Home Blood Pressure Telemonitoring Research Articles

Pharmacist-led blood pressure intervention demonstrates positive results

A pharmacist-managed antihypertensive therapy approach coupled with a home telemonitoring intervention demonstrated statistically significant improvements in blood pressure compared with usual care in the treatment of 450 adults with hypertension during an 18-month period in a Midwestern, urban setting. 1. Margolis K.L. Asche S.E. Bergdall A.R. et al. Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. JAMA. 2013; 310: 46-56 Crossref PubMed Scopus (343) Google Scholar

Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial.

Only about half of patients with high blood pressure (BP) in the United States have their BP controlled. Practical, robust, and sustainable models are needed to improve BP control in patients with uncontrolled hypertension. To determine whether an intervention combining home BP telemonitoring with pharmacist case management improves BP control compared with usual care and to determine whether BP control is maintained after the intervention is stopped. A cluster randomized clinical trial of 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, Minnesota, with 12 months of intervention and 6 months of postintervention follow-up. Eight clinics were randomized to provide usual care to patients (n = 222) and 8 clinics were randomized to provide a telemonitoring intervention (n = 228). Intervention patients received home BP telemonitors and transmitted BP data to pharmacists who adjusted antihypertensive therapy accordingly. Control of systolic BP to less than 140 mm Hg and diastolic BP to less than 90 mm Hg (<130/80 mm Hg in patients with diabetes or chronic kidney disease) at 6 and 12 months. Secondary outcomes were change in BP, patient satisfaction, and BP control at 18 months (6 months after intervention stopped). At baseline, enrollees were 45% women, 82% white, mean (SD) age was 61.1 (12.0) years, and mean systolic BP was 148 mm Hg and diastolic BP was 85 mm Hg. Blood pressure was controlled at both 6 and 12 months in 57.2% (95% CI, 44.8% to 68.7%) of patients in the telemonitoring intervention group vs 30.0% (95% CI, 23.2% to 37.8%) of patients in the usual care group (P = .001). At 18 months (6 months of postintervention follow-up), BP was controlled in 71.8% (95% CI, 65.0% to 77.8%) of patients in the telemonitoring intervention group vs 57.1% (95% CI, 51.5% to 62.6%) of patients in the usual care group (P = .003). Compared with the usual care group, systolic BP decreased more from baseline among patients in the telemonitoring intervention group at 6 months (-10.7 mm Hg [95% CI, -14.3 to -7.3 mm Hg]; P<.001), at 12 months (-9.7 mm Hg [95% CI, -13.4 to -6.0 mm Hg]; P<.001), and at 18 months (-6.6 mm Hg [95% CI, -10.7 to -2.5 mm Hg]; P = .004). Compared with the usual care group, diastolic BP decreased more from baseline among patients in the telemonitoring intervention group at 6 months (-6.0 mm Hg [95% CI, -8.6 to -3.4 mm Hg]; P<.001), at 12 months (-5.1 mm Hg [95% CI, -7.4 to -2.8 mm Hg]; P<.001), and at 18 months (-3.0 mm Hg [95% CI, -6.3 to 0.3 mm Hg]; P = .07). Home BP telemonitoring and pharmacist case management achieved better BP control compared with usual care during 12 months of intervention that persisted during 6 months of postintervention follow-up. clinicaltrials.gov Identifier: NCT00781365.

Abstract 26: Durability Of Blood Pressure Control In A Randomized Trial Of Home Telemonitoring With Pharmacist Case Management (Hyperlink)

Background: Patients with high blood pressure (BP) visit a physician on average 4 times per year, but fewer than half have controlled BP. Practical, effective, and sustainable models are needed to improve BP management. Accumulating evidence supports the effectiveness of team-based models for care and home telemonitoring, but few studies have examined whether effects persist after intervention completion. Aims: Hyperlink is a clinic-randomized trial testing an intervention combining home BP telemonitoring with pharmacist case management in patients with uncontrolled hypertension. Methods: We enrolled 450 patients with uncontrolled BP from 16 primary care clinics, 8 randomized to usual care (UC, 222 patients) and 8 to telemonitoring intervention (TI, 228 patients). TI patients received home telemonitors that transmit BP data to a secure database. Pharmacists met with TI patients by phone and adjusted drug therapy based on home BP data. The intervention had an ‘intensive’ phase for the first 6 months and a ‘maintenance’ phase with less frequent pharmacist support through 12 months. Patients were followed through 18 months to observe durability of effects on BP control (&lt;140/90 mm Hg, &lt;130/80 mm Hg if diabetes or kidney disease). General and generalized linear mixed models were used to accommodate the cluster-randomization. Results: Enrollees were 45% female, 82% white, and 12% black, with mean age of 61 years. Mean BP at baseline was 148/85 mm Hg in both groups. Results indicate a significant effect on BP control in the TI group. Around 71% of TI patients achieved BP control at each time point, while UC BP control was 45.2% at 6 months, 52.8% at 12 months and 57.1% at 18 months. The mean difference in BP change (mm Hg) between groups from baseline was -10.7/-6.0 at 6 months, -9.7/-5.1 at 12 months, and -6.6/-3.0 at 18 months (Table 1, attached). Mean number of drugs per patient increased in TI from 1.5 at baseline to 2.2 at 6 months, persisting through 18 months. A small increase was observed in UC, with 1.4 at baseline, 1.6 at 6 and 12 months, and 1.7 at 18 months. Conclusions: Home telemonitoring with pharmacist case management was effective at reducing BP for 12 months, with a persistent effect 6 months later. Further long-term follow-up of study participants is planned.

The role of home blood pressure telemonitoring in managing hypertensive populations.

Hypertension is a common chronic disease affecting nearly one-third of the United States population. Many interventions have been designed to help patients manage their hypertension. With the evolving climate of healthcare, rapidly developing technology, and emphasis on delivering patient-centered care, home-based blood pressure telemonitoring is a promising tool to help patients achieve optimal blood pressure (BP) control. Home-based blood pressure telemonitoring is associated with reductions in blood pressure values and increased patient satisfaction. However, additional research is needed to understand cost-effectiveness and long-term clinical outcomes of home-based BP monitoring. We review key interventional trials involving home based BP monitoring, with special emphasis placed on studies involving additionally behavioral modification and/or medication management. Furthermore, we discuss the role of home-based blood pressure telemonitoring within the context of the patient-centered medical home and the evolving role of technology.

Clinical usefulness and cost effectiveness of home blood pressure telemonitoring

To systematically review data from randomized controlled studies on the effectiveness of home blood pressure telemonitoring (HBPT) versus usual care with respect to improvement of BP control, healthcare resources utilization and costs, patient's quality of life and adverse events. Electronic databases were searched for publications in English. The benefit and relative risk (RR) were estimated applying a random-effect model. Twenty-three randomized controlled trials with a high level of heterogeneity were selected (7037 patients). Compared to usual care, HBPT improved office SBP by 4.71 mmHg [95% confidence interval (CI): 6.18, 3.24; P < 0.001] and DBP by 2.45 mmHg (3.33, 1.57; P < 0.001). A larger proportion of patients achieved office BP normalization (<140/90 mmHg nondiabetic patients and <130/80 mmHg diabetic patients) in the intervention group [RR: 1.16 (1.04, 1.29); P < 0.001]. HBPT led to a significantly larger prescription of antihypertensive medications [+0.40 (+0.17,+0.62), P < 0.001], but to therapeutic adherence and rate of office consultations similar to usual care. Healthcare costs were significantly (P < 0.001) larger in the HBPT group [+662.92 (+540.81, +785.04) euros per patient], but were similar to those of the usual care when only medical costs were considered [-12.4 (-930.52, +906.23) euros; P = 0.767]. Use of HBPT helped improving the physical component of quality of life [SF-12 or SF-36 questionnaire: +2.78 (+1.15, +4.41) P < 0.001]. No difference was observed in the risk of adverse events [RR: 1.22 (0.86, 1.71); P = 0.111]. HBPT may represent a useful tool to improve hypertension control and associated healthcare outcomes, although it is still more costly compared with usual care.

Blood pressure control and treatment adherence in hypertensive patients with metabolic syndrome: protocol of a randomized controlled study based on home blood pressure telemonitoring vs. conventional management and assessment of psychological determinants of adherence (TELEBPMET Study).

BackgroundInadequate blood pressure control and poor adherence to treatment remain among the major limitations in the management of hypertensive patients, particularly of those at high risk of cardiovascular events. Preliminary evidence suggests that home blood pressure telemonitoring (HBPT) might help increasing the chance of achieving blood pressure targets and improve patient’s therapeutic adherence. However, all these potential advantages of HBPT have not yet been fully investigated.Methods/designThe purpose of this open label, parallel group, randomized, controlled study is to assess whether, in patients with high cardiovascular risk (treated or untreated essential arterial hypertension - both in the office and in ambulatory conditions over 24 h - and metabolic syndrome), long-term (48 weeks) blood pressure control is more effective when based on HBPT and on the feedback to patients by their doctor between visits, or when based exclusively on blood pressure determination during quarterly office visits (conventional management (CM)). A total of 252 patients will be enrolled and randomized to usual care (n=84) or HBPT (n=168). The primary study endpoint will be the rate of subjects achieving normal daytime ambulatory blood pressure targets (<135/85 mmHg) 24 weeks and 48 weeks after randomization. In addition, the study will assess the psychological determinants of adherence and persistence to drug therapy, through specific psychological tests administered during the course of the study. Other secondary study endpoints will be related to the impact of HBPT on additional clinical and economic outcomes (number of additional medical visits, direct costs of patient management, number of antihypertensive drugs prescribed, level of cardiovascular risk, degree of target organ damage and rate of cardiovascular events, regression of the metabolic syndrome).DiscussionThe TELEBPMET Study will show whether HBPT is effective in improving blood pressure control and related medical and economic outcomes in hypertensive patients with metabolic syndrome. It will also provide a comprehensive understanding of the psychological determinants of medication adherence and blood pressure control of these patients.Trial registrationClinical Trials.gov: NCT01541566

Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study

ObjectivesTo explore the experiences of patients and professionals taking part in a randomised controlled trial (RCT) of remote blood pressure (BP) telemonitoring supported by primary care. To identify factors facilitating...

The Role of Home Blood Pressure Telemonitoring in Managing Hypertensive Populations

The Role of Home Blood Pressure Telemonitoring in Managing Hypertensive Populations

Unilateral Catheter-based Renal Sympathetic Denervation in Resistant Arterial Hypertension Shows No Blood Pressure-lowering Effect

A 68-year-old woman with resistant essential arterial hypertension despite the regular use of four antihypertensive drugs was referred to the catheter-based renal sympathetic denervation. Due to the complicated anatomy, insertion of the guiding catheter into the left renal artery was not stable. Thus, renal denervation of only the right renal artery was performed. Before and after renal denervation, the patient’s blood pressure was monitored by home blood pressure (BP) telemonitoring. The average 7-day home BP telemonitoring values before and 1, 2, and 3 months after denervation were 187.1/124.1, 193.3/123.1, 198.3/129.6, and 195.2/128.0 mm Hg. After unilateral renal denervation, no BP decrease occurred. This unique case suggests that unilateral catheter-based renal sympathetic denervation in resistant arterial hypertension shows no BP-lowering effect. Therefore, when treating resistant hypertension by catheter-based renal denervation, it seems advisable to try always to perform an effective bilateral procedure.

Effect of Home Blood Pressure Telemonitoring With Self-Care Support on Uncontrolled Systolic Hypertension in Diabetics

Lowering blood pressure reduces cardiovascular risk, yet hypertension is poorly controlled in diabetic patients. In a pilot study we demonstrated that a home blood pressure telemonitoring system, which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading, improved blood pressure control. Messages were based on care paths defined by running averages of transmitted readings. The present study tests the system's effectiveness in a randomized, controlled trial in diabetic patients with uncontrolled systolic hypertension. Of 244 subjects screened for eligibility, 110 (45%) were randomly allocated to the intervention (n = 55) or control (n = 55) group, and 105 (95.5%) completed the 1-year outcome visit. In the intention-to-treat analysis, mean daytime ambulatory systolic blood pressure, the primary end point, decreased significantly only in the intervention group by 9.1 ± 15.6 mmHg (SD; P < 0.0001), and the mean between-group difference was 7.1 ± 2.3 mmHg (SE; P < 0.005). Furthermore, 51% of intervention subjects achieved the guideline recommended target of <130/80 mmHg compared with 31% of control subjects (P < 0.05). These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians. Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale (baseline, 4.1 ± 3.76; exit, 5.2 ± 4.30; P = 0.014). This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension and improved hypertension control. Home blood pressure monitoring alone had no effect on blood pressure. Promoting patient self-care may have negative psychological effects.

Economic evaluation of telephone self-management interventions for blood pressure control

Half of patients with hypertension have poor blood pressure (BP) control. Recent models for treating hypertension have integrated disease monitoring and telephone-based interventions delivered in patients' homes. This study evaluated the costs of the Hypertension Intervention Nurse Telemedicine Study (HINTS), aimed to improve BP control in veterans. Eligible veterans were randomized to either usual care or 1 of 3 telephone-based intervention groups using home BP telemonitoring: (1) behavioral management, (2) medication management, or (3) combined. Intervention costs were derived from information collected during the trial. Direct medical costs (inpatient, outpatient, and outpatient pharmacy, including hypertension-specific pharmacy) at 18 months by group were calculated using Veterans Affairs (VA) Decision Support System data. Bootstrapped CIs were computed to compare intervention and medical costs between intervention groups and usual care. Patients receiving behavior or medication management showed significant gains in BP control at 12 months; there were no differences in BP control at 18 months. In subgroup analysis, patients with poor baseline BP control receiving combined intervention significantly improved BP at 12 and 18 months. In overall and subgroup samples, average intervention costs were similar in the 3 study arms, and at 18 months, there were no statistically significant differences in direct VA medical costs or total VA costs between treatment arms and usual care. To optimize investment in telephone-based home interventions such as the HINTS, it is important to identify groups of patients who are most likely to benefit from more intensive home BP management.

Design and rationale for Home Blood Pressure Telemonitoring and Case Management to Control Hypertension (HyperLink): A cluster randomized trial

BackgroundPatients with high blood pressure (BP) visit a physician an average of 4 times or more per year in the U.S., yet BP is controlled in fewer than half. Practical, robust and sustainable models are needed to improve BP in patients with uncontrolled hypertension. ObjectivesThe Home Blood Pressure Telemonitoring and Case Management to Control Hypertension study (HyperLink) is a cluster-randomized trial designed to determine whether an intervention that combines home BP telemonitoring with pharmacist case management improves BP control compared to usual care at 6 and 12months in patients with uncontrolled hypertension. Secondary outcomes are maintenance of BP control at 18months, patient satisfaction with their health care, and costs of care. MethodsHyperLink enrolled 450 hypertensive patients with uncontrolled BP from 16 primary care clinics. Eight clinics were randomized to provide usual care (UC) to their patients (n=222) and 8 were randomized to provide the telemonitoring intervention (TI) (n=228). TI patients received home BP telemonitors that internally store and electronically transmit BP data to a secure database. Pharmacist case managers adjust antihypertensive therapy based on the home BP data under a collaborative practice agreement with the clinics' primary care teams. The length of the intervention is 12months, with follow-up to 18months to determine the durability of the intervention. ConclusionsWe will test in a real primary care setting whether combining BP telemonitoring and pharmacist case management can achieve and maintain high rates of BP control compared to usual care.

Abstract 7: Outcomes at Six Months of a Randomized Trial of Home Blood Pressure Telemonitoring with Pharmacist Case Management

Background: Patients with high blood pressure (BP) visit a physician on average 4 times per year, though fewer than half achieve BP control. Practical, effective, and sustainable models are needed to improve BP management. Aims: Hyperlink is a clinic-randomized trial testing an intervention that combines home BP telemonitoring with pharmacist case management in patients with uncontrolled hypertension. Methods: We enrolled 450 patients with uncontrolled BP from 16 primary care clinics. Eight clinics (222 patients) were randomized to usual care and 8 clinics (228 patients) to intervention. Intervention patients received home telemonitors that transmit BP data to a secure database. Pharmacists consult with patients by phone and adjust antihypertensive therapy based on home BP data. The intervention lasts 12 months with follow-up to 18 months to observe durability. The primary outcome is BP control at 6 and 12 months, defined as BP ≤140/90 mm Hg (or ≤130/80 mm Hg in patients with chronic kidney disease or diabetes). Data on demographics, medication use and adherence, and satisfaction with care were also gathered. Here we report 6-month BP outcomes. General and generalized linear mixed models are used to accommodate the cluster-randomization. Results: Enrollees were 45% female, 83% white, and 13% black, with mean age of 61 years. Mean BP at baseline was 148/85 mm Hg in both treatment groups. Of the 403 attending the 6-month visit (197 usual care, 206 intervention), 45.2% in usual care and 71.8% in intervention achieved BP control (p&lt;0.0001). In usual care, mean systolic BP decreased by 10.3 mm Hg and diastolic decreased by 3.4 mm Hg. In intervention, mean systolic BP decreased by 21.6 mm Hg and diastolic decreased by 9.3 mm Hg. The difference in change between groups was 11.3 mm Hg systolic (p&lt;0.0001) and 5.8 mm Hg diastolic (p=0.003). Self-reported satisfaction with care in the six months following baseline was higher for intervention (mean=4.6) than usual care (mean=4.4, p&lt;0.01), on a 5 point scale (1=worst care possible, 5=best care possible). Between baseline and 6 months mean number of antihypertensive drugs used per participant increased from 1.4 to 1.6 in usual care and from 1.5 to 2.3 in intervention. The difference between treatment groups in increased drug use from a particular class was largest among thiazide diuretics (4.6% increase usual care, 27.6% intervention) and ACE inhibitors (1.6% increase usual care, 13.6% intervention). Calcium channel blocker and beta blocker use also increased more among intervention patients, while loop diuretic use decreased. Self-reported adherence to BP medications indicated better adherence for intervention (mean=0.7) than usual care (0.3, p&lt;0.01) measured on the Morisky scale (0-4, lower scores indicating better adherence) during the 6 months following the baseline visit. Conclusions: Home telemonitoring with pharmacist case management was effective at reducing BP for hypertensive patients over 6 months. This intervention may be cost-effective for managing hypertensive patients with uncontrolled BP, especially if results are sustained during the maintenance and post-intervention phases of follow-up.

Home Blood Pressure Monitoring as an Intervention to Control Hypertension

Home Blood Pressure Monitoring as an Intervention to Control Hypertension

Impact of Home Blood Pressure Telemonitoring and Blood Pressure Control: A Meta-Analysis of Randomized Controlled Studies

Home blood pressure telemonitoring figures among the possible solutions that could help improve blood pressure control of hypertensive patients. To summarize the effectiveness of home blood pressure telemonitoring on blood pressure control from randomized, controlled studies. Electronic databases were searched for publications in English, reporting on randomized trials of home blood pressure telemonitoring vs. usual care. Outcome measures were office or ambulatory blood pressure changes, rate of blood pressure control, and number of antihypertensive drugs used by patients. A random effects model was applied. Twelve studies met inclusion criteria. A high level of heterogeneity was found among studies for all the variables explored. Office blood pressure was reduced significantly more in patients randomized to home telemonitoring (systolic: 5.64 (95% confidence interval: 7.92, 3.36) mm Hg; diastolic: 2.78 (3.93, 1.62) mm Hg; 11 comparisons, n = 4,389). The effect on ambulatory blood pressure was smaller than on office blood pressure (systolic: 2.28 (4.32, 0.24); diastolic: 1.38 (3.55, +0.79) mm Hg; 3 comparisons, n = 655). The relative risk of blood pressure normalization (<140/90 mm Hg nondiabetics and <130/80 mm Hg diabetics) in the telemonitoring vs. the usual care group was 1.31 (1.06, 1.62) (5 comparisons, n = 2,432 subjects). Use of telemonitoring was associated with a significantly increased use of antihypertensive medications (+0.22 (+0.02, +0.43), 5 comparisons, n = 1,991). Home blood pressure telemonitoring may represent a useful tool to improve blood pressure control. However, heterogeneity of published studies suggests that well designed, large-scale, randomized, controlled studies are still needed to demonstrate the clinical usefulness of this technique.

PS1-04: Home Blood Pressure Telemonitoring and Case Management to Control Hypertension: HyperLink Trial Design and Baseline Characteristics

Background/Aims: Blood pressure (BP) is not controlled in the majority of people with hypertension (HTN) in the U.S. We describe a study of long-term hypertension outcomes that compares home BP telemonitoring and pharmacist case management vs. usual care. Methods: HyperLink is a cluster-randomized trial (N=450 patients) being conducted at HealthPartners Medical Group clinics. Sixteen clinics were randomly assigned to either the Telemonitoring Intervention (TI) or Usual Care (UC). Recruitment materials are mailed to adult primary care patients in these clinics whose last 2 BP measurements were uncontrolled in the previous 12 months (>140/90, or >130/80 if diabetes or kidney disease present). To be eligible, they are required to have uncontrolled BP confirmed at a research clinic visit. Other medical exclusion criteria are minimal: pregnancy, recent cardiovascular events, symptomatic heart failure, stage 4/5 kidney disease, and dementia. Participants in the TI group receive a home BP telemonitor that stores and transmits all BP measurements to the clinic pharmacist via a modem to a secure web site. Following one intake clinic visit with the pharmacist, participants and pharmacists communicate by telephone every 2–4 weeks for 6 months. HTN treatment is adjusted based on home BP according to an approved written protocol under a collaborative practice agreement with physicians. UC participants may visit a clinic pharmacist but do not receive telemonitoring. The primary outcome is BP control measured at the research clinic visit at 6 months. Secondary outcomes are BP control maintenance at 12 and 18 months, satisfaction and costs. Results: Recruitment began March 1, 2009, and is on track to be completed as predicted in September 2010. During the first 8 mo, 195 participants were recruited, of whom 47% were female, 17% were minority race/ethnicity and 53% were from TI clinics. Detailed baseline characteristics of participants recruited as of February 28, 2010 will be reported. Conclusions: Meaningful and sustained improvement in hypertension control will likely require fundamental changes in the current physician-centered office-visit based model of caring for hypertension. This novel intervention could be implemented widely in diverse and large patient populations based on performance in this randomized trial.

Role of home blood pressure telemonitoring in hypertension management

Despite the increasing use of home blood pressure monitoring (HBPM) in daily practice and the growing awareness in the scientific community about its positive impact on the diagnostic and therapeutic management of patients with high blood pressure (BP), the potential advantages offered by HBPM have not yet been fully exploited. Indeed, use of the information offered by HBPM is often incomplete and imprecise, with the BP values reported by patients in handwritten logbooks being frequently inaccurate, illegible to physicians, or unreliable. Although a practical solution for improvement may come from the use of devices equipped with a storage memory, a step forward in this regard has been taken more recently with the introduction and refinement of systems for the remote telemonitoring of BP values measured at home. However, although several studies have provided evidence on the clinical usefulness of HBPM, only limited data are available on the clinical impact of home blood pressure (HBP) telemonitoring, because of a number of reasons. First, most of the available studies are characterized by a small sample size, and in some cases, the patients were neither randomized nor even matched with a control group. Moreover, technological solutions used in the different studies carried out so far are often heterogeneous, some of them being particularly difficult to use for the patients, thus limiting the effectiveness of the results. BP monitoring programmes, number of BP readings and transmission schedules are often different among the various studies. In addition, patient selection criteria are different from study to study. Finally, different study objectives and important diversities in the types of centres involved (ranging from general practices, to specialists' offices, hospitals or university centres) may have also influenced the quality of results. Large-scale randomized controlled studies, based on easy-to-use technologies, are thus still needed to show the superiority and clinical usefulness of HBP telemonitoring as compared with conventional HBPM. This study summarizes the evidence available on the clinical usefulness and current limitations of this approach, highlighting the results of meta-analyses and randomized controlled trials on this issue. The role of HBP teletransmission in the context of integrated patients' management programmes is also addressed, with indications for further progress in this field.

Economic evaluation of home blood pressure telemonitoring: A randomized controlled trial

Aims. The purpose of the present study was to compare the costs of home blood pressure (BP) telemonitoring (HBPM) with the costs of conventional office BP monitoring. In a randomized controlled trial, 105 hypertensive patients performed HBPM and 118 patients received usual care with conventional office BP monitoring during 6 months. Costs were quantified from the healthcare perspective. Non-parametric simulations were performed to quantify the uncertainty around the mean estimates and cost-effectiveness acceptability curves were made. Major findings. Systolic and diastolic daytime and night-time ambulatory BP (ABP) were reduced in both groups. The uncertainty around the incremental cost effectiveness ratio point estimates was considerable for both systolic and diastolic ABP. For systolic ABP, the difference in cost effectiveness ratio between the two groups was 256 Danish kroner (DKK)/mmHg [95% uncertainty interval, UI −860 to 4544]. For diastolic ABP, the difference in cost effectiveness ratio between the two groups was 655 DKK/mmHg [95% UI −674 to 69315]. Medication and consultation costs were lowest in the intervention group, but were offset by the cost of the telemonitoring equipment. Conclusions. Cost-effectiveness analysis showed that telemonitoring of home BP was more costly compared with usual monitoring of office BP. The cost-effectiveness result is surrounded with considerable uncertainty.Trial registration: ClinicalTrials.gov identifier: NCT282334.

Home blood pressure telemonitoring improves hypertension control in general practice: The TeleBPCare study

Home blood pressure telemonitoring improves hypertension control in general practice: The TeleBPCare study

Feasibility of blood pressure telemonitoring in patients with poor blood pressure control

We examined the feasibility of using home blood pressure (BP) telemonitoring devices for managing patients with poor BP control. We enrolled 591 subjects with a diagnosis of hypertension. Patients were randomized to usual care (n = 147) or to the intervention arm (n = 441). Those in the intervention arm were issued with a home BP telemonitoring device. The device transmitted BP readings automatically via the home telephone line. Technical alerts were generated if patients did not transmit their BP readings according to the protocol. During the first six months, 693 technical alerts were generated by 267 patients. About half of these patients (112) generated more than two technical alerts. Resolution of the alerts showed that 61% were caused by patient non-adherence. Patients who generated >2 technical alerts were younger (61 vs. 64 years; P = 0.001) and were more likely to be non-Caucasian (64% vs. 47%, P = 0.002) than those generating 2 or fewer alerts. Despite the potential for improving health care using home BP telemonitoring, certain patients will require more support to use the equipment successfully.