D2-2: How Did Pharmacists Help Patients Achieve Blood Pressure Control in a Randomized Trial of Home Blood Pressure Telemonitoring Plus Pharmacist Management?

Abstract

Background/Aims

The Hyperlink trial tested a 12-month intervention combining home blood pressure (BP) telemonitoring with pharmacist case management in patients with uncontrolled hypertension. The intervention resulted in improved BP control compared to usual care at both 6 and 12 months (57% vs. 30%, P = 0.001). The mean number of medication classes increased compared to usual care (0.63 vs. 0.22, P <0.001). We use process of care data recorded by the pharmacists and BP telemonitoring data to elucidate reasons for intervention success.

Methods

Hyperlink randomized 450 patients with uncontrolled BP from 16 primary care clinics, and 228 intervention group patients were enrolled from clinics. They used a home blood pressure telemonitor to transmit BP readings to a study pharmacist. Following an in-person intake visit, pharmacists consulted with patients over the phone every 2–4 weeks during the first 6 months, and at 2 month intervals thereafter. They adjusted antihypertensive therapy using a specific treatment algorithm based on BP telemonitoring data. The home BP goal was <135/85 mm Hg (<125/75 for patients with diabetes or kidney disease.)

Results

Mean BP at the research clinic enrollment visit was 148/85, and 143/85 at the pharmacist intake visit. At this visit, pharmacists changed the antihypertensive drug regimen for 10% of patients, while medication changes occurred for 33% at phone visit 1, 36% at phone visit 2, and 19% at phone visit 3. Thereafter, medication changes continued to decline. At the intake visit, pharmacists judged medication adherence to be high (>80%) in only about half of patients, but at subsequent phone visits in >90% of patients. The mean home BP recorded by the pharmacists for patients at the first phone visit was 136/80, and fell steadily to a mean of 126/74 at 3 months, and thereafter declined more slowly to 123/73 at 5 months, with little change thereafter.

Conclusions

Improved adherence and appropriate adjustments to the antihypertensive treatment regimen based on home BP telemonitoring resulted in rapid lowering of BP over a 3-month period. Our results imply that intensive intervention may only be needed for about 3 months in many patients with uncontrolled hypertension.