Blood pressure monitoring and virtual care from a pharmacist

Can home blood pressure monitoring and virtual care from a pharmacist help keep hypertension in check?

According to the Electronic Blood Pressure (e-BP) study, reported in the June 25 issue of the Journal of the American Medical Association, home blood pressure monitoring in combination with assistance from a pharmacist via secure Web communications considerably improved blood pressure control in hypertensive subjects.

The e-BP study, a randomized, controlled trial funded by the National Heart, Lung, and Blood Institute, included 778 Group Health patients, aged 25 to 75 years, with uncontrolled hypertension. Study participants were required to have Internet access and were randomly assigned to 1 of 3 groups: (1) usual care; (2) home blood pressure monitoring and secure patient Website training; or (3) home blood pressure monitoring and secure patient Website training plus pharmacist-assisted care delivered through Web communications.

"To our knowledge, this is the first large randomized controlled trial to use Web-based care and a patient-shared electronic medical record to improve treatment outcomes of a chronic disease," said the study's lead investigator Beverly B. Green, MD, MPH, a family doctor and researcher at Group Health. "We shifted health care from the doctor's office to where people live: in their homes-and online," she added.

Web-based care nearly doubled the percentage of people whose blood pressure was controlled (under 140/90 mm Hg), Dr Green said. "And in the people with the highest blood pressure (at least 160 mm Hg systolic), who are usually hardest to treat, this Web-based care nearly tripled the proportion whose hypertension was under control."

"Secure e-mail communication made it easier for the health care team to work closely with patients to improve care," Dr Green said. "The Web-based care from pharmacists and regular home blood pressure monitoring helped get nearly twice as many patients under control, with average blood pressure drops of 14 points systolic and 7 points diastolic."

"Patients may visit their doctors once a year, or less often," Dr Green said. "But their blood pressure can be out of control between visits. So patients should be involved in their care and take their own blood pressure more often, at home."

Around 1 in 3 US adults have diagnosed hypertension, Dr Green said, and fewer than half of them have their blood pressure under control. Blood pressure also tends to rise with age and weight, so this disease is becoming more prevalent as Americans grow older and heavier. Because uncontrolled hypertension can lead to stroke, heart attacks, heart failure, kidney disease, and a myriad of other disorders, blood pressure control is imperative. More studies are needed to determine whether the e-BP method of keeping blood pressure in check can decrease costs and also be applied to other chronic diseases.