Clinical InvestigationHypertensionManaging hypertension in urban underserved subjects using telemedicine—A clinical trial
Section snippets
Methods
We conducted a randomized, controlled trial to test the hypothesis that self-monitoring of BP and an Internet- and telephone-based communication system will allow more patients to reach goal BP compared with usual care. We studied an urban population comprised mainly of African Americans with a high incidence of both hypertension and diabetes. Subjects were recruited from Temple University Medical Center in Philadelphia, Pennsylvania, and Christiana Health Care Center in Wilmington, Delaware,
Results
The study was conducted over a 4-year period. We recruited 241 subjects, of which 206 completed the 6-month study. Figure shows a flow diagram of the recruiting process. After screening, 241 patients were randomized into 121 controls and 120 telemedicine subjects. Table I shows the demographic characteristics of the subjects. African American subjects represented about 80% of the study population. Sixty-five percent were female, more than 50% had family incomes at or near the poverty level, and
Discussion
We tested a telephone- and Internet- based hypertension self-monitoring intervention for BP control in an urban underserved population. Although more than 50% of subjects in the telemedicine group achieved the goal BP of <140 mm Hg, the control group demonstrated a similar proportion of patients reaching the goal BP. Although the primary end point was not achieved because of improved BP in the control group, the magnitude of the BP change was greater in the telemedicine group. This finding
Summary
In asymptomatic hypertensive individuals, engagement with a health care system was successful in reducing BP. Telemedicine appears to have little advantage, except in nondiabetic patients who showed a substantial improvement in BP control compared with control subjects. The increased number of antihypertensive medications noted in the telemedicine subjects suggests that physician reminders are an important part of hypertension management. The observation that BP was also reduced in the control,
Conclusion
In a community of low-income, underserved urban subjects with a high incidence of hypertension, we demonstrated that minimal engagement with a system of care resulted in a significant reduction of BP. Internet- and telephone-based communications coupled with self-measured BP and physician reminders showed a distinct advantage over usual care in asymptomatic nondiabetic subjects.
References (33)
- et al.
Racial differences in two self-management hypertension interventions
Am J Med
(2011) - et al.
Telecommunications system for monitoring and counseling patients with hypertension: impact on medication adherence and BP control
Am J Hypertens
(1996) - et al.
Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial
Lancet
(2010) - et al.
Reducing cardiovascular disease risk in medically underserved urban and rural communities
Am Heart J
(2011) - et al.
Racial/Ethnic differences in hypertension and hypertension treatment and control in the Multi-Ethnic Study of Atherosclerosis (MESA)
Am J Hypertens
(2004) - et al.
Heart disease and stroke statistics—2011 update: a report from the American Heart Association
Circulation
(2011) - et al.
Coronary heart disease risk factors and attributable risks in African-American women and men: NHANES I epidemiologic follow-up study
Am J Public Health
(1998) - et al.
Trends and disparities in coronary heart disease, stroke, and other CVDs in the United States: findings of the national conference on CVD prevention
Circulation
(2000) - et al.
Slowdown in the decline of stroke mortality in the United States, 1978-1986
Stroke
(1990) - et al.
Divergence of the recent trends in coronary mortality for the four major race-sex groups in the United States
Am J Public Health
(1988)
Contribution of major disease to disparities in mortality
N Engl J Med
Home monitoring service improves mean arterial pressure in patients with essential hypertension. A randomized, controlled trial
Ann Intern Med
Relationship between the frequency of BP self-measurement and BP reduction with antihypertensive therapy: results of the OLMETEL (OLMEsartan TELemonitoring BP) study
Clin Drug Investig
BP telemonitoring is useful to achieve BP control in inadequately treated patients with arterial hypertension
J Hum Hypertens
Effect of home BP telemonitoring with self-care support on uncontrolled systolic hypertension in diabetics
Hypertension
Finding common ground: patient-centeredness and evidence-based chronic illness care
J Altern Complement Med
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This work was supported by a grant from the Agency for Healthcare Quality and Research.
Clinical trial no. NCT00644267.