Home Monitoring Service Improves Mean Arterial Pressure in Patients with Essential Hypertension: A Randomized Controlled Trial
While the use of telecommunication systems in medicine has been increasing, there have been few trials to assess the efficacy of such technology for improving blood pressure (BP) in patients with essential hypertension. A randomized controlled trial (RCT) was conducted to assess the efficacy of an home monitoring service which utilized automatic transmission of BP data over telephone lines, conversion of the data into report form by computer, and facsimile transmission of the form weekly to physicians and patients. One hundred and eleven patients were randomized to either home service or usual care and followed for a median of 11 weeks. The primary endpoint was change in mean arterial pressure (MAP) which was assessed using a 24-hour ambulatory blood pressure monitoring (ABPM) device at both baseline and exit. There was a 3.0 mm Hg decline in MAP from baseline to exit for patients using the home service and a 1.5 mm Hg increase in MAP for patients receiving usual care (p=0.0139). There was a 2.1 mm Hg decline in average diastolic BP (DBP) in the home service group and a 2.3 mm Hg increase in the usual care group (p=0.0120). In addition, the proportion of 24-hour DBP readings above target levels decreased by 6.8% in patients receiving home service, but increased by 6.2% in patients receiving usual care (p=0.0057). The reduction in BP was evident for both genders, for each ethnic group, and for both younger and older patients. For African-Americans, MAP declined by 9.6 mm Hg for those receiving the home service and increased by 5.25 mm Hg for those receiving usual care (p=0.0469). The difference in MAP between the two study arms remained significant after adjustment for patient characteristics. The decrease in BP for home service was, in part, due to more frequent changes in dose and/or type of medication during the course of the trial. This was the first RCT of a home BP service that did not rely on patient self-report and which used 24-hour ABPM at baseline and at exit to assess usual BP. It is recommended that patients with essential hypertension, who are in the process of evaluation for a change in antihypertensive therapy, utilize a home monitoring service.