Effect of Home Blood Pressure Telemonitoring With Self-Care Support on Uncontrolled Systolic Hypertension in Diabetics.

Hypertension. 2012 May 21. Logan AG, Irvine MJ, McIsaac WJ, Tisler A, Rossos PG, Easty A, Feig DS, Cafazzo JA. Prosserman Centre for Health Research, Samuel Lunenfeld Research Institute, Department of Medicine, and University Health Network, Granovsky Gluskin Family Medicine Centre, Mount Sinai Hospital Toronto, Ontario, Canada; Department of Family and Community Medicine, Institute of Health Policy, Management, and Evaluation, and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada; Department of Psychology, York University, Toronto, Ontario, Canada; 1st Department of Medicine, Semmelweis University, Budapest, Hungary.

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 randomized, controlled trial in diabetic patients with uncontrolled systolic hypertension. Of 244 subjects screened for eligibility, 110 (45%) were randomly 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 mm Hg (SD; P<0.0001), and the mean between-group difference was 7.1±2.3 mm Hg (SE; P<0.005). Furthermore, 51% of intervention subjects achieved the guideline recommended target of <130/80 mm Hg 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.

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