Minneapolis, MN—A 12-month intensive hypertension intervention involving telemonitoring and pharmacist management might have been successful, but how long does blood pressure remain lower?

That was the question investigated in a new study published in JAMA Network Open. In this follow-up of a cluster randomized trial of 326 patients with uncontrolled hypertension, research-clinic measurements showed that home blood pressure telemonitoring with pharmacist management lowered blood pressure more than usual care for at least some extended period of time. The success was not sustained, however, through 54 months.

The study, led by HealthPartners Institute researchers, suggests that long-term maintenance strategies might be required to sustain hypertension-intervention effects over the longer term.

Results were previously reported of the 12-month trial of home blood pressure (BP) telemonitoring and pharmacist management intervention, which resulted in significantly greater reductions in systolic BP (SBP) in the intervention group versus the usual-care group at 6, 12, and 18 months (-10.7, -9.7, and -6.6 mm Hg, respectively).

In that trial, the intervention group received a home automated oscillometric BP monitor that stored and transmitted BP data to a secure website. Pharmacists met with patients in person for a 1-hour intake visit, during which they conducted a personalized medication review, taught patients how to use the home BP telemonitoring system, and provided information about hypertension management.

Patients, who were told to transmit at least six measurements weekly, were given an individualized goal—either less than 135/85 mmHg, in general, or less than 125/75 mm Hg for those with diabetes or kidney disease.

Over the first 6 months of the program, patients and pharmacists talked every 2 weeks by telephone until BP control was sustained for 6 weeks, at which point the frequency was reduced to monthly and then to every 2 months in the second 6 months of the intervention period. After a year, patients returned the telemonitors and received no further pharmacist support, returning to usual care with their physicians.

Based on that, researchers sought to determine the durability of the intervention effect on BP through 54 months of follow-up. They also compared BP measurements performed in the research clinic and in routine clinical care.

The follow-up of a cluster randomized clinical trial among 16 primary care clinics and 450 patients with uncontrolled hypertension in a large health system was conducted from March 2009 to November 2015. The focus was on the change in SBP and diastolic BP (DBP) from baseline to 54 months measured as the mean of three measurements obtained at each research-clinic visit.

The 450 patients, with a mean age of 62 years and with slightly more men than women, were randomized to the telemonitoring intervention or to usual care. With a baseline mean SBP of 148 mmHg in both groups, results indicated that the intervention group had mean SBP of 126.7, 125.7, 126.9, and 130.6 mmHg, respectively at 6-, 12-, 18-, and 54-month follow-up.

That was consistently lower than the usual-care group, which had mean SBP of 136.9, 134.8, 133.0, and 132.6 mm Hg, respectively at 6-, 12-, 18-, and 54-month follow-up, researchers point out.

In looking at baseline to 54 months, the study team determined that the differential reduction by study group in SBP was -2.5 mm Hg (95% CI, -6.3 to 1.2 mm Hg; P = .18). The differential reduction by study group from baseline to 54 months of DBP was -1.0 mm Hg (95% CI, -3.2 to 1.2 mm Hg; P = .37).

Researchers emphasized, “The SBP and DBP results from routine clinical measurements suggested significantly lower BP in the intervention group for up to 24 months,” they add. “Long-term maintenance of BP control is likely to require continued monitoring and resumption of the intervention if BP increases.”

 « Click here to return to Weekly News Update.