title: Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial.
abstract: OBJECTIVE
  To determine if an intervention consisting of telemonitoring and supervision by usual primary care clinicians of home self measured blood pressure and optional patient decision support leads to clinically important reductions in daytime systolic and diastolic ambulatory blood pressure in patients with uncontrolled blood pressure.
  
  
  METHODS
  Multicentre randomised controlled trial.
  
  
  METHODS
  20 primary care practices in south east Scotland.
  
  
  METHODS
  401 people aged 29-95 years with uncontrolled blood pressure (mean daytime ambulatory measurement ≥ 135/85 mm Hg but ≤ 210/135 mm Hg).
  
  
  METHODS
  Self measurement and transmission of blood pressure readings to a secure website for review by the attending nurse or doctor and participant, with optional automated patient decision support by text or email for six months.
  
  
  METHODS
  Blinded assessment of mean daytime systolic ambulatory blood pressure six months after randomisation.
  
  
  RESULTS
  200 participants were randomised to the intervention and 201 to usual care; primary outcome data were available for 90% of participants (182 and 177, respectively). The mean difference in daytime systolic ambulatory blood pressure adjusted for baseline and minimisation factors between intervention and usual care was 4.3 mm Hg (95% confidence interval 2.0 to 6.5; P=0.0002) and for daytime diastolic ambulatory blood pressure was 2.3 mm Hg (0.9 to 3.6; P=0.001), with higher values in the usual care group. The intervention was associated with a mean increase of one general practitioner (95% confidence interval 0.5 to 1.6; P=0.0002) and 0.6 (0.1 to 1.0; P=0.01) practice nurse consultations during the course of the study.
  
  
  CONCLUSIONS
  Supported self monitoring by telemonitoring is an effective method for achieving clinically important reductions in blood pressure in patients with uncontrolled hypertension in primary care settings. However, it was associated with increase in use of National Health Service resources. Further research is required to determine if the reduction in blood pressure is maintained in the longer term and if the intervention is cost effective.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN72614272.
authors.affiliation: Centre for Population Health Sciences, Medical School, University of Edinburgh, Edinburgh EH8 9AG, UK. brian.mckinstry@ed.ac.uk
authors.forename: Brian
authors.initials: B
authors.lastname: McKinstry
authors.forename: Janet
authors.initials: J
authors.lastname: Hanley
authors.forename: Sarah
authors.initials: S
authors.lastname: Wild
authors.forename: Claudia
authors.initials: C
authors.lastname: Pagliari
authors.forename: Mary
authors.initials: M
authors.lastname: Paterson
authors.forename: Steff
authors.initials: S
authors.lastname: Lewis
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.forename: Ashma
authors.initials: A
authors.lastname: Krishan
authors.forename: Andrew
authors.initials: A
authors.lastname: Stoddart
authors.forename: Paul
authors.initials: P
authors.lastname: Padfield
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D020000:Decision Support Systems, Clinical; D019468:Disease Management; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D015397:Program Evaluation; D012648:Self Care; D017216:Telemedicine / Q000191:economics / Q000379:methods*
chemical_list: D000959:Antihypertensive Agents