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Managing Hypertension in Urban Underserved Subjects Using Telemedicine—A Clinical Trial
Study Questions:
What is the efficacy of self-monitoring through an Internet- and telephone-based communication-based system in reducing blood pressure (BP) in an urban, underserved population?
Methods:
This was a randomized, controlled trial in which eligible subjects had a systolic BP of 140 mm Hg or above and no overt cardiovascular disease (n = 241, 81% were African-American). The authors included subjects with diabetes and designed the study to analyze the nondiabetic and diabetic groups separately. All subjects underwent an initial health assessment, which included two BP measurements and fasting blood work. Control subjects were instructed to contact their primary care provider for further care. Telemedicine subjects were trained on use of a computer and the Internet; received instructions on use of an optional telephone communication system; and were given a sphygmomanometer, scale if needed, and a pedometer. Telemedicine subjects were instructed to send their data twice weekly. The primary outcome was BP control at 6 months.
Results:
Goal BP was achieved in 52.3% of the control subjects and 54.5% of the telemedicine subjects (p = 0.43). While nondiabetic telemedicine subjects demonstrated a greater reduction in systolic BP (telemedicine group: -19 ± 20 mm Hg, control group: -12 ± 19 mm Hg; p = 0.037), the proportion of nondiabetic telemedicine subjects who reached goal BP was not significantly greater than nondiabetic control subjects (p = 0.26).
Conclusions:
In hypertensive, primarily African-American subjects from an urban, underserved population, an initial health assessment with or without an Internet and telephone-based communication-based system led to >50% of subjects achieving the goal BP of <140 mm Hg.
Perspective:
With an aging population, it will be imperative to design efficient and accurate systems of care to screen and manage the 60-80 million patients with hypertension in the United States. This study demonstrates that patients assigned to a telemedicine intervention and those within a control group who participated in an initial health assessment had comparable gains in achieving BP goals at 6 months. While this study casts doubt about the value of telemedicine (even though the authors suggest telemedicine may be a useful tool for managing hypertension among nondiabetic subjects) and reminds us that nearly 50% of the hypertensive subjects in this study did not achieve goal BP, it offers hope by demonstrating that a single health assessment can lead to gains that are basically tantamount to those from a more intensive intervention.
Keywords: Telemedicine, Hypertension
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