Home monitoring service improves mean arterial pressure in patients with essential hypertension. A randomized, controlled trial.
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.


METHODS
Randomized, controlled trial.


METHODS
University-affiliated primary care outpatient clinics.


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


METHODS
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.


METHODS
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.


CONCLUSIONS
This telecommunication service was efficacious in reducing the mean arterial pressure of patients with established essential hypertension.
Rogers
M A
MA
Department of Medicine, 322 CWB, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
Small
D
D
Buchan
D A
DA
Butch
C A
CA
Stewart
C M
CM
Krenzer
B E
BE
Husovsky
H L
HL
D000368:Aged; D000465:Algorithms; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*
D000959:Antihypertensive Agents