June 24, 2008 High blood pressure (hypertension)
is the leading chronic disease among senior citizens but a new treatment
method has achieved significant results in improving the control of
blood pressure. The patients who monitored their blood pressure from
home and received Web-based pharmacist care and training showed greater
improvement in blood pressure control than patients who received usual
care.
Hypertension (high blood pressure) is one of the
leading causes of death worldwide. Almost 1 in 3 U.S. adults has
hypertension, defined as a sustained systolic and diastolic blood
pressure (BP) of 140 and 90 mm Hg or higher, respectively.
Lowering BP with antihypertensive medications
decreases the risk of death and major disability from cardiovascular and
kidney disease, but hypertension remains inadequately treated in the
majority of affected individuals, according to background information in
the report on the study that appears in the June 25 issue of the Journal
of the American Medical Association.
Electronic medical records (EMRs) and secure
patient Web sites increasingly allow patients to view portions of their
medical records, access health care services and communicate with their
health care team online. However, there has been little research into
the effectiveness of Web services in the care of chronic conditions.
Beverly B. Green, M.D., M.P.H., of the Group Health
Center for Health Studies, Seattle, and colleagues tested whether
hypertension care could be successfully provided remotely over the Web
without in-person clinic visits.
The trial included 778 participants age 25 to 75
years who had uncontrolled hypertension and who also had Internet
access.
Care was delivered over a secure patient Web site
from June 2005 to December 2007. The Web site included online services
such as patients being able to send email to their physician, refilling
prescriptions, requesting appointments, getting test results and looking
up health information.
Participants were randomly assigned to -
> usual care,
> home BP monitoring and secure patient Web site training only, or
> home BP monitoring, secure patient Web site training, plus care
management by a pharmacist delivered through Web communications.
Of 778 patients, 730 (94 percent) completed the
1-year follow-up visit.
The goal was the achieve controlled blood pressure
(BP), which was defined as systolic BP less than 140 mm Hg and
diastolic BP less than 90 mm Hg.
The researchers found that compared with patients
receiving usual care, the group with home BP monitoring and Web
training only had a modest (nonsignificant) increase in the
percentage of patients achieving controlled BP.
The addition of Web-based pharmacist care to
home BP monitoring and Web training resulted in 25 percent more
patients with controlled BP (56%) compared with those receiving usual
care. Although, 31% of those in usual care achieved controlled BP.
The Web pharmacist-home monitoring-Web training
group also had 20 percent more patients with controlled BP than the
home BP monitoring and Web training only group, which had 36 percent
achieve controlled BP.
Compared
with usual care, greater reductions in systolic BP occurred in the group
receiving home BP monitoring and Web training plus pharmacist care and
in the group receiving home BP monitoring and Web training only.
The group receiving home BP monitoring and Web
training plus pharmacist care also had a significant decrease in
diastolic BP compared with the group receiving usual care.
For the group with baseline systolic BP of 160 mm
Hg or higher, the group receiving home BP monitoring and Web training
plus pharmacist care had 3.3 times more patients with BP in control,
compared with usual care.
We believe the pharmacists were successful because
they provided planned care to a defined population, consistently applied
stepped medication protocols, and used comprehensive information
systems, a patient-shared EMR, and Web communications to collaborate
with patients and their physicians, the authors write.
Our findings demonstrate the effectiveness of
using home BP monitoring combined with pharmacy care over the Web to
improve BP control for patients with essential hypertension. More
studies are needed to determine whether similar care can be applied to
other chronic diseases, be implemented in other settings, and decrease
costs.
Editorial: Improving hypertension control rates
- technology, people, or systems?
In an accompanying editorial, Daniel W. Jones,
M.D., of the University of Mississippi Medical Center, Jackson, and
president of the American Heart Association, and Eric D. Peterson, M.D.,
M.P.H., of the Duke Clinical Research Institute, Durham, N.C., and
Contributing Editor, JAMA, comment on the findings of Green and
colleagues.
...it is clear that the current office-based,
physician-centric model for BP treatment has not achieved desired rates
for BP control. The study by Green and colleagues demonstrates that even
early versions of Web and home BP monitoring technologies can facilitate
better BP control if and when they are integrated with receptive
clinical personnel.
While certainly more work will be needed to refine
these models, the future of BP management has taken a significant turn
for the better. By finding new tools, ensuring appropriate use by
patients and clinicians, and integrating these systems into clinical
practice, it will be possible to achieve more effective and
cost-effective BP control, and ultimately to save lives.
Keep up with the latest news for senior citizens, baby
boomers
Compared
with usual care, greater reductions in systolic BP occurred in the group
receiving home BP monitoring and Web training plus pharmacist care and
in the group receiving home BP monitoring and Web training only. 