Abstract 11935: A Successful Trial Multifaceted Randomized Trial of Home Blood Pressure Telemonitoring Plus Pharmacist Management: What Makes It Work and Who Benefits the Most?
Objectives: The Hyperlink trial tested a 12-month multi-component intervention (INT) in patients with uncontrolled hypertension, which resulted in improved blood pressure (BP) control compared to usual care at 6 months (72% vs. 45%, P<0.001) and greater lowering of systolic BP (SBP) (11 mm Hg, p<0.001). We examined patient baseline characteristics that modified the INT effect and conducted a mediation analysis to determine how the INT effect was achieved.
Method: Hyperlink cluster-randomized 450 patients with uncontrolled BP from 16 clinics. Those randomized to INT used a home BP telemonitor to transmit readings to a study pharmacist who consulted with patients by phone and used an algorithm to adjust BP medications. General and generalized linear mixed models with covariate by study arm interactions were used to test baseline patient characteristics that moderated the INT effect on the likelihood of achieving BP control <140/90 mm Hg at 6 months. Path analytic models estimated specific indirect effects of 7 potential mediating variables on change in SBP.
Results: At entry mean age was 61 years, BP was 148/85, and number of BP medications was 1.5. Age was a significant effect modifier, with smaller INT effect in older patients (p<0.05). There was little INT effect in patients treated with ≤3 medications at baseline (p<.001). There was a larger INT effect in patients with higher levels of diastolic BP (p=0.04) and who reported less salt intake (p=0.003), and smaller INT effect in those with diabetes (p=0.01) and cardiovascular disease (p=0.03). In a multivariable model age, number of medications, and salt intake remained significant effect modifiers. The mediation model explained 47% of the effect of the intervention on change in systolic BP, which was largely mediated by medication intensification (23%) and frequency of home monitoring (19%). Improved adherence and lifestyle changes (including salt intake) were not significant mediators.
Conclusions: The Hyperlink INT worked by increasing home BP monitoring and BP medications. It was of most benefit to patients who at the start of the study were younger, were taking 0-2 medications, and reported low salt intake. Further modification is needed to improve BP control for patients with uncontrolled BP on ≤3 medications.
Author Disclosures: S. Asche: None. A. Bergdall: None. S. Dehmer: None. B. Green: None. M. Maciosek: None. R. Nyboer: None. P. O’Connor: None. P. Pawloski: None. J. Sperl-Hillen: None. N. Trower: None. A. Tucker: None. K. Margolis: None.
- © 2014 by American Heart Association, Inc.