Pharmacist-Guided Home Blood Pressure Monitoring May Help Patients
Study found combination led to better control of hypertension
Tuesday, July 2, 2013
After six months of the intervention, nearly 72 percent of the study volunteers had their high blood pressure under control compared to 45 percent in the group that received usual care. Also, the effects of the intervention persisted even after the intervention ended. Six months later, about 72 percent of the intervention group had their high blood pressure under control compared to 57 percent in the usual care group.
"The reason that only about half of people with [high] blood pressure have it under control is that usual care isn't working. We combined two interventions that we thought would be very powerful together -- home monitoring and pharmacist managements -- and this is one system that we've shown works very well for blood pressure control," said senior investigator Dr. Karen Margolis, from the HealthPartners Institute for Education and Research in Minneapolis.
The findings appear in the July 3 issue of the Journal of the American Medical Association.
High blood pressure affects about 30 percent of U.S. adults, according to background information in the study. Treating and controlling high blood pressure can help prevent cardiovascular events, such as heart attacks. However, only about half of the adults in the United States with high blood pressure have it under control.
Home blood pressure monitoring has shown some success in helping people lower their blood pressure, so the researchers took that a step further and used telemonitoring devices that could send blood pressure readings to a pharmacist who could then adjust that person's blood pressure medication accordingly.
The study included 450 people receiving care at one of eight different clinics. All of the people recruited for the study had high blood pressure that wasn't well controlled.
The patients were randomized to receive either usual care (222 people) or the study intervention, which included blood pressure telemonitoring with pharmacist management.
In the study intervention group, each person received a home blood pressure monitor capable of sending readings to a secure website that a pharmacist monitored. At the start of the study, patients met with the pharmacist for an hour and were taught how to use the machines. They were also given lifestyle advice on lowering their blood pressure.
People in the study intervention group were asked to send at least six blood pressure readings from different times of the day to the pharmacist each week. During the first six months of the study, patients and pharmacists talked by phone every two weeks, until blood pressure was under control for at least six weeks, and then they talked monthly. During months seven to 12 of the study, the calls were reduced to every two months. During the calls, pharmacists reviewed lifestyle changes and emphasized adherence to medications.
In between the phone calls, pharmacists were able to make changes to a patient's medication following an algorithm based on national guidelines, according to Margolis. In addition, these changes were reported to the patient's doctor.
Among the 380 people who attended both the six- and 12-month clinic visits, just over 57 percent of those in the intervention group had controlled blood pressure at both visits compared to just 30 percent in the usual care group.
Systolic blood pressure (the top number) dropped by an average of almost 11 mm Hg more for those in the study intervention compared to the usual care group at six months, and by almost 10 mm Hg more at 12 months. Even six months after the study ended, those who had been in the intervention group had systolic blood pressure readings an average of 6.6 mm Hg lower than the usual care group.
Margolis said that the people in the intervention group also felt more confident in managing their high blood pressure, and that they reported more satisfaction than the usual care group.
"Partnering with someone really makes a difference," Margolis said.
She said the cost of the program was about $1,200 to $1,300 per person. It's not clear yet whether or not the program will be able to prevent enough cardiovascular events to make it more cost-effective than usual care, but Margolis said that there may be ways to tailor the program to make it less expensive.
Margolis noted that doctors involved in the program did not express any concerns about having pharmacists making changes to the medication. "They feel that these are the moves they would be doing themselves because they're in keeping with the same treatment patterns that doctors use," she said.
Dr. Joyce Samuel, an assistant professor of pediatrics in the division of nephrology and hypertension at The University of Texas Health Science Center at Houston Medical School, said she has some concerns about using such a system on patients who have more complicated medical conditions, but a well set-up system would likely be fine with routine high blood pressure.
"You'd have to decide up front, who is routine and who's not, and you would need to build in safeguards about when to involve a physician in the decision, but given that so many people have high blood pressure, physicians might welcome such a system," said Samuel.
For patients, Samuel said an intervention like this is more convenient and helps provide them a better way of managing their blood pressure.
"When you bring care into the home, it puts more responsibility on the patient. It creates a psychological shift when they're taking charge, and by being accountable to the pharmacist, it may lead to better adherence," Samuel said. "When you feel fine, it's hard to get yourself to take your medications, but home blood pressure monitoring gives them something tangible to look at. They can see that the medication or the lifestyle changes work."