Telemonitoring cuts cardiovascular events in adults with uncontrolled hypertension

Reuters Health - 01/09/2020 - Adults with uncontrolled hypertension may be half as likely to experience cardiovascular events such as myocardial infarction or cardiac arrest when they participate in a home blood pressure telemonitoring and pharmacist monitoring program, a new study suggests.

Researchers conducted a cluster randomized trial at 16 primary care clinics, assigning 228 adults with uncontrolled hypertension to receive 12 months of home blood pressure telemonitoring and pharmacist management while a control group of 222 similar patients received usual care for uncontrolled hypertension. Researchers looked at a composite endpoint for cardiovascular events over five years: nonfatal myocardial infarction, nonfatal stroke, hospitalized heart failure, coronary revascularization, and cardiovascular death. They also examined costs of care.

At the end of the study period, there were 15 cardiovascular events in the telemonitoring intervention group, compared with 26 in the control group. That translated into a cardiovascular composite endpoint incidence rate of 4.4% in the intervention group compared with 8.6% in the control group (odds ratio 0.49, p=0.09).

"No previous study has directly connected home blood pressure telemonitoring and pharmacist care with preventing cardiovascular events," said lead study author Dr. Karen Margolis, executive director for research at the HealthPartners Institute in Minneapolis, Minnesota.

"We think that home blood pressure monitoring linked with treatment actions by the health care team in between office visits is a model that should be adopted widely," Dr. Margolis said by email.

Over five years, the savings from reduced cardiovascular events exceeded the telemonitoring intervention costs by $1,900 per patient, the researchers report in Hypertension.

Patients assigned to the telemonitoring intervention group measured their blood pressure at home and sent it electronically to pharmacists who made medication adjustments and recommended lifestyle modifications to help manage hypertension.

In both the intervention and control groups, researchers monitored blood pressure at enrollment, 6 months, 12 months, 18 months and 5 years; kept track of any heart attacks, strokes, coronary stents, heart failure hospitalizations and heart-related deaths that occurred; and counted all the costs of blood pressure-related care and cardiovascular event care.

The 15 cardiovascular events in the telemonitoring group included 5 non-fatal heart attacks, 4 non-fatal strokes, 5 heart failure hospitalizations, and 1 cardiovascular death among 10 patients.

In the control group, there were 26 cardiovascular events including 11 non-fatal heart attacks, 12 non-fatal strokes, and 3 heart failure hospitalizations among 19 patients.

One limitation of the study is that results from predominantly white patients in a single health system may not be generalizable to other populations, the study team notes. The reduction in cardiovascular events associated with telemonitoring also wasn't statistically significant, and the study also didn't measure the potential impact of pharmacist interventions on other risk factors for cardiovascular events like cholesterol or smoking status.

"The reduction in cardiovascular events, while impressive, was not statistically significant, and as such, follow up with a more appropriate trial design and patient numbers is needed," Dr. Costantino Iadecola, director and chair of the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine in New York City said by email.

But the model still has potential for the treatment of hypertension, Dr. Iadecola, who wasn't involved in the study, said by email.

Other studies have found blood pressure telemonitoring with support from other allied health professionals can be effective for managing hypertension, said Dr. Ian Kronish, associate director of the Center for Behavioral Cardiovascular Health at Columbia University Irving Medical Center in New York City.

"The take home message for clinicians is that home BP telemonitoring with pharmacist management is a very promising approach for getting their patients to goal in a cost-effective manner," Dr. Kronish, who wasn't involved in the study, said by email. "Clinicians might look to their health system leadership to find ways to create similar programs in their health care context."

By Lisa Rapaport

SOURCE: https://bit.ly/34QD937 Hypertension, online August 31, 2020.



Posted on 1 September 20208 September 2020