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      Long-term Outcomes of the Effects of Home Blood Pressure Telemonitoring and Pharmacist Management on Blood Pressure Among Adults With Uncontrolled Hypertension : Follow-up of a Cluster Randomized Clinical Trial

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          Abstract

          Key Points Question How long does blood pressure remain lower compared with usual care after a 12-month intensive intervention (home telemonitoring and pharmacist management)? Findings In this follow-up of a cluster randomized trial of 326 patients with uncontrolled hypertension, research clinic measurements showed that home blood pressure telemonitoring with pharmacist management lowered blood pressure more than usual care in the first 18 months, but this was not sustained through 54 months. The results from routine clinical measurements suggested significantly lower blood pressure in the intervention group for up to 24 months. Meaning Long-term maintenance strategies may be needed to sustain blood pressure intervention effects over several years.

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          Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context.

          R. Collins, R. Peto, S MacMahon … (1990)
          There are 14 unconfounded randomised trials of antihypertensive drugs (chiefly diuretics or beta-blockers): total 37,000 individuals, mean treatment duration 5 years, mean diastolic blood pressure (DBP) difference 5-6 mm Hg. In prospective observational studies, a long-term difference of 5-6 mm Hg in usual DBP is associated with about 35-40% less stroke and 20-25% less coronary heart disease (CHD). For those dying in the trials, the DBP difference had persisted only 2-3 years, yet an overview showed that vascular mortality was significantly reduced (2p less than 0.0002); non-vascular mortality appeared unchanged. Stroke was reduced by 42% SD 6 (95% confidence interval 35-50%; 289 vs 484 events, 2p less than 0.0001), suggesting that virtually all the epidemiologically expected stroke reduction appears rapidly. CHD was reduced by 14% SD 5 (95% CI 4-22%; 671 vs 771 events, 2p less than 0.01), suggesting that just over half the epidemiologically expected CHD reduction appears rapidly. Although this significant CHD reduction could well be worthwhile, its size remains indefinite for most circumstances (though beta-blockers after myocardial infarction are of substantial benefit). At present, therefore, a sufficiently high risk of stroke (perhaps because of age, blood pressure, or, in particular, history of cerebrovascular disease) may be the clearest indication for antihypertensive treatment.
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            Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials

            (2003)
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              Team-based care and improved blood pressure control: a community guide systematic review.

              Krista K. Proia, Anilkrishna B Thota, Gibril Njie … (2014)
              Uncontrolled hypertension remains a widely prevalent cardiovascular risk factor in the U.S. team-based care, established by adding new staff or changing the roles of existing staff such as nurses and pharmacists to work with a primary care provider and the patient. Team-based care has the potential to improve the quality of hypertension management. The goal of this Community Guide systematic review was to examine the effectiveness of team-based care in improving blood pressure (BP) outcomes.
              Article 0 comments Cited 76 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: JAMA Network Open
                Abbreviated Title: JAMA Network Open
                Publisher: American Medical Association (AMA)
                ISSN (Electronic): 2574-3805
                Publication date Created: September 07 2018
                Publication date (Print): September 07 2018
                Volume: 1
                Issue: 5
                Page: e181617
                Affiliations
                [1 ]HealthPartners Institute for Education and Research, Minneapolis, Minnesota
                [2 ]Kaiser Permanente Washington Health Research Institute, Seattle
                Article
                DOI: 10.1001/jamanetworkopen.2018.1617
                SO-VID: 2e135aca-2b44-4b23-b8b9-44c3ecbbfeff
                Copyright © © 2018
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