A new study found adults with high blood pressure were about half as likely to have serious cardiovascular events after receiving telemonitoring vs those receiving primary care.
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“Home blood pressure monitoring linked with treatment actions from the health care team delivered remotely (telehealth support) in between office visits has been shown to lower blood pressure more than routine care, and patients really like it,” said lead author Karen L. Margolis, MD, executive director of research, HealthPartners Institute of Minneapolis, Minnesota, in an AHA press release. “In addition, by avoiding serious cardiovascular events over 5 years, our results indicate significant cost savings.”
Margolis and colleagues enrolled 450 patients with uncontrolled hypertension at 16 primary care clinics within the HealthPartners system in Minnesota, and randomized participants to 2 groups: 222 patients in the routine primary care group, and 228 in the telemonitoring group that also received 1 year of remote care managed by a pharmacist.
For purposes of the study, uncontrolled hypertension was defined as ≥140/90 mmHg or ≥130/80 mmHg if diabetes mellitus or kidney disease was present.
Overall, the mean age of participants was 61 years, 45% were women, 82% were non-Hispanic white, and 10%-20% had comorbid diabetes, chronic kidney disease, and cardiovascular [CV] disease; approximately 10% in both groups were current smokers.
Results:
● CV composite end point incidence was 4.4% in the telemonitoring group vs 8.6% in the routine primary care group (OR, 0.49 [95% CI, 0.21-1.13], P=0.09).
● Including 2 stent replacements in the telemonitoring group and 10 in the routine primary care group: Secondary CV composite end point incidence was 5.3% in the telemonitoring group vs 10.4% in the primary care group (OR, 0.48, [95% CI, 0.22-1.08], P=0.08).
Participants in the telemonitoring group were able to measure their BP at home and send it electronically to the pharmacist, who then worked with the patients to make medication and lifestyle changes in their treatment.
In clinic visits for all participants, researchers monitored BP at enrollment, 6 months, 12 months, 18 months, and 5 years; documented any heart attacks, strokes, coronary stent placements, heart failure hospitalizations, and CV-related deaths that occurred. Costs were recorded for all BP-related care and CV event care.
Results showed that a heart attack, stroke, stent placement, or heart failure hospitalization occurred in 5.3% of the telemonitoring group vs 10.4% of the routine primary care group (odds ratio, 0.48 [95% CI, 0.22-1.08], P=0.08).
Also, participants in the telemonitoring group reported that they liked having support from a trusted professional, rapid feedback and adjustments to their treatment, and having someone to be accountable to.
“The findings were just short of statistical significance, meaning they could have been due to chance. However, we were surprised that the figures on serious cardiovascular events pointed so strongly to a benefit of the telemonitoring intervention,” continued Margolis.
Study limitations the authors note include its relatively small size and that it was conducted at a single medical group in urban and suburban primary care clinics, limiting a more diverse patient representation that might be seen in other settings across the country.
