title: Managing hypertension in urban underserved subjects using telemedicine--a clinical trial.
abstract: BACKGROUND
  We evaluated an Internet- and telephone-based telemedicine system for reducing blood pressure (BP) in underserved subjects with hypertension.
  
  
  METHODS
  A total of 241 patients with systolic BP ≥140 mm Hg were randomized to usual care (C; n = 121) or telemedicine (T; n = 120). The T group reported BP, heart rate, weight, steps/day, and tobacco use twice weekly. The primary outcome was BP control at 6 months.
  
  
  RESULTS
  Average age was 59.6 years, average body mass index was 33.7 kg/m(2), 79% were female, 81% were African American, 15% were white, 53% were at or below the federal poverty level, 18% were smokers, and 32% had diabetes. Six-month follow-up was achieved in 206 subjects (C: 107, T: 99). Goal BP was achieved in 52.3% in C and 54.5% in T (P = .43). Systolic BP change (C: -13.9 mm Hg, T: -18.2; P = .118) was similar in both groups. Subjects in the T group reported BP 7.7 ± 6.9 d/mo. Results were not affected by age, sex, ethnicity, education, or income. In nondiabetic T subjects, goal BP was achieved in 58.2% compared with 45.2% of diabetic T subjects (P = .024). Nondiabetic T subjects demonstrated a greater reduction in systolic BP (T: -19 ± 20 mm Hg, C: -12 ± 19 mm Hg; P = .037). No difference in BP response between C and T was noted in patients with diabetes.
  
  
  CONCLUSIONS
  In hypertensive subjects, engagement in a system of care with or without telemedicine resulted in significant BP reduction. Telemedicine for nondiabetic patients resulted in a greater reduction in systolic BP compared with usual care. Telemedicine may be a useful tool for managing hypertension particularly among nondiabetic subjects.
authors.affiliation: Cardiology Section, Temple University School of Medicine, Philadelphia, PA 19140, USA. alfred.bove@tuhs.temple.edu
authors.forename: Alfred A
authors.initials: AA
authors.lastname: Bove
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Homko
authors.forename: William P
authors.initials: WP
authors.lastname: Santamore
authors.forename: Mohammed
authors.initials: M
authors.lastname: Kashem
authors.forename: Margaret
authors.initials: M
authors.lastname: Kerper
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Elliott
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015438:Health Behavior; D006293:Health Promotion; D006801:Humans; D006973:Hypertension / Q000517:prevention & control / Q000628:therapy*; D020407:Internet; D008297:Male; D008875:Middle Aged; D019114:Remote Consultation; D013689:Telephone; D014505:Urban Population