Pharmacist-Guided Home Blood Pressure Monitoring
Study found combination led to better control of hypertension
In the study intervention group, each person received a home blood pressure monitor capable of sending readings to a secure website that a pharmacist monitored. At the start of the study, patients met with the pharmacist for an hour and were taught how to use the machines. They were also given lifestyle advice on lowering their blood pressure.
People in the study intervention group were asked to send at least six blood pressure readings from different times of the day to the pharmacist each week. During the first six months of the study, patients and pharmacists talked by phone every two weeks, until blood pressure was under control for at least six weeks, and then they talked monthly. During months seven to 12 of the study, the calls were reduced to every two months. During the calls, pharmacists reviewed lifestyle changes and emphasized adherence to medications.
In between the phone calls, pharmacists were able to make changes to a patient's medication following an algorithm based on national guidelines, according to Margolis. In addition, these changes were reported to the patient's doctor.
Among the 380 people who attended both the six- and 12-month clinic visits, just over 57 percent of those in the intervention group had controlled blood pressure at both visits compared to just 30 percent in the usual care group.
Systolic blood pressure (the top number) dropped by an average of almost 11 mm Hg more for those in the study intervention compared to the usual care group at six months, and by almost 10 mm Hg more at 12 months. Even six months after the study ended, those who had been in the intervention group had systolic blood pressure readings an average of 6.6 mm Hg lower than the usual care group.
Margolis said that the people in the intervention group also felt more confident in managing their high blood pressure, and that they reported more satisfaction than the usual care group.
"Partnering with someone really makes a difference," Margolis said.
She said the cost of the program was about $1,200 to $1,300 per person. It's not clear yet whether or not the program will be able to prevent enough cardiovascular events to make it more cost-effective than usual care, but Margolis said that there may be ways to tailor the program to make it less expensive.