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Home blood pressure monitoring may improve control

By Genevra Pittman

NEW YORK (Reuters Health) - People with high blood pressure who used an at-home monitor and had regular phone calls with their pharmacist kept their numbers in check better than those receiving standard care, in a new study.

One in three U.S. adults has high blood pressure, according to the National Institutes of Health.

Only about half of them have successfully used medication and lifestyle changes to get their numbers into the recommended range to prevent heart problems - less than 140/90 or less than 130/80 for those with diabetes or kidney disease.

So researchers have been looking for new and inexpensive ways to encourage people with hypertension to stick to their medication regimen.

The new study "shows that you don't have to come into the office to have your blood pressure managed," said Dr. Katrin Uhlig from Tufts Medical Center in Boston, who has studied home blood pressure monitoring.

"I don't think it's the fix for everything, but it certainly is very promising," Uhlig, who was not involved in the new research, told Reuters Health.

In another recent study, people who were able to communicate with their pharmacists online ended up with better blood pressure control a year later (see Reuters Health story of May 22, 2013 here:).

For their report, Dr. Karen Margolis from HealthPartners Institute for Education and Research in Minneapolis and her colleagues tested an intervention that involved regular phone meetings with a pharmacist and home blood pressure monitors that transmitted readings to the pharmacist.

The researchers randomly assigned 228 people with uncontrolled high blood pressure to go through the so-called telemonitoring program for a year and 222 others to stick to their usual primary care treatment.

At both the six-month and one-year check-in, people in the intervention group had lower systolic and diastolic blood pressure readings.

At the end of the program, 71 percent of them had their blood pressure in the recommended range, compared to 53 percent of the usual care group.

Those benefits remained after the pharmacist calls ceased, Margolis and her colleagues reported Tuesday in the Journal of the American Medical Association.

Six months after the intervention ended, 72 percent of telemonitoring patients still had their blood pressure under control, versus 57 percent of people in the comparison group.

Participants who received telemonitoring were prescribed more hypertension drugs during the study. They also reported feeling more confident about being able to take care of themselves and made changes such as adding less salt to their food.

"It's kind of creating a feedback loop where the patient is measuring their blood pressure and forwarding that information to the healthcare team, and the healthcare team is able to interpret that information and feed back information to the patient … about how they can achieve better blood pressure control," Margolis told Reuters Health.

The remaining questions, Uhlig said, are if blood pressure reductions will be maintained years down the line, and if people who had the intervention will go on to develop fewer heart conditions.

The intervention would cost about $1,350 per patient to implement outside of a study, the researchers calculated. Margolis said they are planning to continue to follow the patients in this study and perform a more formal cost effectiveness analysis after a few years.

For now, she said patients can buy their own blood pressure monitor for $30 to $40 and use free online programs, such as one from the American Heart Association, to record their readings.

SOURCE: http://bit.ly/JjFzqx Journal of the American Medical Association, online July 2, 2013.

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