Home monitoring service improves mean arterial pressure in patients with essential hypertension - A randomized, controlled trial

Background: Technological advances in the distribution of information have opened new avenues for patient care. Few trials, however, have used telemed icine to improve blood pressure in patients with essential hypertension. Objective: To determine the efficacy of a telecommunication service in redu cing blood pressure. Design: Randomized, controlled trial. Setting: University-affiliate primary care outpatient clinics. Patients: 121 adults with essential hypertension who were under evaluation for a change in antihypertensive therapy. Intervention: A home service consisting of automatic transmission of blood pressure data over telephone lines, computerized conversion of the informat ion into report forms, and weekly electronic transmission of the report for ms to physicians and patients. Measurements: 24-hour ambulatory blood pressure monitoring at baseline and exit. The primary end point was change in mean arterial pressure from basel ine to exit. Results: Mean arterial pressure decreased by 2.8 mm Hg in patients receivin g the home service and increased by 1.3 mm Hg in patients receiving usual c are (P = 0.013 for the difference). Mean diastolic blood pressure decreased by 2.0 mm Hg for home service but increased by 2.1 mm Hg for usual care (P = 0.012 for the difference). Mean systolic blood pressure decreased by 4.9 mm Hg for home service and 0.1 mm Hg for patients receiving usual care (P = 0.047 for the difference). Among African-American patients, mean arterial pressure decreased by 9.6 mm Hg in those receiving home service and increa sed by 5.25 mm Hg in those receiving usual care (P = 0.047). Part of the de crease in blood pressure for home service was due to more frequent changes in the type or dose of antihypertensive medications. Conclusion: This telecommunication service was efficacious in reducing the mean arterial pressure of patients with established essential hypertension.