title: Linking clinic and home:  a randomized, controlled clinical effectiveness trial of real-time, wireless blood pressure monitoring for older patients with kidney disease and hypertension.
abstract: OBJECTIVE
  Older adults with chronic kidney disease have a high rate of uncontrolled hypertension. Home monitoring of blood pressure (BP) is an integral part of management, but requires that patients bring records to clinic visits. Telemonitoring interventions, however, have not targeted older, less technologically-skilled populations.
  
  
  METHODS
  Veterans with stage 3 or greater chronic kidney disease and uncontrolled hypertension were randomized to a novel telemonitoring device pairing a Bluetooth-enabled BP cuff with an Internet-enabled hub, which wirelessly transmitted readings (n=28), or usual care (n=15). Home recordings were reviewed weekly and telemonitoring participants were contacted if BP was above goal. The prespecified primary endpoints were improved data exchange and device acceptability. Secondary endpoint was BP change.
  
  
  RESULTS
  Forty-three participants (average age 68 years, 75% white) completed the 6-month study. Average start-of-study BP was 147/78 mmHg. Those in the intervention arm had a median of 29 (IQR 22, 53) transmitted BP readings per month, with 78% continuing to use the device regularly, whereas only 20% of those in the usual care group brought readings to in-person visits. The median number of telephone contacts triggered by the wireless monitoring was 2 (IQR 1, 4) per patient. Both groups had a significant improvement in systolic BP (P<0.05, for both changes); systolic BP fell a median of 13 mmHg in monitored participants compared with 8.5 mmHg in usual care participants (P for comparison 0.31).
  
  
  CONCLUSIONS
  This low-cost wireless monitoring strategy led to greater sharing of data between patients and clinic and produced a trend toward improvements in BP control over usual care at 6 months.
authors.affiliation: Division of Nephrology, University of California, San Diego, CA, USA. drifkin@ucsd.edu
authors.forename: Dena E
authors.initials: DE
authors.lastname: Rifkin
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Abdelmalek
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Miracle
authors.forename: Chai
authors.initials: C
authors.lastname: Low
authors.forename: Ryan
authors.initials: R
authors.lastname: Barsotti
authors.forename: Phil
authors.initials: P
authors.lastname: Rios
authors.forename: Carl
authors.initials: C
authors.lastname: Stepnowsky
authors.forename: Zia
authors.initials: Z
authors.lastname: Agha
mesh_terms: D000328:Adult; D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory / Q000191:economics / Q000295:instrumentation / Q000379:methods; D003365:Costs and Cost Analysis; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000191:economics / Q000503:physiopathology; D020407:Internet; D007674:Kidney Diseases / Q000150:complications / Q000191:economics / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017216:Telemedicine / Q000191:economics / Q000295:instrumentation / Q000379:methods; D013997:Time Factors