JAMA: Online monitoring by pharmacist may control hypertension

Twitter icon
Facebook icon
LinkedIn icon
e-mail icon
Google icon
Pharmacist care management delivered through secure patient web communications improved blood pressure control in patients with hypertension, according a randomized controlled trial published in the June 24 issue of the Journal of the American Medical Association.

Hypertension is the most common reversible cardiovascular disease risk factor in the U.S. and around the world. By 2025, it is predicted that more than 1.5 billion individuals worldwide will have hypertension, accounting for up to 50 percent of heart disease risk and 75 percent of stroke risk, according to Daniel W. Jones, MD, and Eric D. Peterson, MD, MPH, in an accompanying JAMA editorial.

Beverly B. Green, MD, MPH, from the Group Health Center for Health Studies in Seattle, and colleagues based their three-group randomized controlled trial, the electronic communications and home blood pressure (BP) monitoring study on the chronic care model.

The researchers conducted the trial at an integrated group practice in Washington, enrolling 778 participants aged 25 to 75 years with uncontrolled essential hypertension and internet access. Care was delivered over a secure patient website from June 2005 to December 2007.

Investigators randomly assigned participants to usual care, home BP monitoring and secure patient website training only, or home BP monitoring and secure patient website training plus pharmacist care management delivered through web communications.

Green and colleagues found that the percentage of patients with controlled BP (<140/90 mm Hg) and changes in systolic and diastolic BP at 12 months.

Of 778 patients, 730 (94 percent) completed the one-year follow-up visit, the authors reported. Patients assigned to the home BP monitoring and web training only group had a nonsignificant increase in the percentage of patients with controlled BP (<140/90 mm Hg) compared with usual care (36 vs. 31 percent).

The researchers found that adding web-based pharmacist care to home BP monitoring and web training significantly increased the percentage of patients with controlled BP (56 percent) compared with usual care and home BP monitoring and web training only.

Green and colleagues found that systolic BP was decreased stepwise from usual care to home BP monitoring and web training only to home BP monitoring and web training plus pharmacist care. Diastolic BP was decreased only in the pharmacist care group compared with both the usual care and home BP monitoring and web training only groups.

Compared with usual care, the investigators found that patients who had baseline systolic BP of 160 mm Hg or higher and received home BP monitoring and web training plus pharmacist care had a greater net reduction in systolic BP (–13.2 mm Hg) and diastolic BP (–4.6 mm Hg), and improved BP control (relative risk, 3.32).

The authors noted that the study was limited to patients with uncontrolled essential hypertension, who were required to have computer, internet and email access.

They also said that “the pharmacists were successful because they provided planned care to a defined population, consistently applied stepped medication protocols, and used comprehensive information systems, a patient-shared EMR and web communications to collaborate with patients and their physicians.”

While Jones and Peterson said that the JAMA study is “an important demonstration of both the promise of nontraditional, nonclinic models for hypertension management,” they also wrote that “like many evaluations of first-generation technologies, it has raised more questions than it fully answers.” Among other concerns, they questioned whether such technology will have widespread adoption; whether the strategies will leave behind certain socioeconomic strata; and whether physicians will accept the new model of shared control.

Jones and Peterson concluded that by “finding new tools, ensuring appropriate use by patients and clinicians and integrating these systems into clinical practice, it will be possible to achieve more effective and cost-effective BP control, and ultimately to save lives.”