Telemonitoring and phone consultation of patients by pharmacists yielded significantly better blood pressure reduction than usual care, researchers reported.
A program in which pharmacists monitored and provided consultation to patients with hypertension led to dramatically improved blood pressure control compared with usual care, according to the results of a study presented at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions 2012 held May 9-11, 2012, in Atlanta.
In the study, researchers enrolled 450 patients with uncontrolled hypertension (mean blood pressure at baseline of 148/85 mm Hg) at 16 primary care clinics. Enrollees were 45% female, 83% white, 13% black, and had a mean age of 61. Half the clinics, with 222 patients, were randomized to provide usual care, while the other half, with 228 patients, were randomized to provide pharmacist intervention. Patients in the intervention group periodically recorded their blood pressure and relayed it to secure databases. Pharmacists reviewed the data, consulted with the patients every 2 to 4 weeks by phone, and made appropriate adjustments to the patients' antihypertensive therapy.
The intervention lasted for 12 months with a follow-up at 18 months to test how well its effects lasted. The current study reports blood pressure outcomes at 6 months after baseline. Of the 450 enrollees, 403 attended the 6-month follow-up: 197 in the usual care group and 206 in the intervention group. Of these, 71.8% in the intervention group attained the study’s blood pressure goal of less than 140/90 mm Hg (less than 130/80 mm Hg for those with chronic kidney disease or diabetes), compared with 42.3% of those in the usual care group. The average blood pressure in the intervention group at 6 months was 126/76 mm Hg, compared with 138/82 mm Hg for the usual care group.
Between baseline and the 6-month follow-up, the mean number of antihypertensive groups prescribed to those in the intervention group increased from 1.5 to 2.3, compared with an increase from 1.4 to 1.6 in the usual care group. The difference in drug use by class was greatest among thiazide diuretics (4.6% increase in the usual care group and 27.6% increase in the intervention group) and ACE inhibitors (1.6% increase in the usual care group and 13.6% increase in the intervention group). Patients in the intervention group also reported better adherence to their medication regimens and greater satisfaction with their care than those in the usual care group.
“These early results suggest that home blood pressure telemonitoring with extra telephone care by a pharmacist was very effective in improving blood pressure control,” said lead study author Karen Margolis, MD, MPH, director of clinical research of HealthPartners Research Foundation in Bloomington, Minnesota, in a press release. “If these early results can be sustained over the long run, it might decrease the number of patients who suffer heart attacks, strokes, or other complication of high blood pressure.”
Dr. Margolis also noted that the study participants were health conscious, so results could be different with less motivated participants.