Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. Comparative effectiveness of home blood pressure telemonitoring (HBPTM) plus nurse case management versus HBPTM alone among Black and Hispanic stroke survivors: study protocol for a randomized controlled trial Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study The rationale and design of reduction of uncontrolled hypertension by Remote Monitoring and Telemedicine (REMOTE) study Economic evaluation of home blood pressure telemonitoring: A randomized controlled trial Effectiveness of home telehealth in comorbid diabetes and hypertension: a randomized, controlled trial. Blood pressure control during telemonitoring of home blood pressure. A randomized controlled trial during 6 months Mixed methods feasibility study for a trial of blood pressure telemonitoring for people who have had stroke/transient ischaemic attack (TIA) Feasibility of blood pressure telemonitoring in patients with poor blood pressure control Home blood pressure telemonitoring improves hypertension control in general practice. The TeleBPCare study Telemonitoring and Protocolized Case Management for Hypertensive Community-Dwelling Seniors With Diabetes: Protocol of the TECHNOMED Randomized Controlled Trial Using simple telehealth in primary care to reduce blood pressure: a service evaluation Effect of Home Blood Pressure Telemonitoring With Self-Care Support on Uncontrolled Systolic Hypertension in Diabetics Outcomes of a home telehealth intervention for patients with diabetes and hypertension. Hypertension Intervention Nurse Telemedicine Study (HINTS): testing a multifactorial tailored behavioral/educational and a medication management intervention for blood pressure control. Effect of home telehealth care on blood pressure control: A public healthcare centre model Telemonitoring-based service redesign for the management of uncontrolled hypertension (HITS): cost and cost-effectiveness analysis of a randomised controlled trial
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 Black and Hispanic stroke survivors experience higher rates of recurrent stroke than whites . This disparity is partly explained by disproportionately higher rates of uncontrolled hypertension in these population s. Home blood pressure telemonitoring ( HBPTM ) and nurse case management ( NCM ) have proven efficacy in addressing the multilevel barriers to blood pressure ( BP ) control and reducing BP . However , the effectiveness of these interventions has not been evaluated in stroke patients . This study is design ed to evaluate the comparative effectiveness , cost-effectiveness and sustainability of these two telehealth interventions in reducing BP and recurrent stroke among high-risk Black and Hispanic stroke survivors with uncontrolled hypertension . Methods / Design A total of 450 Black and Hispanic patients with recent nondisabling stroke and uncontrolled hypertension are r and omly assigned to one of two 12-month interventions : 1 ) HBPTM with wireless feedback to primary care providers or 2 ) HBPTM plus individualized , culturally-tailored , telephone-based NCM .  Patients are recruited from stroke centers and primary care practice s within the Health and Hospital Corporations ( HHC ) Network in New York City . Study visits occur at baseline , 6 , 12 and 24 months . The primary outcomes are within-patient change in systolic BP at 12 months , and the rate of stroke recurrence at 24 months . The secondary outcome is the comparative cost-effectiveness of the interventions at 12 and 24 months ; and exploratory outcomes include changes in stroke risk factors , health behaviors and treatment intensification . Recruitment for the stroke telemonitoring hypertension trial is currently ongoing . Discussion The combination of two established and effective interventions along with the utilization of health information technology supports the sustainability of the HBPTM + NCM intervention and feasibility of its widespread implementation . Results of this trial will provide strong empirical evidence to inform clinical guidelines for management of stroke in minority stroke survivors with uncontrolled hypertension . If effective among Black and Hispanic stroke survivors , these interventions have the potential to substantially mitigate racial and ethnic disparities in stroke recurrence . Trial registration Clinical Trials.gov NCT02011685 . Registered 10 December 2013 Objectives To explore the experiences of patients and professionals taking part in a r and omised controlled trial ( RCT ) of remote blood pressure ( BP ) telemonitoring supported by primary care . To identify factors facilitating or hindering the effectiveness of the intervention and those likely to influence its potential translation to routine practice . Design Qualitative study adopting a qualitative descriptive approach . Participants 25 patients , 11 nurses and 9 doctors who were participating in an RCT of BP telemonitoring .  A maximum variation sample of patients from within the trial based on age , sex and deprivation status of the practice was sought . Setting 6 primary care practice s in Scotl and . Method Data were collected via taped semistructured interviews . Initial thematic analysis was inductive . Multiple strategies were employed to ensure that the analysis was credible and trustworthy . Results Prior to the trial , both patients and professionals were reluctant to increase the medication based on single BP measurements taken in the surgery . BP measurements based on multiple electronic readings were perceived as more accurate as a basis for action . Patients using telemonitoring became more engaged in the clinical management of their condition . Professionals reported that telemonitoring challenged existing roles and work practice s and increased workload . Lack of integration of telemonitoring data with the electronic health record was perceived as a drawback . Conclusions BP telemonitoring in a usual care setting can provide a trusted basis for medication management and improved BP control . It increases patients ’ engagement in the management of their condition , but supporting telemetry and greater patient engagement can increase professional workloads and dem and changes in service organisation . Successful service design in practice would have to take account of how additional roles and responsibilities could be realigned with existing work and data management practice s. The embedded qualitative study was included in the protocol for the HITS trial registered with IS RCT N no. 72614272 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 Abstract Aims . The purpose of the present study was to compare the costs of  home blood pressure ( BP ) telemonitoring ( HBPM )  with the costs of conventional office BP monitoring . In a r and omized controlled trial , 105 hypertensive patients performed HBPM and 118 patients received usual care with conventional office BP monitoring  during 6 months . Costs were quantified from the healthcare perspective . Non-parametric simulations were performed to quantify the uncertainty around the mean estimates and cost-effectiveness acceptability curves were made . Major findings . Systolic and diastolic daytime and night-time ambulatory BP ( ABP ) were reduced in both groups . The uncertainty around the incremental cost effectiveness ratio point estimates was considerable for both systolic and diastolic ABP . For systolic ABP , the difference in cost effectiveness ratio between the two groups was 256 Danish kroner (DKK)/mmHg [ 95 % uncertainty interval , UI −860 to 4544 ] . For diastolic ABP , the difference in cost effectiveness ratio between the two groups was 655 DKK/mmHg [ 95 % UI −674 to 69315 ] . Medication and consultation costs were lowest in the intervention group , but were offset by the cost of the telemonitoring equipment . Conclusions . Cost-effectiveness analysis showed that telemonitoring of home BP was more costly compared with usual monitoring of office BP . The cost-effectiveness result is surrounded with considerable uncertainty . Trial registration : Clinical Trials.gov identifier : NCT282334 BACKGROUND Increased emphasis is being placed on the critical need to control hypertension ( HTN ) in patients with diabetes . OBJECTIVE The objective of this study was to evaluate the efficacy of a nurse-managed home telehealth intervention to improve outcomes in veterans with comorbid diabetes and HTN . DESIGN A single-center , r and omized , controlled clinical trial design comparing two remote monitoring intensity levels and usual care in patients with type 2 diabetes and HTN being treated in primary care was used . MEASUREMENTS Primary outcomes were hemoglobin A1c and systolic blood pressure ( SBP ) ; secondary outcome was adherence . RESULTS Intervention subjects experienced decreased A1c during the 6-month intervention period compared with the control group , but 6 months after the intervention was withdrawn , the intervention groups were comparable with the control group . For SBP , the high-intensity subjects had a significant decrease in SBP compared with the other groups at 6 months and this pattern was maintained at 12 months . Adherence improved over time for all groups , but there were no differences among the three groups . LIMITATIONS Subjects had relatively good baseline control for A1c and SBP ; minorities and women were underrepresented . CONCLUSIONS Home telehealth provides an innovative and pragmatic approach to enhance earlier detection of key clinical symptoms requiring intervention . Transmission of education and advice to the patient on an ongoing basis with close surveillance by nurses can improve clinical outcomes in patients with comorbid chronic illness Aim . To compare the effectiveness of antihypertensive treatment based on telemonitoring of home blood pressure ( BP ) and conventional monitoring of office BP . Methods . Hypertensive patients ( n = 236 ) participated in a r and omized , controlled study . In the intervention group , antihypertensive treatment was based on home BP monitoring . BP readings were registered by a PDA and automatically transmitted to a server , by which the patient and doctor could communicate . In the control group , patients received usual care with office visits to adjust antihypertensive treatment as needed . Primary outcome was difference in systolic daytime ambulatory BP monitoring ( ABPM ) change between baseline and 6 months . Results . In both groups , systolic daytime ABPM decreased significantly from baseline to follow‐up . The decrease in systolic daytime ABPM was −11.9 mmHg in the intervention group and −9.6 mmHg in the control group ( mean difference −2.3 [ 95 % CI −6.1 to −1.5 ] , p = 0.225 ) . The likelihood of daytime ABPM normalization was similar in the two groups [ 32/113 ( 28 % ) vs 46/123 ( 37 % ) , p = 0.139 ] . Conclusion . Antihypertensive treatment based on telemonitoring of home BP was as effective as usual monitoring of office BP with regards to reduction of BP . Trial registration : Clinical Trials.gov identifier : NCT00282334 Background Good blood pressure ( BP ) control reduces the risk of recurrence of stroke/transient ischaemic attack ( TIA ) . Although there is strong evidence that BP telemonitoring helps achieve good control , none of the major trials have considered the effectiveness in stroke/TIA survivors . We therefore conducted a feasibility study for a trial of BP telemonitoring for stroke/TIA survivors with uncontrolled BP in primary care . Method Phase 1 was a pilot trial involving 55 patients stratified by stroke/TIA r and omised 3:1 to BP telemonitoring for 6 months or usual care . Phase 2 was a qualitative evaluation and comprised semi-structured interviews with 16 trial participants who received telemonitoring and 3 focus groups with 23 members of stroke support groups and 7 carers . Results Overall , 125 patients ( 60 stroke patients , 65 TIA patients ) were approached and 55 ( 44 % ) patients were r and omised including 27 stroke patients and 28 TIA patients . Fifty-two participants ( 95 % ) attended the 6-month follow-up appointment , but one declined the second daytime ambulatory blood pressure monitoring ( ABPM ) measurement result ing in a 93 % completion rate for ABPM − the proposed primary outcome measure for a full trial . Adherence to  telemonitoring  was good ; of the 40 participants who were  telemonitoring  , 38 continued to provide readings throughout the 6 months . There was a mean reduction of 10.1 mmHg in systolic ABPM in the telemonitoring group compared with 3.8 mmHg in the control group , which suggested the potential for a substantial effect from telemonitoring . Our qualitative analysis found that many stroke patients were concerned about their BP and telemonitoring increased their engagement , was easy , convenient and reassuring . Conclusions A full-scale trial is feasible , likely to recruit well and have good rates of compliance and follow-up . Trial Registration IS RCT N61528726 15/12/2011 We examined the feasibility of using home blood pressure ( BP ) telemonitoring devices for managing patients with poor BP control .  We enrolled 591 subjects with a diagnosis of hypertension . Patients were r and omized to usual care ( n = 147 ) or to the intervention arm ( n = 441 ) . Those in the intervention arm were issued with a home BP telemonitoring device . The device transmitted BP readings automatically via the home telephone line . Technical alerts were generated if patients did not transmit their BP readings according to the protocol . During the first six months , 693 technical alerts were generated by 267 patients . About half of these patients ( 112 ) generated more than two technical alerts . Resolution of the alerts showed that 61 % were caused by patient non-adherence . Patients who generated > 2 technical alerts were younger ( 61 vs. 64 years ; P = 0.001 ) and were more likely to be non-Caucasian  ( 64 % vs. 47 % , P = 0.002 ) than those generating 2 or fewer alerts . Despite the potential for improving health care using home BP telemonitoring , certain patients will require more support to use the equipment successfully Background Self blood pressure monitoring at home may improve blood pressure control and patients ' compliance with treatment , but its implementation in daily practice faces difficulties . Teletransmission facilities may offer a more efficient approach to long-term home blood pressure monitoring . Methods Twelve general practitioners screened 391 consecutive uncontrolled mild – moderate hypertensive patients ( 80 % treated ) , 329 of whom ( 58 ± 11 years , 54 % men ) were r and omized to either usual care on the basis of office blood pressure ( group A , n = 113 ) or to integrated care on the basis of teletransmitted home blood pressure  ( group B , n = 216 ) . Twenty-four-hour ambulatory blood pressure monitoring  was performed at baseline and after 6 months , during which treatment was optimized according to either office ( group A ) or home ( group B ) blood pressure values . We compared differences between groups in the rate of daytime ambulatory blood pressure normalization ( < 130/80 mmHg ) , need of treatment changes during follow-up , quality of life scores , and healthcare costs . Results Baseline office blood pressures were 149 ± 12/89 ± 9 and 148 ± 13/89 ± 7 mmHg in groups A ( n = 111 ) and B ( n = 187 ) respectively , the corresponding daytime values being 140 ± 11/84 ± 8 and 139 ± 11/84 ± 8 mmHg . The percentage of daytime blood pressure normalization was higher in group B ( 62 % ) than in group A ( 50 % ) ( P < 0.05 ) . There were less frequent treatment changes in group B than in group A ( 9 vs. 14 % , P < 0.05 ) . Quality of life tended to be higher and costs lower in group B. Conclusion Patients ' management based on home blood pressure teletransmission led to a better control of ambulatory blood pressure than with usual care , with a more regular treatment regimen 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 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 Lowering blood pressure reduces cardiovascular risk , yet hypertension is poorly controlled in diabetic patients . In a pilot study we demonstrated that a home blood pressure telemonitoring system , which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading , improved blood pressure control . Messages were based on care paths defined by running averages of transmitted readings . The present study tests the system 's effectiveness in a r and omized , controlled trial in diabetic patients with uncontrolled systolic hypertension . Of 244 subjects screened for eligibility , 110 ( 45 % ) were r and omly allocated to the intervention ( n=55 ) or control ( n=55 ) group , and 105 ( 95.5 % ) completed the 1-year outcome visit . In the intention-to-treat analysis , mean daytime ambulatory systolic blood pressure , the primary end point , decreased significantly only in the intervention group by 9.1±15.6 mmHg ( SD ; P<0.0001 ) , and the mean between-group difference was 7.1±2.3 mmHg ( SE ; P<0.005 ) . Furthermore , 51 % of intervention subjects achieved the guideline recommended target of < 130/80 mmHg compared with 31 % of control subjects ( P<0.05 ) . These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians . Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale ( baseline , 4.1±3.76 ; exit , 5.2±4.30 ; P=0.014 ) . This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension  and improved hypertension control . Home blood pressure monitoring alone had no effect on blood pressure . Promoting patient self-care may have negative psychological effects BACKGROUND Home telehealth programs often focus on a single disease , yet many patients who need monitoring have multiple conditions . This study evaluated secondary outcomes from a clinical trial evaluating the efficacy of home telehealth to improve outcomes of patients with co-morbid diabetes and hypertension . SUBJECTS AND METHODS A single-center r and omized controlled clinical trial compared two remote monitoring intensity levels ( low and high ) and usual care in patients with type 2 diabetes and hypertension being treated in primary care . Secondary outcomes assessed were knowledge ( diabetes , hypertension , medications ) , self-efficacy , adherence ( diabetes , medications ) , and patient perceptions of the intervention mode . RESULTS Knowledge scores improved in the high-intensity intervention group participants , but upon further analysis , we found the intervention effect was not mediated by gain in knowledge . No significant differences were found across the groups in self-efficacy , adherence , or patient perceptions of the intervention mode . CONCLUSIONS Home telehealth can enhance detection of key clinical symptoms that occur between regular physician visits . While our intervention improved glycemic and blood pressure control , the mechanism of the effect for this improvement was not clear 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 Objective This study aim ed to evaluate the effectiveness of home telehealth care combined with case management by public health nurses , in improving blood pressure control in patients with hypertension . Methods This cohort study examined the data of patients with hypertension obtained from a telehealth service centre data base , between July 2011– June 2012 . Eligible patients were adults ( ≥40 years old ) with both prehypertension and hypertension , living alone or in the remote suburbs of metropolitan areas . Demographic data were collected from 12 district public health centre in Taipei , Taiwan . Following enrolment , patients received an appropriate and vali date d home telehealth device kit for automatic blood pressure monitoring and automated modem via a telephone line or a desktop computer with Internet connection to enable data transmission between the patient ’s home and telehealth service centre . Patients were instructed to upload the measured data immediately every day . The study outcomes included blood pressure and home telehealth service utilisation . Results Of the 432 patients recruited , 408 ( 94 % ) completed data collection . Linear regression analysis found an average 22.1 mm Hg reduction in systolic blood pressure after one year . The mean slope of systolic blood pressure was classified as decreased or non-decreased . An systolic blood pressure decreasing trend was observed in 52.2 % patients , while 47.8 % patients showed an increasing systolic blood pressure trend . Patients in the decreased systolic blood pressure group tended to be older ( p = 0 . 0001 ) , with a greater proportion of hypertension alarms ( p = 0 . 001 ) , improved self-blood pressure monitoring behaviour ( p = 0.009 ) and higher self-measured blood pressure monitoring frequency ( p = 0 . 010 ) . Patients in the decreased systolic blood pressure group had a higher self-measured blood pressure monitoring frequency ( odds ratio = 0.95 , 95 % confidence interval , 0.91–0.99 , p = 0 . 013 ) than their counterparts . Conclusions Home telehealth care combined with care management by public health nurses based in public health care centre was feasible and effective for improving blood pressure control among patients with hypertension . Further studies should conduct a thorough analysis of the cost-effectiveness of this intervention . A r and omised controlled trial with a longer follow-up period is required to examine the effects of the improved home telehealth device kit on the care of patients with hypertension Objectives To compare the costs and cost-effectiveness of managing patients with uncontrolled blood pressure ( BP ) using telemonitoring versus usual care from the perspective of the National Health Service ( NHS ) . Design Within trial post hoc economic evaluation of data from a pragmatic r and omised controlled trial using an intention-to-treat approach . Setting 20 socioeconomically diverse general practice s in Lothian , Scotl and . Participants 401 primary care patients aged 29–95 with uncontrolled daytime ambulatory blood pressure ( ABP ) ( ≥135/85 , but < 210/135 mm Hg ) . Intervention Participants were central ly r and omised to 6 months of a telemonitoring service comprising of self-monitoring of BP transmitted to a secure website for review by the attending nurse/doctor and patient , with optional automated patient decision-support by text/email ( n=200 ) or usual care ( n-201 ) . R and omisation was undertaken with minimisation for age , sex , family practice , use of three or more hypertension drugs and self-monitoring history . Main outcome measures Mean difference in total NHS costs between trial arms and blinded assessment of mean cost per 1 mm Hg systolic BP point reduced .  Results Home telemonitoring of BP costs significantly more than usual care ( mean difference per patient £ 115.32 ( 95 % CI £ 83.49 to £ 146.63 ; p<0.001 ) ) . Increased costs were due to telemonitoring service costs , patient training and additional general practitioner and nurse consultations . The mean cost of systolic BP reduction was £ 25.56/mm Hg ( 95 % CI £ 16.06 to £ 46.89 ) per patient . Conclusions Over the 6-month trial period , supported telemonitoring was more effective at reducing BP than usual care but also more expensive . If clinical gains are maintained , these additional costs would be very likely to be compensated for by reductions in the cost of future cardiovascular events . Longer-term modelling of costs and outcomes is required to fully examine the cost-effectiveness implication s. Trial registration International St and ard R and omised Controlled Trials , number IS RCT N72614272
For those surrogate outcomes , low-strength evidence failed to show difference .
In subgroup analysis , high strength evidence supported a lower BP with HBPT that lasted for 6 or 12 months and was accompanied with counselling support from study personnel .
HBPT can improve BP control in the hypertensive patients .
It may be more efficacious when a proactive additional support is provided during the intervention process
To summarise evidence about the effectiveness of home blood pressure telemonitoring ( HBPT )  and identify the key components of intervention .