Effect of Home Blood Pressure Telemonitoring and Pharmacist Management on Blood Pressure Control

Margolis, Karen L.; Asche, Stephen E.; Bergdall, Anna R.; Dehmer, Steven P.; Groen, Sarah; Kadrmas, Holly M.; Kerby, Tessa; Klotzle, Krissa J.; Maciosek, Michael V.; Michels, Ryan; O’Connor, Patrick J.; Pritchard, Rachel; Sekenski, Jaime; Sperl-Hillen, JoAnn M.; Trower, Nicole K.

doi:10.1001/jama.2013.6549

Cited by 498 publications

(544 citation statements)

References 36 publications

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confidence: 99%

“…5 Based on previous studies, 4,8 we hypothesized that patients taking two or fewer antihypertensive medications at study baseline would respond to medication management, but those taking three or more antihypertensive medications would not. We also examined whether differences in treatment intensification might explain any observed variations in the impact of medication management.…”

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confidence: 99%

“…4,8 A recent meta-analysis indicated that, among telemedicine trials reporting the number of prescribed antihypertensive agents, patients took an average of only 1.8 baseline BP medications. 9 Therefore, while the value of telemedicine-based medication management for patients with low antihypertensive drug counts is clear, this approach's impact among highercount patients is not established.…”

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confidence: 99%

“…[13][14][15] In order to explore the uncertain impact of telemedicine-based medication management for patients with high medication counts, we analyzed data from the Hypertension Intervention Nurse Telemedicine Study (HINTS), a trial of telemedicine-based medication management for hypertension. 5 Based on previous studies, 4,8 we hypothesized that patients taking two or fewer antihypertensive medications at study baseline would respond to medication management, but those taking three or more antihypertensive medications would not. We also examined whether differences in treatment intensification might explain any observed variations in the impact of medication management.…”

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confidence: 99%

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Baseline Antihypertensive Drug Count and Patient Response to Hypertension Medication Management

Crowley

Olsen

Woolson

et al. 2015

J of Clinical Hypertension

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Telemedicine-based medication management improves hypertension control, but has been evaluated primarily in patients with low antihypertensive drug counts. Its impact on patients taking three or more antihypertensive agents is not well-established. To address this evidence gap, the authors conducted an exploratory analysis of an 18-month, 591-patient trial of telemedicine-based hypertension medication management. Using general linear models, the effect of medication management on blood pressure for patients taking two or fewer antihypertensive agents at study baseline vs those taking three or more was compared. While patients taking two or fewer antihypertensive agents had a significant reduction in systolic blood pressure with medication management, those taking three or more had no such response. The between-subgroup effect difference was statistically significant at 6 months (À6.4 mm Hg [95% confidence interval, À12.2 to À0.6]) and near significant at 18 months (À6.0 mm Hg [95% confidence interval, À12.2 to 0.2]). These findings suggest that baseline antihypertensive drug count may impact how patients respond to hypertension medication management and emphasize the need to study management strategies specifically in patients taking three or more antihypertensive medications. J Clin Hypertens (Greenwich). 2016;18:322-328. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.Despite widespread recognition that hypertension is a modifiable cardiovascular risk factor, up to half of hypertensive patients have inadequate blood pressure (BP) control.1 Because hypertension causes tremendous morbidity and costs, 2,3 care redesign strategies that can improve BP control are urgently needed. Trials have demonstrated that medication management, which utilizes telemedicine or other strategies to enhance treatment intensification outside the traditional clinic visit, can effectively lower BP vs usual care.4-8 Medication management approaches therefore hold substantial promise as a means of increasing rates of BP control.Many trials of telemedicine-based medication management, however, have focused on patients taking relatively few antihypertensive medications, including two particularly high-impact trials in which patients averaged fewer than two antihypertensive agents at study baseline. 4,8 A recent meta-analysis indicated that, among telemedicine trials reporting the number of prescribed antihypertensive agents, patients took an average of only 1.8 baseline BP medications.9 Therefore, while the value of telemedicine-based medication management for patients with low antihypertensive drug counts is clear, this approach's impact among highercount patients is not established. This evidence gap is problematic, because antihypertensive use continues to increase and the proportion of patients with hypertension requiring three or more BP medications is rising.10-12 This high-count group includes the particularly challenging population meeting criteria for resistant hypertension, 12 a condi...

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Baseline Antihypertensive Drug Count and Patient Response to Hypertension Medication Management

Crowley

Olsen

Woolson

et al. 2015

J of Clinical Hypertension

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show abstract

“…3 Many studies have documented the positive impact that pharmacists can have on patient outcomes by providing comprehensive medication management services. [4][5][6][7][8][9][10] However, additional research is needed to determine the impact of these services on patient outcomes when they are provided after hospital admissions. Of special interest are specific patient populations that are at higher risk for clinically significant medication errors, including elderly patients who have health conditions associated with high rates of hospital readmission.…”

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confidence: 99%