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Controlling Hypertension with Web-Based Communication
Involvement of healthcare professionals — but not necessarily physicians — still was important.
Only one third of patients with clinically significant hypertension achieve adequate control. A solution to this problem might lie in Web-based care. Researchers at a large integrated group practice recruited 730 patients (mean age, 59; mostly white and well educated) with Internet access and uncontrolled hypertension (diastolic blood pressure [BP] between 90 and 109 mm Hg, or systolic BP between 140 and 199 mm Hg; generally taking at least one hypertension medication). They were randomized to usual care, to home BP monitoring (with Web-based communication, or to the latter intervention plus involvement of a pharmacist. Web-based communication included secure e-mail, e-prescribing, and resources about lifestyle modification. Pharmacists provided telephone and Web-based consultations and prepared medication action plans.
At 12 months of follow-up, investigators observed no difference in BP control between usual-care patients and those who received home BP monitoring and Web-based support: In both groups, roughly 30% to 35% of patients attained BPs of 
140/90 mm Hg. In contrast, 56% of patients who received pharmacist care achieved this degree of control, which was a significant improvement over the other groups. Mean systolic and diastolic BP decreased by 14 and 7 mm Hg, respectively, in the pharmacist-care group, compared with 5 to 8 mm Hg and 4 mm Hg, respectively, in the other groups.
Comment: As editorialists note, these study participants were atypical, in that they were relatively young, mostly white, and highly educated. However, the results show that successful strategies for chronic disease management often involve new approaches to communication and changes in healthcare systems that have little to do with office-based care provided by physicians. Indeed, a recent joint scientific statement calls for HBPM as a routine component of care for most hypertensive patients (JW Jun 24 2008)
Published in Journal Watch General Medicine June 24, 2008
Citation(s):
Green BB et al. Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: A randomized controlled trial. JAMA 2008 Jun 25; 299:2857.
- Original article (Subscription may be required)
- Medline abstract (Free)
Jones DW and Peterson ED. Improving hypertension control rates: Technology, people, or systems? JAMA 2008 Jun 25; 299:2896.
- Original article (Subscription may be required)
- Medline abstract (Free)