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Going Online to Draw the Line on High Blood Pressure
Date:6/24/2008

Conferring with pharmacists permits quicker changes in drugs, improved management, study finds,,,,

TUESDAY, June 24 (HealthDay News) -- Monitoring your blood pressure at home and reporting those results to a pharmacist via the Web helps keep blood pressure readings lower than standard care does, a new study found.

In fact, more than half of people who used this system of blood pressure management were able to achieve normal blood pressure readings, compared to just 31 percent of people on standard blood pressure management, according to the study.

"Hypertension is a common condition; about one in three people have it, but less than half are controlling it," said the study's lead author, Dr. Beverly Green, a family physician and investigator for the Group Health Center for Health Studies, in Seattle. "We saw a modest improvement in systolic pressure for the home monitoring plus Web training group, but the third group -- [those who were home monitoring and reporting the results to a pharmacist who could adjust medications] -- had almost two times the control as usual care."

Results of the study are published in the June 25 issue of the Journal of the American Medical Association.

Because only about one-third of people with high blood pressure [hypertension] are controlling it, and because studies have shown that keeping your blood pressure in the normal range can decrease the risk of death, the Group Health researchers wanted to design a system that could improve the care of people with hypertension, Green said.

Having patients monitor their blood pressure at home is useful, but physicians don't always have the time to review these numbers unless a patient comes in for a visit, which isn't always easy for the patient. To work around this, the study authors designed a Web-based training system to teach people how to manage their high blood pressure, and they showed them how to use home blood pressure monitors.

Members of one group in the study received the Web-based training and home monitors and were told to report their readings to their physicians. Another group received the training and monitors, but was instructed to report the readings to pharmacists who had been trained in using "stepped" medication measures for managing high blood pressure. Both home monitoring groups were told to take their blood pressure readings at least twice a week, and to take two measurements each time. The goal was to keep blood pressure readings below 135/85 mm/Hg.

Members of a third group -- the usual care group -- were told to work with their physicians on managing their high blood pressure, but were given no further instruction or home monitors.

The study included almost 800 patients between the ages of 25 and 75, who were randomly assigned to one of the three groups. Most completed one year of follow-up.

In the usual care group, 31 percent achieved blood pressure control of less than 140/90 mm/Hg, while in the home monitoring group, 36 percent achieved control. But the group with the Web-based pharmacist care fared best, with 56 percent achieving blood pressure control.

And, Green said, those who had the highest blood pressure readings were the most improved with the addition of pharmacist care. She said the reason behind the improvement was simply that medication doses were quickly changed or new medications added by the pharmacists to bring blood pressure under control.

"The feedback loop was closed much more quickly here," said Dr. Eric Peterson, a professor of medicine at the Duke Clinical Research Institute in Durham, N.C. "If you have to bring a patient in to change their medications, you don't want to make them come in too often, so it's possible months will go by before changes are made.

"What we have to do is figure out how to integrate new technologies into the current system," added Peterson, who co-wrote an accompanying editorial in the journal. "This system that they [the Seattle researchers] have developed might reduce overall costs, but it's not a system that could easily expand to the rest of the country because if you're not in a Group Health-like practice, you only get paid when you see patients in your office. In this system, doctors would have to devote their time, but can't get paid for it."

But, he added, "There's definitely potential for these models and better management systems will evolve into better blood pressure control."

Until the health-care system works out the kinks in blood pressure management systems, both Green and Peterson recommend keeping track of your own blood pressure at home. If your readings are consistently high, let your doctor know so he or she can adjust your medications.

More information

To learn more about managing high blood pressure, visit the National Heart, Lung, and Blood Institute.



SOURCES: Beverly Green, M.D., M.P.H., family physician and investigator, Group Health Center for Health Studies, Seattle; Eric Peterson, M.D., professor of medicine, Duke Clinical Research Institute, Durham, N.C.; June 25, 2008, Journal of the American Medical Association


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