Can a pharmacist-assisted Web-based care program improve hypertension control?

A pharmacist-assisted management program including home blood pressure monitoring and regular web site communication resulted in a higher rate of adequate blood pressure control in hypertensive adults than usual office-based care or home blood pressure monitoring and web site communication alone. (LOE = 1b)

Green BB, Cook AJ, Ralston JD, et al. Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control. A randomized controlled trial. JAMA 2008;299:2857-67.  [PMID:18577730]

Randomized controlled trial (single-blinded)

Government

Concealed

Outpatient (any)

Effective efforts to improve blood pressure (BP) control in hypertensive patients are urgently needed. These investigators identified 778 adults, aged 25 to 75 years, with Internet access and uncontrolled hypertension (systolic pressure from 141 to 199 mm Hg and/or diastolic pressure from 91 to 109 mm Hg) and no other coexisting serious disease. Eligible subjects were randomly assigned (concealed allocation) to either usual care with their individual clinician; home BP monitoring and web site training; or home BP monitoring and Web site training plus pharmacist-assisted care management. Web site access and training included usual care plus e-mail communication with individual clinicians, medication refills, lab information, and patient education tools. Pharmacist-assisted care consisted of active individual-based, online medication adjustment using nationally accepted hypertension guidelines. Individuals assessing outcomes remained blind to treatment group assignment. Complete follow-up occurred for 94% of patients at 12 months and all analyses were by intention-to-treat. Adequate BP control (< 140/90 mm Hg) occurred significantly more often in the home BP monitoring/Web site training plus pharmacist-assisted care group compared to the home BP monitoring/web site training and usual care groups (56% vs. 36%, 31%, respectively; NNT = 5, range 3-7). There was no significant difference in the rate of adequate BP control between the usual care and home BP monitoring/Web site training group.