Home Monitoring Service Improves Mean Arterial Pressure in Patients with Essential Hypertension

Home Monitoring Service Improves Mean Arterial Pressure in Patients with Essential Hypertension

A Randomized, Controlled Trial

From State University of New York Upstate Medical University, Syracuse, New York.

Abstract

Background: Technological advances in the distribution of information have opened new avenues for patient care. Few trials, however, have used telemedicine to improve blood pressure in patients with essential hypertension.

Objective: To determine the efficacy of a telecommunication service in reducing blood pressure.

Design: Randomized, controlled trial.

Setting: University-affiliated primary care outpatient clinics.

Patients: 121 adults with essential hypertension who were under evaluation for a change in antihypertensive therapy.

Intervention: A home service consisting of automatic transmission of blood pressure data over telephone lines, computerized conversion of the information into report forms, and weekly electronic transmission of the report forms to physicians and patients.

Measurements: 24-hour ambulatory blood pressure monitoring at baseline and exit. The primary end point was change in mean arterial pressure from baseline to exit.

Results: Mean arterial pressure decreased by 2.8 mm Hg in patients receiving the home service and increased by 1.3 mm Hg in patients receiving usual care (P = 0.013 for the difference). Mean diastolic blood pressure decreased by 2.0 mm Hg for home service but increased by 2.1 mm Hg for usual care (P = 0.012 for the difference). Mean systolic blood pressure decreased by 4.9 mm Hg for home service and 0.1 mm Hg for patients receiving usual care (P = 0.047 for the difference). Among African-American patients, mean arterial pressure decreased by 9.6 mm Hg in those receiving home service and increased by 5.25 mm Hg in those receiving usual care (P = 0.047). Part of the decrease in blood pressure for home service was due to more frequent changes in the type or dose of antihypertensive medications.

Conclusion: This telecommunication service was efficacious in reducing the mean arterial pressure of patients with established essential hypertension.

Article and Author Information

Acknowledgments: The authors thank Deborah Mickinkle for technical support.
Grant Support: By Welch Allyn, Inc.
Requests for Single Reprints: Mary A.M. Rogers, PhD, MS, Department of Medicine, 322 CWB, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210.
Current Author Addresses: Dr. Rogers: Department of Medicine, 322 CWB, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210.
Drs. Small, Buchan, Krenzer, and Husovsky: Department of Medicine, State University of New York Upstate Medical University, 550 Harrison Center, Suite 200, Syracuse, NY 13210.
Dr. Butch: Internists Associates, 739 Irving Avenue, Suite 200, Syracuse, NY 13210.
Ms. Stewart: Department of Medicine, 325 CWB, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210.
Author Contributions: Conception and design: M.A.M. Rogers, D. Small.
Analysis and interpretation of the data: M.A.M. Rogers, D.A. Buchan, C.A. Butch, C.M. Stewart, B.E. Krenzer, H.L. Husovsky.
Drafting of the article: M.A.M. Rogers.
Critical revision of the article for important intellectual content: M.A.M. Rogers, D. Small, D.A. Buchan, C.A. Butch, C.M. Stewart, B.E. Krenzer, H.L. Husovsky.
Final approval of the article: M.A.M. Rogers, D. Small, D.A. Buchan, C.A. Butch, B.E. Krenzer, H.L. Husovsky.
Provision of study materials or patients: D. Small, D.A. Buchan, C.A. Butch, C.M. Stewart, B.E. Krenzer, H.L. Husovsky.
Statistical expertise: M.A.M. Rogers.
Obtaining of funding: M.A.M. Rogers.
Administrative, technical, or logistic support: M.A.M. Rogers, D. Small, C.M. Stewart.
Collection and assembly of data: C.M. Stewart.