Effect of Home Blood Pressure Telemonitoring and Pharmacist Management On Blood Pressure Control: The HyperLink Cluster Randomized Trial

This is a review for the research article "Effect of Home Blood Pressure Telemonitoring and Pharmacist Management On Blood Pressure Control: The HyperLink Cluster Randomized Trial" by Margolis et al.

Introduction

High blood pressure(BP) is a chronic condition affecting 30% of U.S adults. Although BP control has improved over the past 2 decades, BP is controlled to recommended levels in only about half of American adults with hypertension. Home BP monitoring has been identified as a useful adjunct to team-based care for hypertension. Several recent studies suggest that a combined intervention of telemedicine with nurse- or pharmacist-led care may be effective for improving hypertension management. The objective of this HyperLink study was to determine the effect and durability of home BP telemonitoring with pharmacist case management in patients representative of the range of co-morbidity and hypertension severity in typical primary care practices.

Methods

The HyperLink study is a two-group clinic-randomized controlled trial with 12 months of intervention and 6 months of post-intervention follow-up, conducted at HealthPartners Medical Group, a multi-specialty practice in the Minneapolis-St. Paul metropolitan area that is part of an integrated health system. The authors identified 450 adults with uncontrolled BP recruited from 14,692 patients in HealthPartners Medical Group using electronic medical records. Of the 450 patients, 228 patients were assigned randomly to Telemonitoring Intervention and 222 patients were assigned to Usual Care. 4 doctoral pharmacists worked in intervention clinics. At these clinics there was a clinical practice agreement between pharmacists and primary care physicians that allowed pharmacists to prescribe and change antihypertensive therapy within specified parameters. Intervention patients received home monitors that store and transmit BP data to a secure website via modem. During the first 6 months of intervention, patients and pharmacists met every two weeks via phone until BP control was sustained for 6 weeks, then frequency was reduced to monthly. During phone visits, pharmacists assessed and adjusted antihypertensive drug therapy based on an algorithm using the percentage of home BP readings meeting goal and patients conditions. Pharmacists communicated with patients' primary care teams through the electronic medical record following each visit. After 12 months, patients returned the telemonitors, returned to their primary physicians' care, and received no pharmacist support