Telemonitoring and Protocolized Case Management for Hypertensive Community-Dwelling Seniors With Diabetes: Protocol of the TECHNOMED Randomized Controlled Trial The rationale and design of reduction of uncontrolled hypertension by Remote Monitoring and Telemedicine (REMOTE) study Managing hypertension in urban underserved subjects using telemedicine--a clinical trial. Telecare of diabetic patients with intensified insulin therapy. A randomized clinical trial. The effect of telecare on the quality of life and psychological well-being of elderly recipients of social care over a 12-month period: the Whole Systems Demonstrator cluster randomised trial. The physician at a distance: the use of videoconferencing in the treatment of patients with hypertension Telemedicine improves diagnosis of essential hypertension compared with usual care Effects of Nurse-Managed Telemonitoring on Blood Pressure at 12-Month Follow-Up Among Urban African Americans A coordinated PCP-Cardiologist Telemedicine Model (PCTM) in China’s community hypertension care: study protocol for a randomized controlled trial Accuracy of telemedicine in detecting uncontrolled hypertension and its impact on patient management. Telecare for Diabetes, CHF or COPD: Effect on Quality of Life, Hospital Use and Costs. A Randomised Controlled Trial and Qualitative Evaluation Hypertension Intervention Nurse Telemedicine Study (HINTS): testing a multifactorial tailored behavioral/educational and a medication management intervention for blood pressure control. Mobile telemonitoring for achieving tighter targets of blood pressure control in patients with complicated diabetes: a pilot study. Using simple telehealth in primary care to reduce blood pressure: a service evaluation Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. Economic evaluation of telephone self-management interventions for blood pressure control. Mobile phone-based remote patient monitoring system for management of hypertension in diabetic patients.
Background Diabetes and hypertension are devastating , deadly , and costly conditions that are very common in seniors . Controlling hypertension in seniors with diabetes dramatically reduces hypertension-related complications . However , blood pressure ( BP ) must be lowered carefully because seniors are also susceptible to low BP and attendant harms . Achieving “ optimal BP control ” ( ie , avoiding both undertreatment and overtreatment ) is the ultimate therapeutic goal in such patients . Regular BP monitoring is required to achieve this goal . BP monitoring at home is cheap , convenient , widely used , and guideline endorsed . However , major barriers prevent proper use . These may be overcome through use of BP telemonitoring — the secure teletransmission of BP readings to a health portal , where BP data are summarized for provider and patient use , with or without protocol ized case management . Objective To examine the incremental effectiveness , safety , cost-effectiveness , usability , and acceptability of home BP telemonitoring , used with or without protocol ized case management , compared with “ enhanced usual care ” in community-dwelling seniors with diabetes and hypertension . Methods A 300-patient , 3-arm , pragmatic r and omized controlled trial with blinded outcome ascertainment will be performed in seniors with diabetes and hypertension living independently in seniors ’ residences in greater Edmonton . Consenting patients will be r and omized to usual care , home BP telemonitoring alone , or home BP telemonitoring plus protocol ized pharmacist case management . Usual care subjects will receive a home BP monitor but neither they nor their providers will have access to teletransmitted data . In both telemonitored arms , providers will receive telemonitored BP data summaries . In the case management arm , pharmacist case managers will be responsible for review ing teletransmitted data and initiating guideline -concordant and protocol ized changes in BP management . Results Outcomes will be ascertained at 6 and 12 months . Within- study -arm change scores will be calculated and compared between study arms . These include : ( 1 ) clinical outcomes : proportion of subjects with a mean 24-hour ambulatory systolic BP in the optimal range ( 110 - 129 mmHg in patients 65 - 79 years and 110 - 139 mmHg in those ≥80 years : primary outcome ) ; additional ambulatory and home BP outcomes ; A1c and lipid profile ; medications , cognition , health care use , cardiovascular events , and mortality . ( 2 ) Safety outcomes : number of serious episodes of hypotension , syncope , falls , and electrolyte disturbances ( requiring third party assistance or medical attention ) . ( 3 ) Humanistic outcomes : quality of life , satisfaction , and medication adherence . ( 4 ) Economic outcomes : incremental costs , incremental cost-utility , and cost per mmHg change in BP of telemonitoring ± case management compared with usual care ( health payor and societal perspectives ) . ( 5 ) Intervention usability and acceptability to patients and providers . Conclusion The potential benefits of telemonitoring remain largely unstudied and unproven in seniors . This trial will comprehensively assess the impact of home BP telemonitoring across a range of outcomes . Results will inform the value of implementing home-based telemonitoring within supportive living residences in Canada . Trial Registration Clinical trials.gov NCT02721667 ; https:// clinical trials.gov/ct2/show/NCT02721667 ( Archived by Webcite at http://www.webcitation.org/6i8tB20Mc Abstract Purpose : Although self-measurement of home blood pressure ( HBP ) is common in Japan and HBP telemonitoring via the Internet is possible , whether telemonitoring improves HBP control better than conventional practice remains unclear . Furthermore , hypertension care with online communication using telemonitored HBP is feasible , whereas the efficacy and safety of such telemedicine have not been established . We aim to compare traditional care , care with office visits using HBP telemonitoring , and antihypertensive telemedicine based on HBP telemonitoring . Methods and design : In total , 444 patients with uncontrolled hypertension will be recruited and r and omly assigned to three groups : ( 1 ) control : usual care with office visits and HBP self-report , ( 2 ) telemonitoring : weekly assessment of transmitted HBP by physicians and treatment adjustment upon office visits , or ( 3 ) telemedicine : online communication instead of office visits to adjust medication using telemonitored HBP . Primary outcome is the time to control of HBP , and secondary outcomes include achieved HBP levels , adherence , treatment intensity , adverse events , patient satisfaction and cost-effectiveness . Discussion : Hypertension care with telemonitoring and telemedicine are expected to require shorter time to achieve HBP control compared to usual care . Combining HBP telemonitoring with telemedicine may lower the hurdles for starting and persisting to hypertension treatment and eventually reduce cardiovascular events BACKGROUND We evaluated an Internet- and telephone-based telemedicine system for reducing blood pressure ( BP ) in underserved subjects with hypertension . METHODS A total of 241 patients with systolic BP ≥140 mm Hg were r and omized to usual care ( C ; n = 121 ) or telemedicine  ( T ; n = 120 ) . The T group reported BP , heart rate , weight , steps/day , and tobacco use twice weekly . The primary outcome was BP control at 6 months . RESULTS Average age was 59.6 years , average body mass index was 33.7 kg/m(2 ) , 79 % were female , 81 % were African American , 15 % were white , 53 % were at or below the federal poverty level , 18 % were smokers , and 32 % had diabetes . Six-month follow-up was achieved in 206 subjects ( C : 107 , T : 99 ) . Goal BP was achieved in 52.3 % in C and 54.5 % in T ( P = .43 ) . Systolic BP change ( C : -13.9 mm Hg , T : -18.2 ; P = .118 ) was similar in both groups . Subjects in the T group reported BP 7.7 ± 6.9 d/mo . Results were not affected by age , sex , ethnicity , education , or income . In nondiabetic T subjects , goal BP was achieved in 58.2 % compared with 45.2 % of diabetic T subjects ( P = .024 ) . Nondiabetic T subjects demonstrated a greater reduction in systolic BP ( T : -19 ± 20 mm Hg , C : -12 ± 19 mm Hg ; P = .037 ) . No difference in BP response between C and T was noted in patients with diabetes . CONCLUSION In hypertensive subjects , engagement in a system of care with or without telemedicine result ed in significant BP reduction . Telemedicine for nondiabetic patients result ed in a greater reduction in systolic BP compared with usual care . Telemedicine may be a useful tool for managing hypertension particularly among nondiabetic subjects BACKGROUND Patients with insulin dependent diabetes require frequent advice if their metabolic control is suboptimal . A telemedical system for transmission of self monitoring blood glucose values from the patients ' home to the diabetes center with a combined modem-interface is described . Data are processed by PC and advice is given by telephone . The study focuses on metabolic outcome , fiscal and administrative aspects . METHODS A prospect i ve , r and omized trial with 46 patients with intensified insulin therapy was conducted , 30 patients used telecare and 16 conventional care .  RESULTS HbA1c , as a parameter of metabolic control , dropped from 8.3 % to 7.3 % in the telecare group and from 8.0 % to 6.8 % in the conventional group after 8 months of observation . There was no significant difference between the two groups . Time expenditure for telemanagement , compared to conventional advice , was moderately higher , but there was a substantial amount of time on the patients side that could be saved mainly by reduction of to travel time and work stoppage . Setting up an optimal telemanagement scenario a cost analysis was done . This yields a cost saving of about 650 EURO per year . CONCLUSION Telemanagement of insulin-requiring diabetic patients is a cost and time saving procedure for the patients and results in metabolic control comparable to conventional outpatient management BACKGROUND home-based telecare ( TC ) is utilised to manage risks of independent living and provide prompt emergency responses . This study examined the effect of TC on health-related quality of life ( HRQoL ) , anxiety and depressive symptoms over 12 months in patients receiving social care . DESIGN a study of participant-reported outcomes [ the Whole Systems Demonstrator ( WSD ) Telecare Question naire Study ; baseline n = 1,189 ] was nested in a pragmatic cluster-r and omised trial of TC ( the WSD Telecare trial ) , held across three English Local Authorities . General practice ( GP ) was the unit of r and omisation and TC was compared with usual care ( UC ) . METHODS participant-reported outcome measures were collected at baseline , short-term ( 4 months ) and long-term ( 12 months ) follow-up , assessing generic HRQoL , anxiety and depressive symptoms . Primary intention-to-treat analyses tested treatment effectiveness and were conducted using multilevel models to control for GP clustering and covariates for participants who completed question naire measures at baseline assessment plus at least one other assessment ( n = 873 ) . RESULTS analyses found significant differences between TC and UC on Short Form-12 mental component scores ( P < 0.05 ) , with parameter estimates indicating being a member of the TC trial-arm increases mental component scores ( UC-adjusted mean = 40.52 ; TC-adjusted mean = 43.69 ) . Additional significant analyses revealed , time effects on EQ5D ( decreasing over time ) and depressive symptoms ( increasing over time ) . CONCLUSIONS TC potentially contributes to the amelioration in the decline in users ' mental HRQoL over a 12-month period . TC may not transform the lives of its users , but it may afford small relative benefits on some psychological and HRQOL outcomes relative to users who only receive UC . International St and ard R and omised Controlled Trial Number Register : IS RCT N 43002091 We evaluated the feasibility and quality of uncomplicated hypertension care based on telemedicine in a rural area of northern Sweden . The intervention subjects were 91 consecutive patients with primary hypertension . For comparison , 182 age- and sex-matched patients with hypertension were r and omly selected from a similar health centre . The telemedicine equipment consisted of a video link between the physician and the patients , supported by a system for accessing medical data via the Internet . During a 21-month study period , telemedicine was used in 270 ( 91 % ) of the 297 consultations in the intervention group . All health personnel involved in the telemedicine treatment rated the method as feasible . Both systolic and diastolic blood pressure improved in the two groups during the study period . In the intervention group , a higher proportion had their blood pressure within treatment goals ( systolic blood pressure < 140 mmHg , diastolic blood pressure < 90 mmHg ) both at baseline and at follow-up than in the comparison group . An adjusted multivariate model ( adjustment for sex , age , time between visits , change in number of drugs between first and last visit , blood pressure at first visit ) showed that the intervention group had a higher probability ( OR 2.7 , 95 % CI 1.4–5.2 ) of reaching the target blood pressure levels than the reference group . Treatment of hypertension by means of telemedicine was quite feasible and at least as effective as face-to-face consultations with a physician A r and omized controlled trial was conducted to assess the efficacy of a telemedicine service for the diagnosis of essential hypertension . The telemedicine service consisted of using an automatic home blood pressure monitor connected to an ordinary telephone line for the transmission of the data to a central computer . After use of the home monitor for a week , the results were converted to a report form and faxed to the patient 's physician . The gold st and ard for assessment of true hypertension status was 24 h ambulatory blood pressure monitoring . A total of 74 patients from outpatient clinics were r and omized into either the  telemedicine service  or  usual care . Use of the telemedicine service significantly improved the detection of essential hypertension compared with usual care : in the telemedicine group , 64 % of patients with essential hypertension were diagnosed ; in the usual care group , 26 % of patients with essential hypertension were diagnosed . Furthermore , diagnosis occurred earlier in the telemedicine group than in patients receiving usual care .  Specificity and positive predictive value were similar in the two groups Background : Nearly one in three adults in the United States has hypertension . Hypertension is one of the largest risk factors for cardiovascular diseases , and it is growing in prevalence , especially among African Americans . Objectives : To test the hypothesis that individuals who participate in usual care ( UC ) plus blood pressure ( BP ) telemonitoring ( TM ) will have a greater reduction in BP from baseline to 12-month follow-up than would individuals who receive UC only . Methods : A two-group , experimental , longitudinal design with block stratified r and omization for antihypertensive medication use was used . African Americans with hypertension were recruited through free BP screenings offered in the community . Data were collected through a structured interview and brief physical exam . Cross tabs , repeated measures analysis of variance , and independent t tests were used to analyze the study 's hypothesis . Results : The TM intervention group had a greater reduction in systolic BP ( 13.0 mm Hg ) than the enhanced UC group ( 7.5 mm Hg ; t = −2.09 , p = .04 ) from baseline to the 12-month follow-up . Although the TM intervention group had a greater reduction in diastolic BP ( 6.3 mm Hg ) compared with the enhanced UC group ( 4.1 mm Hg ) , the differences were not statistically significant ( t = −1.56 , p = .12 ) . Discussion : Telemonitoring of BP result ed in clinical ly and statistically significant reductions in systolic BP over a 12-month period ; if maintained over a longer period of time , the reductions could improve care and outcomes significantly for African Americans with hypertension Background Hypertension is a major risk factor for cardiovascular disease , and its control rate has remained low worldwide . Studies have found that telemonitoring blood pressure ( BP ) helped control hypertension in r and omized controlled trials . However , little is known about its effect in a structured primary care model in which primary care physicians ( PCPs ) are partnering with cardiology specialists in electronic healthcare data sharing and medical interventions . This study aims to identify the effects of a coordinated PCP-cardiologist model that applies telemedicine tools to facilitate community hypertension control in China . Methods / design Patients with hypertension receiving care at four community healthcare centers that are academically affiliated to Shanghai Chest Hospital , Shanghai JiaoTong University are eligible if they have had uncontrolled BP in the previous 3 months and access to mobile Internet . Study subjects are r and omly assigned to three interventional groups : ( 1 ) usual care ; ( 2 ) home-based BP telemonitor with embedded Global System for Mobile Communications ( GSM ) module and unlimited data plan , an app to access personal healthcare record and receive personalized lifestyle coaching contents , and proficiency training of their use ; or ( 3 ) this plus coordinated PCP-cardiologist care in which PCPs and cardiologists share data via a secure CareLinker website to determine interventional approaches . The primary outcome is mean change in systolic blood pressure over a 12-month period . Secondary outcomes are changes of diastolic blood pressure , HbA1C , blood lipids , and medication adherence measured by the eight-item Morisky Medication Adherence Scale . Discussion This study will determine whether a coordinated PCP-Cardiologist Telemedicine Model that incorporates the latest telemedicine technologies will improve hypertension care . Success of the model would help streamline the present community healthcare processes and impact a greater number of patients with uncontrolled hypertension . Trial registration Clinical Trials.gov , NCT02919033 . Registered on 23 September 2016 This study was aim ed at assessing the diagnostic accuracy of telemedicine among hypertensive patients . This was a cross-sectional analysis of patients attending a hypertension clinic over a year-long study . Patients were seen both by telemedicine and in-person on the same day with order of the encounters r and omly determined . A telemedicine system , which utilized phone lines , was employed . For each type of encounter , whether telemedicine ( TM ) or in-person ( IP ) , clinical data on blood pressure ( BP ) control as well as physician ordering patterns were collected . Receiver Operator Characteristic ( ROC ) curves were used to assess the validity of TM as compared to IP in the assessment of uncontrolled hypertension .  Sixty-two patients participated result ing in 107-paired visits over the year-long study period . The mean age of the 62 participants was 67.1 + /- 11.4 years ; 56.6 % were men . ROC curves for detecting elevated mean blood pressure provided an area under the curve ( auc ) of 0.87 ( 95 % CI , 0.80 - 0.95 ) . ROC curves for the detection of uncontrolled systolic hypertension provided an auc of 0.86 ( 95 % CI , 0.78 - 0.93 ) . Telemedicine-determined BP differed slightly , but statistically significant ( p < 0.05 ) , from IP assessment s. Meanwhile , there was no difference in ordering diagnostic tests or therapeutics detectable between the two encounter types . Telemedicine proved to be a valid means for detecting uncontrolled BP among hypertensive patients Objectives To assess the effect of telecare on health related quality of life , self-care , hospital use , costs and the experiences of patients , informal carers and health care professionals . Methods Patients were r and omly assigned either to usual care or to additionally entering their data into a commercially-available electronic device that uploaded data once a day to a nurse-led monitoring station . Patients had congestive heart failure ( Site A ) , chronic obstructive pulmonary disease ( Site B ) , or any long-term condition , mostly diabetes ( Site C ) . Site C contributed only intervention patients – they considered a usual care option to be unethical . The study took place in New Zeal and between September 2010 and February 2012 , and lasted 3 to 6 months for each patient . The primary outcome was health-related quality of life ( SF36 ) . Data on experiences were collected by individual and group interviews and by question naire . Results There were 171 patients ( 98 intervention , 73 control ) . Quality of life , self-efficacy and disease-specific measures did not change significantly , while anxiety and depression both decreased significantly with the intervention . Hospital admissions , days in hospital , emergency department visits , outpatient visits and costs did not differ significantly between the groups . Patients at all sites were universally positive . Many felt safer and more cared-for , and said that they and their family had learned more about managing their condition . Staff could all see potential benefits of telecare , and , after some initial technical problems , many staff felt that telecare enabled them to effectively monitor more patients . Conclusions Strongly positive patient and staff experiences and attitudes complement and contrast with small or non-significant quantitative changes . Telecare led to patients and families taking a more active role in self-management . It is likely that subgroups of patients benefitted in ways that were not measured or visible within the quantitative data , especially feelings of safety and being cared-for . Trial Registration Australian New Zeal and Clinical Trials Registry BACKGROUND Only 31 % of Americans with hypertension have their blood pressure ( BP ) under effective control . We describe a study that tests 3 different interventions in a r and omized controlled trial using home BP telemedicine monitoring . METHODS A sample of hypertensive patients with poor BP control at baseline ( N = 600 ) are r and omized to 1 of 4 arms : ( 1 ) control group -- a group of hypertensive patients who receive usual care ; ( 2 ) nurse-administered tailored behavioral intervention ; ( 3 ) nurse-administered medication management according to a hypertension decision support system ; ( 4 ) combination of the 2 interventions . The interventions are triggered based on home BP values transmitted via telemonitoring devices over st and ard telephone lines . The tailored behavioral intervention involves promoting adherence with medication and health behaviors . Patients r and omized to the medication management or the combined arm have their hypertension regimen changed by the study team using a vali date d hypertension decision support system based on evidence -based hypertension treatment guidelines and individualized to patients ' comorbid illnesses . The primary outcome is BP control : < or = 140/90 mm Hg ( nondiabetic ) and < or = 130/80 mm Hg ( diabetics ) measured at 6-month intervals over 18 months ( 4 total measurements ) . CONCLUSIONS Given the increasing prevalence of hypertension and our inability to achieve adequate BP control using traditional models of care , testing novel interventions in patients ' homes may improve access , quality , and outcomes BACKGROUND Hypertension is a major risk factor for the long-term complications of diabetes . Mobile , self-measurement of blood pressure is emerging as a method to manage blood pressure in general , but its impact in patients with diabetes is unclear . METHODS We r and omized 137 patients with diabetes and hypertension to either  mobile telemonitoring  ( n = 72 ) or usual care ( n = 65 ) . Clinic blood pressure was recorded at baseline and after 6 months . Patients in the intervention arm transmitted weekly blood pressure readings wirelessly , using adapted sensors via mobile phones to a central server . Clinicians received the data in real-time and using a web-based application provided management advice to the patient and their physicians . RESULTS Systolic blood pressure fell significantly in the patients in the intervention group ( mean [ 95 % confidence interval ] , -6.5 [ -0.8 to -12.2 ] mm Hg ; P = 0.027 ) and remained unchanged in the control group ( 2.1 [ 9.3 to -5.0 ] mm Hg ; P = 0.57 ) . Patients within the intervention arm of African origin seemed to benefit more from the intervention . In addition , those who achieved a systolic blood pressure of < 120 mm Hg had lower average blood sugars than those with higher readings ( 7.8 [ SD 1.6 ] vs. 8.9 [ SD 2.2 ] mmol/L ; P = 0.02 ) . CONCLUSIONS In patients with diabetes , mobile telemonitoring has potential for delivering intensified care to improve blood pressure control , and its use may be associated with reduced exposure to hyperglycemia Objectives This service evaluation examines how efficiently an innovative , simple and interactive blood pressure ( BP ) management intervention improves BP control in general practice . Design Prospect i ve service evaluation . Setting Ten volunteer general practitioner ( GP ) practice s in Stoke on Trent , UK . Participants Practice staff identified 124 intervention patients and invited them to participate based on two inclusion criteria : ( 1 ) patient has chronic kidney disease ( CKD ) stages 3 or 4 with BP persistently > 130/85 mm Hg or ( 2 ) patient is > 50 years-old ( without CKD stages 3–5 ) with BP persistently > 140/90 mm Hg despite prescribed antihypertensive medication . Three selected hypertensive control patients per intervention patient underwent usual clinical care ( n=364 ) . Interventions Intervention patients used ‘ Florence ’ , a simple , interactive mobile phone texting service with BP management intervention for 3 months , or for less time if their BP became controlled . Patients measured their BP , text their readings to Florence , received an immediate automatic response and had results review ed by their GP/ practice nurse at least weekly . Main outcome measures Baseline data including recent BP readings and medications were collected ; similar information was obtained for 6 months for both control and intervention patients . Average BP readings and medication usage were determined . Results At final data collection , five intervention patients had not yet completed the full programme . Control and intervention patients were well matched except that intervention patients had significantly greater baseline BP . Greatest BP reductions were among hypertensive intervention patients without CKD stages 3–5 . Intervention patients had significantly more BP readings and more changes in medication over the 3-month data collection period . Conclusions Simple telehealth is acceptable and effective in reducing patients ’ BP . In future , poorly controlled patients could be targeted to maximise BP reductions or broader use could improve diagnostic accuracy and accessibility for patients who struggle to regularly attend their GP surgery IMPORTANCE Only about half of patients with high blood pressure ( BP ) in the United States have their BP controlled . Practical , robust , and sustainable models are needed to improve BP control in patients with uncontrolled hypertension . OBJECTIVES To determine whether an intervention combining home BP telemonitoring with pharmacist case management improves BP control compared with usual care and to determine whether BP control is maintained after the intervention is stopped . DESIGN , SETTING , AND PATIENTS A cluster r and omized clinical trial of 450 adults with uncontrolled BP recruited from 14,692 patients with electronic medical records across 16 primary care clinics in an integrated health system in Minneapolis-St Paul , Minnesota , with 12 months of intervention and 6 months of postintervention follow-up . INTERVENTIONS Eight clinics were r and omized to provide usual care to patients ( n = 222 ) and 8 clinics were r and omized to provide a telemonitoring intervention ( n = 228 ) . Intervention patients received home BP telemonitors and transmitted BP data to pharmacists who adjusted antihypertensive therapy accordingly . MAIN OUTCOMES AND MEASURES Control of systolic BP to less than 140 mm Hg and diastolic BP to less than 90 mm Hg ( < 130/80 mm Hg in patients with diabetes or chronic kidney disease ) at 6 and 12 months . Secondary outcomes were change in BP , patient satisfaction , and BP control at 18 months ( 6 months after intervention stopped ) . RESULTS At baseline , enrollees were 45 % women , 82 % white , mean ( SD ) age was 61.1 ( 12.0 ) years , and mean systolic BP was 148 mm Hg and diastolic BP was 85 mm Hg .  Blood pressure was controlled at both 6 and 12 months in 57.2 % ( 95 % CI , 44.8 % to 68.7 % ) of patients in the telemonitoring intervention group vs 30.0 % ( 95 % CI , 23.2 % to 37.8 % ) of patients in the usual care group ( P = .001 ) . At 18 months ( 6 months of postintervention follow-up ) , BP was controlled in 71.8 % ( 95 % CI , 65.0 % to 77.8 % ) of patients in the telemonitoring intervention group vs 57.1 % ( 95 % CI , 51.5 % to 62.6 % ) of patients in the usual care group ( P = .003 ) . Compared with the usual care group , systolic BP decreased more from baseline among patients in the telemonitoring intervention group at 6 months ( -10.7 mm Hg [ 95 % CI , -14.3 to -7.3 mm Hg ] ; P<.001 ) , at 12 months ( -9.7 mm Hg [ 95 % CI , -13.4 to -6.0 mm Hg ] ; P<.001 ) , and at 18 months ( -6.6 mm Hg [ 95 % CI , -10.7 to -2.5 mm Hg ] ; P = .004 ) . Compared with the usual care group , diastolic BP decreased more from baseline among patients in the telemonitoring intervention group at 6 months ( -6.0 mm Hg [ 95 % CI , -8.6 to -3.4 mm Hg ] ; P<.001 ) , at 12 months ( -5.1 mm Hg [ 95 % CI , -7.4 to -2.8 mm Hg ] ; P<.001 ) , and at 18 months ( -3.0 mm Hg [ 95 % CI , -6.3 to 0.3 mm Hg ] ; P = .07 ) . CONCLUSIONS AND RELEVANCE Home BP telemonitoring and pharmacist case management achieved better BP control compared with usual care during 12 months of intervention that persisted during 6 months of postintervention follow-up . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00781365 BACKGROUND Half of patients with hypertension have poor  blood pressure ( BP ) control . Recent models for treating hypertension have integrated disease monitoring and telephone-based interventions delivered in patients ' homes . This study evaluated the costs of the Hypertension Intervention Nurse Telemedicine Study ( HINTS ) , aim ed to improve BP control  in veterans . METHODS Eligible veterans were r and omized to either  usual care  or 1 of 3 telephone-based intervention groups using home BP telemonitoring : ( 1 ) behavioral management , ( 2 ) medication management , or ( 3 ) combined . Intervention costs were derived from information collected during the trial . Direct medical costs ( inpatient , outpatient , and outpatient pharmacy , including hypertension-specific pharmacy ) at 18 months by group were calculated using Veterans Affairs ( VA ) Decision Support System data . Bootstrapped CIs were computed to compare intervention and medical costs between intervention groups and usual care . RESULTS Patients receiving behavior or medication management showed significant gains in BP control at 12 months ; there were no differences in BP control at 18 months . In subgroup analysis , patients with poor baseline BP control receiving combined intervention significantly improved BP at 12 and 18 months . In overall and subgroup sample s , average intervention costs were similar in the 3 study arms , and at 18 months , there were no statistically significant differences in direct VA medical costs or total VA costs between treatment arms and usual care . CONCLUSIONS To optimize investment in telephone-based home interventions such as the HINTS , it is important to identify groups of patients who are most likely to benefit from more intensive home BP management BACKGROUND Rising concern over the poor level of blood-pressure ( BP ) control among hypertensive patients has prompted search es for novel ways of managing hypertension . The objectives of this study were to develop and pilot-test a home BP tele-management system that actively engages patients in the process of care . METHODS Phase 1 involved a series of focus-group meetings with patients and primary care providers to guide the system 's development . In Phase 2 , 33 diabetic patients with uncontrolled ambulatory hypertension were enrolled in a 4-month pilot study , using a before- and -after design to assess its effectiveness in lowering BP , its acceptability to users , and the reliability of home BP measurements . RESULTS The system , developed using commodity hardware , comprised a Bluetooth-enabled home BP monitor , a mobile phone to receive and transmit data , a central server for data processing , a fax-back system to send physicians ' reports , and a  BP alerting system . In the pilot study , 24-h ambulatory BP fell by 11/5 ( + /-13/7 SD ) mm Hg ( both P < .001 ) , and BP control improved significantly . Substantially more home readings were received by the server than expected , based on the preset monitoring schedule . Of 42 BP alerts sent to patients , almost half ( n = 20 ) were due to low BP . Physicians received no critical BP alerts . Patients perceived the system as acceptable and effective . CONCLUSIONS The encouraging results of this study provide a strong rationale for a long-term , r and omized , clinical trial to determine whether this home BP tele-management system improves BP control in the community among patients with uncontrolled hypertension
TC led to a greater decrease in systolic and diastolic BP  than UC .
The differences between TC and UC for systolic BP tend to become larger when no treatment modification is applied .
TC seems a valuable tool for hypertension management
There is an increasing interest for using telecare(TC ) in the management of hypertension .