SAN FRANCISCO - Measure it, modem it, manage it better.
In a randomized trial, patients who measured their blood pressures at home, modemed the data to physicians, and got instant computerized feedback did better at reaching blood pressure goals than did patients who got usual care, Dr. Thomas Pickering said at the annual meeting of the American Society of Hypertension.

The study, funded mainly by the National Heart, Lung, and Blood Institute, showed that the computer-aided telemetry approach reduced the use of drugs to manage white-coat hypertension and increased the use of drugs for sustained hypertension.

Telephonic transmission avoids the unreliability of patient reporting and the inconvenience of trying to interpret the patient's handwritten notes, noted Dr. Pickering of Mount Sinai Medical Center, New York.

For the study, 171 managed care patients were randomized to usual clinic management of their hypertension or to home telemonitoring. The telemonitored group used a device (LifeLink Monitoring) that stored blood pressure readings and could be hooked up to a phone jack to transmit the data. When the server computer got the data, the patient received immediate feedback about current average blood pressure levels, and the physician was sent information by fax or e-mail, Dr. Pickering said.

After 1 year, ambulatory blood pressure measures showed larger reductions from baseline in the telemonitored group than in the usual-care group. The total number of clinic visits also was less in the telemonitored patients. (The physicians were not instructed about how often they should see the patients.)
The results are encouraging, he said, because they show that patients with sustained hypertension were get-ting the drugs they needed to get their hypertension under control, while the patients with white-coat hypertension were getting the feedback they needed to limit swings in blood pressure.
Home-monitoring devices can store and extract the data in a number of ways, but the telephonic connection may be the most convenient, Dr. Pickering said. Some devices connect to printers; others can download the data directly to a patient's personal computer or store readings in memory to be downloaded once connected to a physician's computer. With these methods, the physician sees the measurements only during office visits.

Telemonitoring offers the possibility of creating a "virtual hypertension clinic" with regular communication between the patient and health care providers outside of office visits, he said.

Dr. Pickering and his associates have started a new study of adherence to therapy in hypertensive patients randomized to usual care or telemonitoring. Telemonitored patients whose blood pressures remain uncontrolled will be counseled and followed by a nurse case manager who will contact them exclusively by phone.