Heart attacks and strokes halved using pharmacist-led home blood pressure telemonitoring
A study published this week in the American Heart Association journal Hypertension found that 12 months of pharmacist-managed home blood pressure telemonitoring and pharmacist management lowered hypertension for two years.
Researchers also observed that study participants enrolled in telemonitoring were about half as likely to have a heart attack or stroke as those receiving usual primary care.
"The findings were just short of statistical significance, meaning they could have been due to chance," said lead study author Dr. Karen L. Margolis in a statement. "However, we were surprised that the figures on serious cardiovascular events pointed so strongly to a benefit of the telemonitoring intervention.”
WHY IT MATTERS
Uncontrolled high blood pressure can have serious medical consequences, including heart failure, stroke, kidney damage, eye damage and aneurysms. According to the Centers for Disease Control and Prevention, only about one in four adults with hypertension have their condition under control. High blood pressure is more common among Black adults than in white, Asian or Latino adults, and a greater percentage of men have high blood pressure than women.
As the study authors note, self-monitoring of blood pressure without additional support only offers moderate benefits, but patient support can lead to lower and improved blood pressure.
For the Hypertension study, researchers combined home blood pressure telemonitoring with pharmacist care management. The 450 patients in the telemonitoring group were instructed to submit at least six blood pressure measurements weekly using an automated monitor that stored and transmitted data to a secure website through AMC Health.
During the first six months, patients and pharmacists met every two weeks via telephone to review the data, discuss adherence to medication and lifestyle changes, and talk about treatment issues until blood pressure control was sustained for six weeks; frequency was then reduced to monthly and then bimonthly.
Researchers found that the telemonitoring, combined with pharmacist care management, lowered blood pressure for about two years compared with usual primary care.
They also observed reduced cardiovascular events in the study group by about 50% over five years – which could, they noted, result in cost savings if the reduction is not due to chance.
Researchers also cautioned that the trial was relatively small, conducted in a single medical group and included relatively few patients of color or with lower income. "Hence, our results might not be representative of those that would be seen in other settings or with different populations," they said.
They also pointed out that the pharmacist intervention may have had other effects on cardiovascular risk factors, such as tobacco use or other medication management.
THE LARGER TREND
Remote patient monitoring can be an important tool for safeguarding individual health – especially during the COVID-19 crisis, when patients may not be able to readily seek in-person care.
Given the effect of hypertension on maternal mortality and morbidity in particular, Fran Ayalasomayajula, head of the population health portfolio for worldwide healthcare at HP, told Healthcare IT News this past month that she wants to get a blood pressure monitor into the hands of every patient in their third trimester of pregnancy.
"Using digital tools in that way – putting the emphasis on the mother and adding attention to the mother – we can address these things," she said.
ON THE RECORD
"Home blood pressure monitoring linked with treatment actions from the healthcare team delivered (telehealth support) remotely in between office visits has been shown to lower blood pressure more than routine care, and patients really like it," said Hypertension study lead Margolis.
Kat Jercich is senior editor of Healthcare IT News.
Healthcare IT News is a HIMSS Media publication.