge Questionnaire, HBPM Perception Scale, and HBPM Adherence Scale, respectively. A generalized estimating equations analysis was used to analyze the primary outcomes in the intention-to-treat analysis. Of the 165 patients enrolled in the program (n=84, 50.9% in the web-based HBPM group and n=81, 49.1% in the control group), 145 (87.9%) completed the follow-up assessment. During the follow-up period, 11 instances of hypotension occurred in 9 patients in the web-based HBPM group, compared to 15 instances in 14 patients in the control group. The predialysis BP control rate increased from 30% (25/84) to 48% (40/84) in the web-based HBPM group after the 6-month intervention, whereas in the control group, it decreased from 37% (30/81) to 25% (20/81; χ22=16.82, P<.001; odds ratio 5.11, 95% CI 2.14-12.23, P<.001). The web-based HBPM group demonstrated a significant reduction after the 6-month intervention in the predialysis systolic BP (t163=2.46, P=.02; β=-6.09, 95 % CI -10.94 to -1.24, P=.01) and the predialysis diastolic BP (t163=3.20, P=.002; β=-4.93, 95% CI -7.93 to -1.93, P=.001). Scores on the HBPM Knowledge Questionnaire (t163=-9.18, P<.001), HBPM Perception Scale (t163=-10.65, P<.001), and HBPM Adherence Scale (t163=-8.04, P<.001) were significantly higher after 6 months of intervention. The implementation of a web-based HBPM program can enhance predialysis BP control and the knowledge, perception, and adherence to HBPM among patients undergoing hemodialysis. This web-based HBPM program should be promoted in appropriate clinical settings.

Status of home blood pressure monitoring and influencing factors of regular home blood pressure monitoring among elderly uncontrolled hypertensive patients in Central and Western China

Objective: To describe the prevalence of home blood pressure monitoring and analyze the factors influencing regular blood pressure monitoring among elderly uncontrolled hypertensive patients in Central and Western China. Methods: It was a cross-sectional study, which enrolled hypertensive patients aged over 60 years with office blood pressure ≥140/90 mmHg (1 mmHg=0.133 kPa) from September 2019 to July 2020 in 72 hospitals in Central and Western China. Patients completed the electronic questionnaires, and were divided into regular and irregular home blood pressure monitoring groups. The proportion of patients using different types of sphygmomanometers and the percentage of patients with regular home blood pressure monitoring (at least weekly) were explored. The generalized linear mixed model was used to define the influencing factors of regular home blood pressure monitoring. Results: A total of 3 857 patients were included in this study. Age was 67(64,71) years old and there were 2 163 males (56.1%). Overall, sphygmomanometer was available at home for 3 044(78.9%) patients, 2 168(56.2%) patients conducted regular home blood pressure monitoring. Among the patients with a sphygmomanometer at home, 2 370(77.9%) of the sphygmomanometers were upper arm electronic device. Older age, higher income, longer history of hypertension, multiple antihypertensive medications and awareness of diagnostic criteria of hypertension and hypertension complications were associated with a higher prevalence of regular home blood pressure monitoring (all P<0.05). Conclusions: Among the elderly hypertensive patients with uncontrolled blood pressure in Central and Western China, there is a relatively high prevalence of home sphygmomanometer ownership and regular monitoring. Age, family income, history of hypertension, number of antihypertensive drugs and knowledge of hypertension are the influencing factors of regular home blood pressure monitoring in this population.

Knowledge and practice of home blood pressure monitoring 6 months after the risk and assessment management programme: does health literacy matter?

BackgroundLittle is known whether patients with lower health literacy could retain the practice and knowledge of home blood pressure monitoring (HBPM) after an educational programme.MethodsA cluster randomised controlled trial in...

A randomized controlled trial on home blood pressure monitoring and quality of care in stage 2 and 3 hypertension.

In a 12-week, randomized, controlled trial, we investigated whether home blood pressure monitoring (HBPM) would improve treatment adherence and blood pressure control in stage 2 and 3 hypertension. Eligible patients (18-75 years of age and 160-199/100-119 mmHg of clinic systolic/diastolic blood pressure after a 1-week wash-out) were randomized in a 1:4 ratio to an experimental group (with HBPM) and a control group (without HBPM). All patients started antihypertensive treatment with the irbesartan 150 mg/hydrochlorothiazide 12.5 mg/day combination, with the possible addition of irbesartan 150 mg/day and uptitration to irbesartan 300 mg/hydrochlorothiazide 25 mg/day at 4 and 8 weeks of follow-up, respectively. The primary endpoint was the clinic blood pressure control (systolic/diastolic, nondiabetes <140/90 mmHg and diabetes <130/80 mmHg) rate at 12 weeks of follow-up. The randomized patients in the HBPM (n = 96) and control groups (n = 405) had similar characteristics at baseline and similar use of higher dosages of irbesartan/hydrochlorothiazide (300 mg/12.5-25 mg) at 4 (9.4% vs. 12.2%, P = 0.45) and 8 weeks of follow-up (27.1% vs. 35.5%, P = 0.13). During follow-up, both the cumulative treatment discontinuation rate (1.0% vs. 12.6%, P = 0.0008) and the less optimal treatment adherence rate (<90% of prescribed medication, 1.0% vs. 9.9%, P = 0.005) were significantly lower in the HBPM group than in the control group. The proportion of patients who achieved the goal of clinic blood pressure control at 12 weeks of follow-up was significantly higher in the HBPM group than in the control group (66.7% vs. 55.1%, P = 0.04). In conclusion, HBPM improved treatment adherence and blood pressure control in patients with hypertension, despite similar antihypertensive treatment intensities.

Home blood pressure monitoring in the antenatal and postpartum period: A systematic review meta-analysis.

Recent evidence suggests that home blood pressure monitoring (HBPM) is an effective way of managing women with hypertensive disorders of pregnancy (HDP) without increasing adverse outcomes. The aim of this systematic review and meta-analysis was to investigate the safety and efficacy of HBPM during pregnancy. Medline, EMBASE and the Cochrane library databases were searched electronically in November 2018. Studies were included from which data could be extracted on the pregnancy outcomes and included pregnancies with HDP or at increased risk of developing HDP. Data from nine studies were included in the meta-analysis. The use of HBPM during the antenatal period was associated with reduced risk of induction of labor (OR: 0.55, 95% CI: 0.36-0.82, 444 women, I2=0%), prenatal hospital admissions (OR: 0.31, 95% CI: 0.19-0.49, 416 women, I2=0%) and diagnosis of preeclampsia (OR: 0.50, 95% CI: 0.31-0.81, 725 women, I2=37%). The number of antenatal visits was significantly less in the HBPM group (standard mean difference: -0.49, 95% CI: -0.82 to -0.16, 738 women, I2=75%). There were no significant differences between HBPM and conventional care regarding composite maternal, fetal or neonatal outcomes when used during the antenatal period. There were no significant differences between the groups who had HBPM compared to those who had conventional care regarding postpartum readmissions and obtaining a blood pressure measurement within 10days of delivery after discharge. The significant clinical heterogeneity and low quality of evidence are the main limitations, and therefore, more high quality studies are needed.

Effects of self-monitoring devices on blood pressure in older adults with hypertension and diabetes: a randomised controlled trial

BackgroundHypertension and diabetes frequently coexist, which results in the difficulty of hypertension control in community-dwelling elderly adults who lack effective prevention and control strategies. The aim of this study is...

Pregnancy outcomes following home blood pressure monitoring in gestational hypertension.

To assess the safety and efficacy of home blood pressure monitoring (HBPM) and office (traditional) blood pressure measurements in a cohort of pregnant women with gestational hypertension (GH). This was a cohort study at St. George's Hospital, University of London conducted between December 2013 and August 2018. The inclusion criteria was pregnant women with a diagnosis of GH. Eligible patients were counseled and trained by a specialist midwife and were provided with an automated Microlife® "WatchBP Home" BP machine. Each patient followed an individualised schedule of hospital visits and BP measurements based on the HBPM pathway or standard hospital protocol which was based on the National Institute of Health and Care Excellence (NICE) guideline. Adverse fetal, neonatal and maternal outcomes as well as number of antenatal hospital visits were recorded and compared between HBPM and office (traditional) pathways. 143 women with GH were included in the study (80 HBPM vs 63 standard care). There were no significant difference between the two groups in maternal high-dependency unit admission (P = 0.999), birth weight centile (P = 0.803), fetal growth restriction (p = 0.999), neonatal intensive care unit admissions (p = 0.507) and composite neonatal (p = 0.654), maternal (p = 0.999) or fetal adverse outcomes (p = 0.999). The number of Day Assessment Unit (DAU) visits was significantly lower in the HBPM group than the traditional pathway (median 4.0 vs. 5.0, P = 0.009). The difference was greater when the number of visits were adjusted for the duration of monitoring in weeks (median: 1.0 vs 1.5, P < 0.001). There were no significant difference between the two groups in the total number of outpatient (P = 0.357) and triage visits (p = 0.237). However, the total number of antenatal visits adjusted for the duration of monitoring was significantly lower for the HBPM group compared to the traditional pathway (median 1.4 vs 1.8, P = 0.020). HBPM in women with GH results in significantly less antenatal visits compared to women on a standard pathway of care. The two groups had comparable fetal, neonatal and maternal adverse outcomes. Large multicentre studies are needed to ascertain the safety of rare adverse pregnancy outcomes.

Home blood-pressure monitoring in a hypertensive pregnant population: cost-minimization study.

Traditional blood-pressure monitoring in hypertensive pregnant women requires frequent visits to the maternity outpatient services. Home blood-pressure monitoring (HBPM) could offer a cost-saving alternative that is acceptable to patients. The aim of this study was to undertake a health economic analysis of HBPM compared with traditional monitoring in hypertensive pregnant women. This was a cost-minimization study of hypertensive pregnant women who had HBPM with or without the adjunct of a smartphone application (App), via a specially designed pathway, and a control group managed according to the local protocol of regular hospital visits for blood-pressure monitoring. Outcome measures were the number of outpatient visits, inpatient bed stays and investigations performed. Maternal, fetal and neonatal adverse outcomes were also recorded. Health economic analysis was performed using direct cost comparison of the study dataset and process scenario modeling. The HBPM group included 108 women, of whom 29 recorded their results on the smartphone App and 79 in their notes. The control group comprised 58 patients. There were significantly more women with chronic hypertension in the HBPM group than in the control group (49.1% vs 25.9%, P= 0.004). The HBPM group had significantly longer duration of monitoring (9 weeks vs 5 weeks, P= 0.004) and started monitoring at an earlier gestational age (30.0 weeks vs 33.6 weeks, P= 0.001) compared with the control group. Despite these differences, the mean saving per week for each patient using HBPM compared with traditional monitoring was £200.69, while for each HBPM patient using the smartphone App, the weekly saving was £286.53 compared with the control group. The process modeling method predicted weekly savings of between £98.32 and £245.80 per patient using HBPM compared with traditional monitoring. HBPM in hypertensive pregnancy appears to be cost saving compared with traditional monitoring, without compromising maternal, fetal or neonatal safety. Larger studies are required to confirm these findings. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Home Blood Pressure Monitoring Has Similar Effects on Office Blood Pressure and Medication Compliance as Usual Care.

BackgroundHome blood pressure monitoring is recommended to achieve controlled blood pressure. This study evaluated home blood pressure monitoring-improvement of office blood pressure control and treatment compliance among hypertensive patients.MethodsA randomized controlled trial was conducted from December 2014 to April 2015. The home blood pressure monitoring group used an automatic blood pressure device along with standard hypertension outpatient care. Patients were seen at baseline and after 2 months. Medication adherence was measured using a novel validated Medication Adherence Scale (MAS) questionnaire. Office blood pressure and MAS were recorded at both visits. The primary outcomes included evaluation of mean office blood pressure and MAS within groups and between groups at baseline and after 2 months.ResultsMean changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) and MAS differed significantly within groups. The home blood pressure monitoring group showed greater mean changes (SBP 17.6 mm Hg, DBP 9.5 mm Hg, MAS 1.5 vs. SBP 14.3 mm Hg, DBP 6.4 mm Hg, MAS 1.3), while between group comparisons showed no significant differences across all variables. The adjusted mean difference for mean SBP was 4.74 (95% confidence interval [CI], -0.65 to 10.13 mm Hg; P=0.084), mean DBP was 1.41 (95% CI, -2.01 to 4.82 mm Hg; P=0.415), and mean MAS was 0.05 (95% CI, -0.29 to 0.40 mm Hg; P=0.768).ConclusionShort-term home blood pressure monitoring significantly reduced office blood pressure and improved medication adherence, albeit similarly to standard care.

The Effectiveness of Home Blood Pressure on 24-Hour Blood Pressure Control: A Randomized Controlled Trial.

Home blood pressure monitoring (HBPM) is cited as an effective approach for improving blood pressure control. The objective of this study was to determine the effectiveness of HBPM combined with a health education session in reducing blood pressure and improving medication adherence among adults with hypertension. Two hundred thirteen participants were enrolled in a 3-month study and randomized to receive HBPM or usual care. Participants were also randomized to receive an educational session delivered using a pamphlet or a computer-based program. Topics of the educational session included preventing hypertension, managing weight, staying active, and cutting down on salt and fat. At the 3-month follow-up, there was a reduction in ambulatory blood pressure among the HBPM group. However, the differences found within the HBPM group were no greater than those found among the control group. We did not detect a statistically significant difference in adherence to medication when comparing the HBPM to the usual care group. HBPM and educational session did not lower blood pressure or improve medication adherence in our sample. A greater effect may have been seen if coupled with an enhanced educational intervention and if blood pressure measures were shared with the provided. The findings of this study provide useful insights for future HBPM studies.

Home blood-pressure monitoring in a hypertensive pregnant population.

The majority of patients with chronic or gestational hypertension do not develop pre-eclampsia. Home blood-pressure monitoring (HBPM) has the potential to offer a more accurate and acceptable means of monitoring hypertensive patients during pregnancy compared with traditional pathways of frequent outpatient monitoring. The aim of this study was to determine whether HBPM reduces visits to antenatal services and is safe in pregnancy. This was a case-control study of 166 hypertensive pregnant women, which took place at St George's Hospital, University of London. Inclusion criteria were: chronic hypertension, gestational hypertension or high risk of developing pre-eclampsia, no significant proteinuria (≤ 1+ proteinuria on dipstick testing) and normal biochemical and hematological markers. Exclusion criteria were maternal age < 16 years, systolic blood pressure > 155 mmHg or diastolic blood pressure > 100 mmHg, significant proteinuria (≥ 2+ proteinuria on dipstick testing or protein/creatinine ratio > 30 mg/mmol), evidence of small-for-gestational age (estimated fetal weight < 10th centile), signs of severe pre-eclampsia, significant mental health concerns or insufficient understanding of the English language. Pregnant women in the HBPM group were taught how to measure and record their blood pressure using a validated machine at home and attended every 1-2 weeks for assessment depending on clinical need. The control group was managed as per the local protocol prior to the implementation of HBPM. The two groups were compared with respect to number of visits to antenatal services and outcome. There were 108 women in the HBPM group and 58 in the control group. There was no difference in maternal age, parity, body mass index, ethnicity or smoking status between the groups, but there were more women with chronic hypertension in the HBPM group compared with the control group (49.1% vs 25.9%, P= 0.004). The HBPM group had significantly fewer outpatient attendances per patient (6.5 vs 8.0, P= 0.003) and this difference persisted when taking into account differences in duration of monitoring (0.8 vs 1.6 attendances per week, P< 0.001). There was no difference in the incidence of adverse maternal, fetal or neonatal outcome between the two groups. HBPM in hypertensive pregnancies has the potential to reduce the number of hospital visits required by patients without compromising maternal and pregnancy outcomes. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Abstract 076: Factors Associated With Home Blood Pressure Monitoring Among US Adults: The National Health and Nutrition Examination Survey (NHANES), 2013-2014

Introduction: National prevalence data on home blood pressure monitoring (HBPM) has previously been reported from 2009-2010, but no recent data has been reported. Methods: This report is based on national-level, cross-sectional data for noninstitutionalized US adults aged ≥18 years (n = 6,113 participants) from the National Health and Nutrition Examination Survey (NHANES), 2013-2014. Results: Overall, 25.5% (1560 of 6113) of the adults engaged in HBPM monitoring in the 2013-2014 survey year. This is an increase from the previous NHANES 2009-2010 analysis reporting a 21.7% (1302 of 6001) rate. The frequency of HBPM increased with higher age, higher education level, having a partner, hypertensive, hypertensive aware, and hypertensive treated. Both SBP and DBP were higher in the HBPM group and were both statistically significant. The groups of hypertensive, hypertensive-aware, and hypertensive-treated patients all showed higher rates of HBPM use than nonuse. The frequency of HBPM monitoring in the categories of less than monthly, monthly, and weekly was reported at rates of 7.8% (476 of 6113), 6.6% (401 of 6113), and 11.2% (683 of 6113), respectively. These reported rates are consistent and slightly increased in the weekly HBPM reported use compared with the NHANEs 2009-2010 analysis (7.2% [432 of 6001], 6.6% [396 of 6001], and 7.9% [474 of 6001), respectively). Adjusting for covariables, those who were aware of, treated for, and had known hypertension were more likely to have a higher frequency of HBPM than the reference: unaware, untreated, and no known hypertension (odds ratio (OR) = 1.98; OR = 2.13; and OR = 1.64, respectively). Individuals with less than a high school diploma and having no partner were less likely to perform HBPM than the reference: high school graduate or greater and having a partner (OR = 0.73; OR = 0.65, respectively). Conclusions: Approximately 21.0% (1084 of 6113) of adults engaged in monthly or more frequent HBPM which is an increase from the reported 14.5%(870 of 6001) rate in the 2009-2010 analysis. Having hypertension, being aware of hypertension, and being treated for hypertension were associated with an increased frequency of HBPM. Having no partner and less than a high school diploma were associated with lower frequency of HBPM.

P 47 Learning to evaluate and manage antenatal blood pressure at home (LEANBH)

Introduction LEANBH (Learning to Evaluate and manage ANtenatal Blood pressure at Home) is a prospective, observational, non-interventional cohort, pilot study of a novel connected health solution aimed at empowering women to self-manage blood pressure (BP) monitoring in pregnancy. Hypertension in pregnancy affects around 5–8% of all pregnancies and misdiagnosis or poorly managed BP in pregnancy negatively affects maternal and neonatal outcomes. Objectives The primary objective of this study was to assess the feasibility and acceptability of home blood pressure monitoring (HBPM) and to compare these BP readings taken at home using the LEANBH architecture to those taken in healthcare settings (hospital and general practice). Patients, materials and methods Healthy primigravida with low risk singleton pregnancies were recruited from Cork University Maternity Hospital, Ireland. Women were equipped with a Microlife WatchBP Home Monitor, an Urisys 1100® Urine Analyzer and the mobile app developed for use throughout pregnancy as part of the Leanbh project. Participants were encouraged to submit BP and urine readings from home as frequently as possible and especially prior to an antenatal visit. All women attended their planned healthcare visits as usual. Mean arterial pressure (MAP) was calculated from the BP readings uploaded to a LEANBH platform throughout pregnancy and analysed using SPSS version 2.0 Mann-Whitney test. Results 51 women volunteered with 46 of them completing the study. 27 women were equipped with the devices with 5 subsequently withdrawing from this group while 24 women were recruited into the control group. A total of 1381 home BP readings and 983 healthcare setting BP readings were recorded with 972 paired (home vs healthcare setting) MAP available for analysis (Figure 1:). The Mann-Whitney test performed showed a significant difference between the home vs healthcare setting MAP with a P value A user error rate of 3.8% was noted among the HBPM group. Conclusion BP taken at home was significantly lower than that taken in a health care setting, suggesting that the incidence of white coat hypertension in this cohort is under reported. The low error rate suggests that HPBM is easy to use. A large randomized control trial is planned to fully evaluate the utility of this technology solution.

OS 07-04 HOME BLOOD PRESSURE MONITORING IMPROVED SAFETY IN PATIENTS WITH SEVERE HYPERTENSION

Objective: Home blood pressure monitoring (HBPM) is more likely to reflect the patient's underlying blood pressure (BP), than measurements in the clinic. HBPM coupled with titration of medications under the guidance of doctors, is a viable intervention to control hypertension. The purpose of this study is to evaluate whether HBPM can increase the safety of the combination therapy of three or more different classes of antihypertensive drugs. Design and Method: We enrolled patients with severe (grade 3) hypertension, whose BP remain uncontrolled under combination treatment with standard doze of an angiotensin II receptor blocker and hydrochlorothiazide. The third drug amlodipine 5 mg daily was prescribed before patients were randomly assigned to the BP management only in clinic, or HBPM for 8 weeks. Office visits at baseline, 4th and 8th week were required to all the patients. Patients under HBPM management took BP measurement twice daily, with a memory-equipped device in the morning and evening, and allowed to titrate the doze following the doctor's instruction. Results: One hundred and eighty patients average aged 69 ± 8.4 years were enrolled. 20% patents in the HBPM group titrated amlodipine to 2.5 mg daily or stop taking if there is hypotension, or intolerance to the lowing BP. There was no difference in the BP control rate at 8th week office visit between two groups. However, The reductions in systolic BP were greater under office BP management at 8th weeks(P = 0.025). Patients under HBPM management complained less about dizziness or fatigue compared with office BP management in 8 weeks (P = 0.032). Conclusions: HBPM combined with titration under guidance of doctors encourages patient-centered care and reduces the side-affect caused by BP lowing. It has advantage to prevent hypotension in the management of severe hypertension need three kinds of antihypertensive drugs or above, thus improve the safety of the combined treatment, especially in the elderly.

A Pharmacist-Led, American Heart Association Heart360 Web-Enabled Home Blood Pressure Monitoring Program

To determine whether a pharmacist-led, Heart360-enabled, home blood pressure monitoring (HBPM) intervention improves blood pressure (BP) control compared with usual care (UC). This randomized, controlled trial was conducted in 10 Kaiser Permanente Colorado clinics. Overall, 348 patients with BP above recommended levels were randomized to the HBPM (n=175) or UC (n=173) groups. There were no statistically significant differences in baseline characteristics between the groups; however, there was a trend toward a higher baseline BP for the HBPM group compared with the UC group (148.8 versus 145.5 mm Hg for systolic BP; 89.6 versus 88.0 mm Hg for diastolic BP). At 6 months, the proportion of patients achieving BP goal was significantly higher in the HBPM group (54.1%) than in the UC group (35.4%; P<0.001). Compared with the UC group, the HBPM group experienced a -12.4-mm Hg larger (95% confidence interval, -16.3 to -8.6) reduction in systolic BP and a -5.7-mm Hg larger (95% confidence interval, -7.8 to -3.6) reduction in diastolic BP. The impact of the intervention on BP reduction was even larger for the subgroup of patients with diabetes mellitus or chronic kidney disease. The HBPM group had more e-mail and telephone contacts and greater medication regimen intensification. The proportion of patients reporting high satisfaction with hypertension care was significantly greater in the HBPM group (58%) than in the UC group (42%), P<0.001. A pharmacist-led, Heart360-supported, home BP monitoring intervention led to greater BP reductions, superior BP control, and higher patient satisfaction than UC.

Efficacy of isolated home blood pressure monitoring for blood pressure control

Rates of control of hypertension remain unsatisfactory worldwide and simple methods to encourage patients to adhere to treatments are still necessary. In this randomized controlled trial, we evaluated the efficacy of a protocol of home blood pressure monitoring (HBPM), without medication titration, to improve BP assessed by ambulatory BPM (ABPM). Patients with hypertension under drug treatment and with uncontrolled BP at office and by 24-h ABPM were randomly assigned to HBPM or usual care. The treatment was not modified during the trial. Follow-up visits were conducted at 7 and 30 days after randomization, and at 60 days to assess the outcome. Deltas between baseline and final ABPM measurements were calculated for 24-h, nightly and daily ambulatory SBP and DBP. Of 558 patients screened, 136 fulfilled the eligibility criteria and were randomized, and 121 (89%) completed the trial. The between groups deltas (95% confidence interval) of variation of 24 h, nightly and daily SBP were 5.4 (0.9-9.8) (P = 0.018), 10.9 (2.9-18.9) (P = 0.012) and 4.4 mmHg (-0.1 to 8.8) (P = 0.055), respectively; the corresponding deltas for DBP were 4.5 (1.6-7.4) (P = 0.003), 3.4 (0.4-6.3) (P = 0.025) and 5.8 mmHg (2.5-9.0) (P = 0.001), respectively. At the end of the trial, 32.4% of patients of the HBPM groups and 16.2% of the control group had 24-h SBP less than 130/80 mmHg (P = 0.03). A protocol of HBPM without medication titration enhances the control of BP assessed by ABPM.

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

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 (&lt;130/80 mm Hg for patients with diabetes or chronic kidney disease and &lt;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 &lt; 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 &lt; 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.

Two self-management interventions to improve hypertension control: a randomized trial.

Fewer than 40% of persons with hypertension in the United States have adequate blood pressure (BP) control. To compare 2 self-management interventions for improving BP control among hypertensive patients. A 2 x 2 randomized trial, stratified by enrollment site and patient health literacy status, with 2-year follow-up. (ClinicalTrials.gov registration number: NCT00123058). 2 university-affiliated primary care clinics. 636 hypertensive patients. A centralized, blinded, and stratified randomization algorithm was used to randomly assign eligible patients to receive usual care, a behavioral intervention (bimonthly tailored, nurse-administered telephone intervention targeting hypertension-related behaviors), home BP monitoring 3 times weekly, or the behavioral intervention plus home BP monitoring. The primary outcome was BP control at 6-month intervals over 24 months. 475 patients (75%) completed the 24-month BP follow-up. At 24 months, improvements in the proportion of patients with BP control relative to the usual care group were 4.3% (95% CI, -4.5% to 12.9%) in the behavioral intervention group, 7.6% (CI, -1.9% to 17.0%) in the home BP monitoring group, and 11.0% (CI, 1.9%, 19.8%) in the combined intervention group. Relative to usual care, the 24-month difference in systolic BP was 0.6 mm Hg (CI, -2.2 to 3.4 mm Hg) for the behavioral intervention group, -0.6 mm Hg (CI, -3.6 to 2.3 mm Hg) for the BP monitoring group, and -3.9 mm Hg (CI, -6.9 to -0.9 mm Hg) for the combined intervention group; patterns were similar for diastolic BP. Changes in medication use and diet were monitored only in intervention participants; 24-month outcome data were missing for 25% of participants, BP control was adequate at baseline in 73% of participants, and the study setting was an academic health center. Combined home BP monitoring and tailored behavioral telephone intervention improved BP control, systolic BP, and diastolic BP at 24 months relative to usual care. .

Two Self-management Interventions to Improve Hypertension Control

Background: Fewer than 40% of persons with hypertension in the United States have adequate blood pressure (BP) control. Objective: To compare 2 self-management interventions for improving BP control among hypertensive patients. Design: A 2 × 2 randomized trial, stratified by enrollment site and patient health literacy status, with 2-year follow-up. (ClinicalTrials.gov registration number: NCT00123058) Setting: 2 university-affiliated primary care clinics. Patients: 636 hypertensive patients. Intervention: A centralized, blinded, and stratified randomization algorithm was used to randomly assign eligible patients to receive usual care, a behavioral intervention (bimonthly tailored, nurse-administered telephone intervention targeting hypertension-related behaviors), home BP monitoring 3 times weekly, or the behavioral intervention plus home BP monitoring. Measurements: The primary outcome was BP control at 6-month intervals over 24 months. Results: 475 patients (75%) completed the 24-month BP follow-up. At 24 months, improvements in the proportion of patients with BP control relative to the usual care group were 4.3% (95% CI, −4.5% to 12.9%) in the behavioral intervention group, 7.6% (CI, −1.9% to 17.0%) in the home BP monitoring group, and 11.0% (CI, 1.9%, 19.8%) in the combined intervention group. Relative to usual care, the 24-month difference in systolic BP was 0.6 mm Hg (CI, −2.2 to 3.4 mm Hg) for the behavioral intervention group, −0.6 mm Hg (CI, −3.6 to 2.3 mm Hg) for the BP monitoring group, and −3.9 mm Hg (CI, −6.9 to −0.9 mm Hg) for the combined intervention group; patterns were similar for diastolic BP. Limitation: Changes in medication use and diet were monitored only in intervention participants; 24-month outcome data were missing for 25% of participants, BP control was adequate at baseline in 73% of participants, and the study setting was an academic health center. Conclusion: Combined home BP monitoring and tailored behavioral telephone intervention improved BP control, systolic BP, and diastolic BP at 24 months relative to usual care. Primary Funding Source: National Heart, Lung, and Blood Institute; Pfizer Foundation Health Communication Initiative; and the American Heart Association.

Home blood pressure monitoring in blood pressure control among haemodialysis patients: an open randomized clinical trial

It is not known if the adjustment of antihypertensive therapy based on home blood pressure monitoring (HBPM) can improve blood pressure (BP) control among haemodialysis patients. This is an open randomized clinical trial. Hypertensive patients on haemodialysis were randomized to have the antihypertensive therapy adjusted based on predialysis BP measurements or HBPM. Before and after 6 months of follow-up, patients were submitted to ambulatory blood pressure monitoring (ABPM) for 24 h, HBPM during 1 week and echocardiogram. A total of 34 and 31 patients completed the study in the HBPM and predialysis BP groups, respectively. At the end of study, the systolic (SBP) and diastolic (DBP) blood pressure during the interdialytic period measured by ABPM were significantly lower in the HBPM group in relation to the predialysis BP group (mean 24-h BP: 135 +/- 12 mmHg/76 +/- 7 mmHg versus 147 +/- 15 mmHg/79 +/- 8 mmHg; P < 0.05). In the HBPM analysis, the HBPM group showed a significant reduction only in SBP compared to the predialysis BP group (weekly mean: 144 +/- 21 mmHg versus 154 +/- 22 mmHg; P < 0.05). There were no differences between the HBPM and predialysis BP groups in relation to the left ventricular mass index at the end of the study (108 +/- 35 g/m(2) versus 110 +/- 33 g/m(2); P > 0.05). Decision making based on HBPM among haemodialysis patients has led to a better BP control during the interdialytic period in comparison with predialysis BP measurements. HBPM may be a useful adjuvant instrument for blood pressure control among haemodialysis patients.