title: Effect of home blood pressure telemonitoring with self-care support on uncontrolled systolic hypertension in diabetics.
abstract: Lowering blood pressure reduces cardiovascular risk, yet hypertension is poorly controlled in diabetic patients. In a pilot study we demonstrated that a home blood pressure telemonitoring system, which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading, improved blood pressure control. Messages were based on care paths defined by running averages of transmitted readings. The present study tests the system's effectiveness in a randomized, controlled trial in diabetic patients with uncontrolled systolic hypertension. Of 244 subjects screened for eligibility, 110 (45%) were randomly allocated to the intervention (n = 55) or control (n = 55) group, and 105 (95.5%) completed the 1-year outcome visit. In the intention-to-treat analysis, mean daytime ambulatory systolic blood pressure, the primary end point, decreased significantly only in the intervention group by 9.1 ± 15.6 mmHg (SD; P < 0.0001), and the mean between-group difference was 7.1 ± 2.3 mmHg (SE; P < 0.005). Furthermore, 51% of intervention subjects achieved the guideline recommended target of <130/80 mmHg compared with 31% of control subjects (P < 0.05). These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians. Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale (baseline, 4.1 ± 3.76; exit, 5.2 ± 4.30; P = 0.014). This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension and improved hypertension control. Home blood pressure monitoring alone had no effect on blood pressure. Promoting patient self-care may have negative psychological effects.
authors.affiliation: Prosserman Centre for Health Research, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, 435-600 University Avenue, Toronto, Ontario M5G 1X5, Canada. logan@lunenfeld.ca
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Logan
authors.forename: M Jane
authors.initials: MJ
authors.lastname: Irvine
authors.forename: Warren J
authors.initials: WJ
authors.lastname: McIsaac
authors.forename: Andras
authors.initials: A
authors.lastname: Tisler
authors.forename: Peter G
authors.initials: PG
authors.lastname: Rossos
authors.forename: Anthony
authors.initials: A
authors.lastname: Easty
authors.forename: Denice S
authors.initials: DS
authors.lastname: Feig
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Cafazzo
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000704:Analysis of Variance; D001007:Anxiety / Q000523:psychology; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D003863:Depression / Q000523:psychology; D048909:Diabetes Complications / Q000503:physiopathology / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000517:prevention & control* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012648:Self Care / Q000379:methods*; D013599:Systole; D017216:Telemedicine / Q000379:methods*