A combination of at-home blood pressure (BP) telemonitoring and management by clinical pharmacists dramatically reduced hypertension compared to traditional physician-based management, and the beneficial effects persisted at least six months after the intervention was terminated, according to a study published July 2 in the Journal of the American Medical Association.

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The prospective HyperLink trial randomized 450 patients with uncontrolled hypertension to standard care or to a clinical pharmacy-based hypertension program with at least six weekly BP tests at home, regular in-person clinic visits and follow-up telephone consultations for 12 months. BP test results were automatically uploaded to a secure website for pharmacist review and integration with each patient's electronic medical record. Clinical pharmacists were responsible for reviewing, adjusting, initiating and halting hypertension medications under a prescribing protocol.

All of the patients were chronically hypertensive at baseline, with a BP greater than 140/90 or greater than 130/80 for those with diabetes or chronic kidney disease. At six months, BP was controlled in 71.8 percent of the telemonitoring/pharmacy intervention group compared to 45.2 percent of the usual care group (p<0.001). At 12 months, BP was controlled in 71.2 percent of the telemonitoring/ pharmacy intervention group and 52.8 percent of the usual care group (p=0.005). At 18 months, six months after the final pharmacy management visit, BP was controlled in 71.8 percent of the telemonitoring/pharmacy intervention group and 57.1 percent of the usual care group (p=0.003).

"Compared with usual primary care, home BP telemonitoring with pharmacist management resulted in large improvements in BP control and substantial decreases in BP," wrote lead author Karen Margolis, MD, MPH, HealthPartners Institute for Education and Research, Minneapolis. "We observed maintenance of the level of BP control achieved at six months in the telemonitoring intervention group through 18 months. In contrast, BP control gradually improved in the usual care group, but remained substantially lower than the telemonitoring intervention group by an absolute 15 percent by 18 months."

Telemonitoring and pharmacist intervention added an estimated $1,350 per patient in direct care costs, Margolis added. While it may be possible to reduce per-patient costs through volume discounts for telemonitoring and more precise patient targeting, future analyses will examine indirect costs as well as long-term cost savings from averting hypertension-related adverse events.

"Margolis et. al. have demonstrated that hypertension treatment can be accomplished using a telemedicine system with home measured blood pressure and a pharmacist providing medication and lifestyle management," said Alfred A. Bove, MD, PhD, MACC, past president of the ACC. "Many hypertensive patients with no other serious comorbidities are amenable to a telemedicine based BP management system. Other studies have supported the concept of a nurse or pharmacist as the initial care provider for management of hypertension. With the large number of hypertensive patients, and the growing shortage of physicians, this type of care management system can play an important role in the treatment of hypertension."

Keywords: Electronic Health Records, Follow-Up Studies, Referral and Consultation, Telemedicine, Blood Pressure Monitoring, Ambulatory, Comorbidity, Blood Pressure Determination, Hypertension, Primary Health Care, Diabetes Mellitus, Renal Insufficiency, Chronic, United States

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