title: Design and rationale for Home Blood Pressure Telemonitoring and Case Management to Control Hypertension (HyperLink): a cluster randomized trial.
abstract: BACKGROUND
  Patients with high blood pressure (BP) visit a physician an average of 4 times or more per year in the U.S., yet BP is controlled in fewer than half. Practical, robust and sustainable models are needed to improve BP in patients with uncontrolled hypertension.
  
  
  OBJECTIVE
  The Home Blood Pressure Telemonitoring and Case Management to Control Hypertension study (HyperLink) is a cluster-randomized trial designed to determine whether an intervention that combines home BP telemonitoring with pharmacist case management improves BP control compared to usual care at 6 and 12 months in patients with uncontrolled hypertension. Secondary outcomes are maintenance of BP control at 18 months, patient satisfaction with their health care, and costs of care.
  
  
  METHODS
  HyperLink enrolled 450 hypertensive patients with uncontrolled BP from 16 primary care clinics. Eight clinics were randomized to provide usual care (UC) to their patients (n=222) and 8 were randomized to provide the telemonitoring intervention (TI) (n=228). TI patients received home BP telemonitors that internally store and electronically transmit BP data to a secure database. Pharmacist case managers adjust antihypertensive therapy based on the home BP data under a collaborative practice agreement with the clinics' primary care teams. The length of the intervention is 12 months, with follow-up to 18 months to determine the durability of the intervention.
  
  
  CONCLUSIONS
  We will test in a real primary care setting whether combining BP telemonitoring and pharmacist case management can achieve and maintain high rates of BP control compared to usual care.
authors.affiliation: HealthPartners Research Foundation, Minneapolis, MN 55440-1524, USA. Karen.l.margolis@healthpartners.com
authors.forename: Karen L
authors.initials: KL
authors.lastname: Margolis
authors.forename: Tessa J
authors.initials: TJ
authors.lastname: Kerby
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Asche
authors.forename: Anna R
authors.initials: AR
authors.lastname: Bergdall
authors.forename: Michael V
authors.initials: MV
authors.lastname: Maciosek
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Connor
authors.forename: JoAnn M
authors.initials: JM
authors.lastname: Sperl-Hillen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory / Q000191:economics / Q000379:methods*; D019090:Case Management / Q000191:economics; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D016014:Linear Models; D054539:Medication Therapy Management / Q000191:economics; D008875:Middle Aged; D008910:Minnesota; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000191:economics; D012107:Research Design; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents