Managing hypertension in urban underserved subjects using telemedicine—A clinical trial

• Published in: The American heart journal Vol. 165; no. 4; pp. 615 - 621
• Main Authors: Bove, Alfred A., MD, PhD, Homko, Carol J., RN, PhD, Santamore, William P., PhD, Kashem, Mohammed, MD, PhD, Kerper, Margaret, RN, Elliott, Daniel J., MD, MSCE
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.04.2013; Elsevier Limited
• Subjects: Adult; African Americans; Aged; Cardiovascular; Cardiovascular disease; Cholesterol; Communications systems; Diabetes; Drug therapy; Family medical history; Female; Glucose; Health Behavior; Health care access; Health Promotion; Humans; Hypertension; Hypertension - prevention & control; Hypertension - therapy; Internet; Male; Middle Aged; Mortality; Older people; Questionnaires; Remote Consultation; Studies; Telemedicine; Telephone; Triglycerides; Urban Population; Voice recognition
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2013.01.004

Background We evaluated an Internet- and telephone-based telemedicine system for reducing blood pressure (BP) in underserved subjects with hypertension. Methods A total of 241 patients with systolic BP ≥140 mm Hg were randomized to usual care (C; n = 121) or telemedicine (T; n = 120). The T group reported BP, heart rate, weight, steps/day, and tobacco use twice weekly. The primary outcome was BP control at 6 months. Results Average age was 59.6 years, average body mass index was 33.7 kg/m2 , 79% were female, 81% were African American, 15% were white, 53% were at or below the federal poverty level, 18% were smokers, and 32% had diabetes. Six-month follow-up was achieved in 206 subjects (C: 107, T: 99). Goal BP was achieved in 52.3% in C and 54.5% in T ( P = .43). Systolic BP change (C: −13.9 mm Hg, T: −18.2; P = .118) was similar in both groups. Subjects in the T group reported BP 7.7 ± 6.9 d/mo. Results were not affected by age, sex, ethnicity, education, or income. In nondiabetic T subjects, goal BP was achieved in 58.2% compared with 45.2% of diabetic T subjects ( P = .024). Nondiabetic T subjects demonstrated a greater reduction in systolic BP (T: −19 ± 20 mm Hg, C: −12 ± 19 mm Hg; P = .037). No difference in BP response between C and T was noted in patients with diabetes. Conclusion In hypertensive subjects, engagement in a system of care with or without telemedicine resulted in significant BP reduction. Telemedicine for nondiabetic patients resulted in a greater reduction in systolic BP compared with usual care. Telemedicine may be a useful tool for managing hypertension particularly among nondiabetic subjects.