medwireNews: Six months of telemonitoring with support from primary care physicians leads to significant reductions in patients' self-measured blood pressure, shows a randomized trial published in the BMJ.
"The intervention was viewed positively by both clinicians and patients and has the potential to be implemented in many healthcare settings, which may be facilitated by improved integration with existing primary care electronic health records," report lead researcher Brian McKinstry (University of Edinburgh, UK) and team.
There were 401 patients, aged 29-95 years, in the study. The 200 patients assigned to the telemonitoring intervention group measured their blood pressure twice each morning and twice each evening for the first week and at least weekly for the remainder of the 6-month study period. They transmitted the results to a secure website from which their primary physician or a nurse practitioner could view the data to determine the need for treatment modification.
The intervention cost £ 109.32 (US$ 173.41; € 130.24) more per patient over the 6-month period than usual care. Most of this was direct costs of the intervention, such as the monitor and website costs, but the intervention group required an extra 1.09 general practitioner consultations, 0.58 nurse consultations, and 0.54 nurse telephone consultations, relative to patients who received usual care.
Yet the extra expense and resource use was associated with significant blood pressure reductions. Baseline daytime ambulatory blood pressure was 146.0/87.4 and 146.5/85.7 mmHg in the intervention and usual-care groups, respectively. After accounting for this slight difference, blood pressure fell by a significant 4.27/2.3 mmHg more in the intervention than usual-care groups.
Also, office blood pressure declined by 4.6/2.8 mmHg more in the intervention than usual-care groups, which was again a significant difference.
Both groups had increases in the number of antihypertensives used during the study, but significantly more so in the intervention group, with 38% having an increase compared with 13% in the usual-care group. Furthermore, 39% of the intervention group versus 12% of the usual-care group had an increase in the dose of their antihypertensive drugs.
Notably, before the intervention began, both patients and physicians had admitted to being reluctant to intensify antihypertensive treatment on the basis of single office readings, say McKinstry et al.
However, the team cautions: "Before advocating rolling out this intervention at scale, further research is required to determine if the reduction in blood pressure achieved over six months is maintained in the longer term and that it is cost effective."
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Eleanor McDermid, Senior medwireNews Reporter