Abstract 3307: Nurse-Managed Telemonitoring is Associated with Improved Blood Pressure at 12-Months Follow-up in African Americans
Introduction: Current rates of hypertension control are unacceptable, particularly among African Americans who are disproportionately impacted by the disease. Nurse-managed blood pressure (BP) telemonitoring may offer hope for achieving better levels of BP control.
Hypothesis: We tested the hypothesis that individuals who participated in usual care (UC) plus BP telemonitoring (TM) would have a lower BP over 12-months follow-up than individuals who receive UC only.
Methods: A two-group design with block-stratified randomization for antihypertensive medication use was used. A convenience sample of 387 African Americans with hypertension (mean age 60±13 years) was recruited through BP screenings then randomly assigned to either TM (n=194) or UC (n=193) following baseline data collection. At all visits, BP was measured using a validated electronic BP monitor (Omron HEM-737 Intellisense). Repeated measures analysis was conducted using SAS Proc Mixed with an autoregressive covariance structure.
Results: Both the TM and UC groups experienced decreases in SBP and DBP during the study. The results showed significant effects of treatment group, time, and their interaction on both SBP and DBP. Adjusted for baseline value, SBP was 4 mmHg (SE=1.2) lower overall in the TM group than in the UC group (t=3.5, p=0.0006). The baseline-adjusted, between-group difference (SE) in SBP from baseline to 12-month follow-up was 12.2 mmHg (1.8) (t=6.7; p<0.0001). For DBP, the TM group had overall readings 1.6 mmHg (SE=0.7) lower than in the UC group (t=2.44; p=0.02). The baseline-adjusted, between group difference (SE) in DBP from baseline to 12-month follow-up was 5.8 mmHg (1.0) (t=5.8; p<0.0001).
Conclusions: While both groups had improved BP readings, different patterns of BP over time were evident by group. Those in the TM group had consistently lower SBP and DBP at each time point than participants in the UC group. However, the largest decrease was between baseline and 3 months in the TM group, with no additional significant decreases at later follow-ups. The UC group showed smaller yet metered decreases throughout the entire study period. More studies are needed to test strategies for enhancing the effectiveness of TM beyond the initial phase of monitoring.