Posted By Clod on January 20, 2012
Automatic monitoring of blood pressure (BP) in patients’ homes, with weekly reports to physicians, was effective in reducing BP levels, according to a report published in the June 5 issue of the Annals of Internal Medicine. Patients who had automatic BP monitoring in this randomized, controlled clinical trial had reduced readings compared to a control group of patients who received “usual care,” and the benefits were particularly striking for African-American patients.
High blood pressure (HBP) is very common in adults, and is under-diagnosed and under-treated. It is a major risk factor in the causation of heart disease, stroke, and kidney disease, and it is more common in the African-American population. Treatments include diet, exercise, and medications. Yet, despite its potentially devastating sequelae, many HBP patients are not adequately treated: their BP remains elevated.
In recent years, doctors have recommended that HBP patients monitor their BP at home. While this is easy to do in theory, in actuality there have been substantial differences between BP measured electronically and that reported by patients themselves. It has also been shown that 24-hour BP measurement is far more accurate than occasional measurements taken by patients.
To obtain more accurate readings, Mary A.M. Rogers, Ph.D., M.S., and her colleagues at the State University of New York-Upstate Medical University in Syracuse designed a randomized, controlled trial utilizing 24-hour automatic ambulatory BP monitoring (ABPM) at baseline and at the study termination 8 weeks later, to determine BP levels and changes in those levels more accurately.
Sixty patients with diagnosed HBP were randomized to the study group, which received ABPM with centralized reporting and processing of their BP data, including weekly reports provided to their primary physician — as well as to the patients themselves. The readings were transmitted over telephone lines. Sixty-one patients were randomized to the control group, which received usual care. Their BP treatment was given according to the recommendations of the Joint National Committee on HBP, with BP measurements done at office or clinic visits.
The results showed that BP readings decreased for the study patients, but increased or remained the same for the control group. Mean (average) diastolic pressure, the lower number, decreased 2.0 mm in the study group, but increased by 2.1 mm in the controls; mean systolic (higher number) decreased 4.9 mm in the ABPM group, but increased 0.1 mm in the controls. The differences were even more significant in the African-American patients. The main reason for the difference, according to the study authors, was more frequent changes in type and dose of BP medications in the study patients.
In this randomized, controlled trial, a telecommunication service utilizing ABPM was effective in decreasing BP in patients with established HBP. BP decreased in patients who used the service, while it worsened in patients receiving usual care. The authors state, “[A]ccurate and timely information is an essential cornerstone for the provision of quality medical care. Technological advances…must be tested and, if efficacious, be made available. Our results suggest that this telecommunications service may be a useful adjunct to antihypertensive therapy and warrants investigation in larger study samples.”
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