title: The Impact of a Multidisciplinary Information Technology–Supported Program on Blood Pressure Control in Primary Care Effectiveness of tailored lifestyle interventions, using web-based and print-mail, for reducing blood pressure among rural women with prehypertension: main results of the Wellness for Women: DASHing towards Health clinical trial Effect of Home Blood Pressure Telemonitoring With Self-Care Support on Uncontrolled Systolic Hypertension in Diabetics Web-based care management in patients with poorly controlled diabetes. Effectiveness of home-centered care through telemedicine applications for overweight and obese patients: a randomized controlled trial Improving Blood Pressure Control: Results of Home-based Post-acute Care Interventions Efficacy of a weight-loss website based on positive deviance. A randomized trial. 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abstract: Background —Hypertension is a leading mortality risk factor yet inadequately controlled in most affected subjects . Effective programs to address this problem are lacking . We hypothesized that an information technology – supported management program could help improve blood pressure ( BP ) control . Methods and Results —This r and omized controlled trial included 223 primary care hypertensive subjects with mean 24-hour BP > 130/80 and daytime BP > 135/85 mm Hg measured with ambulatory monitoring ( ABPM ) . Intervention subjects received a BP monitor and access to an information technology – supported adherence and BP monitoring system providing nurses , pharmacists , and physicians with monthly reports . Control subjects received usual care . The mean ( ±SD ) follow-up was 348 ( ±78 ) and 349 ( ±84 ) days in the intervention and control group , respectively . The primary end point of the change in the mean 24-hour ambulatory BP was consistently greater in intervention subjects for both systolic ( −11.9 versus −7.1 mm Hg ; P<0.001 ) and diastolic BP ( −6.6 versus −4.5 mm Hg ; P=0.007 ) . The proportion of subjects that achieved Canadian Guideline target BP ( 46.0 % versus 28.6 % ) was also greater in the intervention group ( P=0.006 ) . We observed similar BP declines for ABPM and self-recorded home BP suggesting the latter could be an alternative for confirming BP control . The intervention was associated with more physician-driven antihypertensive dose adjustments or changes in agents ( P=0.03 ) , more antihypertensive classes at study end ( P=0.007 ) , and a trend toward improved adherence measured by prescription refills ( P=0.07 ) . Conclusions —This multidisciplinary information technology – supported program that provided feedback to patients and healthcare providers significantly improved blood pressure levels in a primary care setting Background Lifestyle modification is recommended for management of prehypertension , yet finding effective interventions to reach rural women is a public health challenge . This community-based clinical trial compared the effectiveness of st and ard advice to two multi-component theory-based tailored interventions , using web-based or print-mailed delivery , in reducing blood pressure among rural women , ages 40–69 , with prehypertension . Methods 289 women with prehypertension enrolled in the Wellness for Women : DASHing towards Health trial , a 12-month intervention with 12-month follow-up . Women were r and omly assigned to groups using a 1:2:2 ratio , comparing st and ard advice ( 30-minute counseling session ) to two interventions ( two 2-hour counseling sessions , 5 phone goal - setting sessions , strength-training video , and 16 tailored newsletters , web-based or print-mailed ) . Linear mixed model methods were used to test planned pairwise comparisons of marginal mean change in blood pressure , healthy eating and activity , adjusted for age and baseline level . General estimating equations were used to examine the proportion of women achieving normotensive status and meeting health outcome criteria for eating and activity . Results Mean blood pressure reduction ranged from 3.8 ( SD = 9.8 ) mm Hg to 8.1 ( SD = 10.4 ) mm Hg . The 24-month estimated marginal proportions of women achieving normotensive status were 47 % for web-based , and 39 % for both print-mailed and st and ard advice groups , with no group differences ( p = .11 and p = .09 , respectively ) . Web-based and print-mailed groups improved more than st and ard advice group for waist circumference ( p = .017 and p = .016 , respectively ) ; % daily calories from fat ( p = .018 and p = .030 ) and saturated fat ( p = .049 and p = .013 ) ; daily servings of fruit and vegetables ( p = .008 and p < .005 ) ; and low fat dairy ( p < .001 and p = .002 ) . Greater improvements were observed in web-based versus st and ard advice groups in systolic blood pressure ( p = .048 ) and estimated VO2max ( p = .037 ) . Dropout rates were 6 % by 6-months , 11.4 % by 24 months , with no differences across groups . Conclusions Rural women with prehypertension receiving  distance-delivery theory-based lifestyle modifications can achieve a reduction of blood pressure and attainment of normotensive status . Trial registration Clinical Trials.gov Lowering blood pressure reduces cardiovascular risk , yet hypertension is poorly controlled in diabetic patients . In a pilot study we demonstrated that a home blood pressure telemonitoring system , which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading , improved blood pressure control . Messages were based on care paths defined by running averages of transmitted readings . The present study tests the system 's effectiveness in a r and omized , controlled trial in diabetic patients with uncontrolled systolic hypertension . Of 244 subjects screened for eligibility , 110 ( 45 % ) were r and omly allocated to the intervention ( n=55 ) or control ( n=55 ) group , and 105 ( 95.5 % ) completed the 1-year outcome visit . In the intention-to-treat analysis , mean daytime ambulatory systolic blood pressure , the primary end point , decreased significantly only in the intervention group by 9.1±15.6 mmHg ( SD ; P<0.0001 ) , and the mean between-group difference was 7.1±2.3 mmHg ( SE ; P<0.005 ) . Furthermore , 51 % of intervention subjects achieved the guideline recommended target of < 130/80 mmHg compared with 31 % of control subjects ( P<0.05 ) . These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians . Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale ( baseline , 4.1±3.76 ; exit , 5.2±4.30 ; P=0.014 ) . This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension  and improved hypertension control . Home blood pressure monitoring alone had no effect on blood pressure . Promoting patient self-care may have negative psychological effects OBJECTIVE To assess the effects of web-based care management on glucose and blood pressure control over 12 months in patients with poorly controlled diabetes . RESEARCH DESIGN AND METHODS For this study , 104 patients with diabetes and HbA(1c ) ( A1C ) > or = 9.0 % who received their care at a Department of Veterans Affairs medical center were recruited . All participants completed a  diabetes education class  and were r and omized to continue with their usual care ( n = 52 ) or receive web-based care management ( n = 52 ) . The web-based group received a notebook computer , glucose and blood pressure monitoring devices , and access to a care management website . The website provided educational modules , accepted uploads from monitoring devices , and had an internal messaging system for patients to communicate with the care manager . RESULTS Participants receiving web-based care management had lower A1C over 12 months ( P < 0.05 ) when compared with education and usual care . Persistent website users had greater improvement in A1C when compared with intermittent users ( -1.9 vs. -1.2 % ; P = 0.051 ) or education and usual care ( -1.4 % ; P < 0.05 ) . A larger number of website data uploads was associated with a larger decline in A1C ( highest tertile -2.1 % , lowest tertile -1.0 % ; P < 0.02 ) . Hypertensive participants in the web-based group had a greater reduction in systolic blood pressure ( P < 0.01 ) . HDL cholesterol rose and triglycerides fell in the web-based group ( P < 0.05 ) . CONCLUSIONS Web-based care management may be a useful adjunct in the care of patients with poorly controlled diabetes OBJECTIVE : To determine if home-centered monitoring through telemedicine has an impact on clinical characteristics , metabolic profile and quality of life in overweight and obese patients . DESIGN : R and omized controlled trial , 6-month duration . SETTING : Tertiary care academic hospital . SUBJECTS : A total of 122 patients were eligible to participate as they met the inclusion criteria of increased body mass index ( BMI > 25 kg/m2 ) , age>18 and < 70 y and ability to operate electronic microdevices . INTERVENTIONS : All patients in the control group ( n=77 ) received st and ard hospital care .  Patients in the intervention group ( n=45 ) , additionally , measured three times a week , for 6 months , their blood pressure and body weight and transmitted them to an automated call center . These values were not shared with the patients ’ physician or dietician . MAIN OUTCOME MEASURES : Clinical ( body weight , BMI , blood pressure ) , laboratory ( fasting plasma glucose , triglycerides , HDL-cholesterol , total cholesterol ) and quality of life parameters ( SF-36 ® , Visual Analog Scale of European Quality -5 Dimensions , Obesity Assessment Survey ) . Data were analyzed in an intention-to-treat-way ( last observation carried forward ) . RESULTS : Drop-out rate was similar in the control and intervention groups : 12 vs 11 percent , respectively , P = NS . There were no significant differences at baseline between intervention and control groups in all main outcome parameters . There were significant decreases for patients in the intervention group in body weight ( from 101.6±22.4 to 89.2±14.7 kg , P=0.002 , P=0.05 vs controls at 6 months ) , total cholesterol ( from 247.6±42.0 to 220.7±42.6 mg/dl , P=0.002 , P=0.05 vs controls at 6 months ) and triglycerides ( from 148.4±35.0 to 122.3±31.4 mg/dl , P=0.001 , P=0.01 vs controls at 6 months ) . Intervention group patients made a total of 1997 phone contacts . The number of phone contacts was correlated positively with Social Functioning ( SF ) , Vitality ( VT ) and Mental Health ( MH ) scores of SF-36 ® at baseline ( r=0.48 , r=0.41 , r=0.41 , respectively , P=0.05 ) but not with weight loss . CONCLUSIONS : Home-centered , intense treatment through the use of telemedicine can be effective in improving short-term obesity outcomes Background Blood pressure ( BP ) control remains elusive for many Americans . Although home health nurses are uniquely positioned to help vulnerable individuals achieve BP control , hypertension ( HTN ) management has not been a high priority in post-acute care . Objective To examine the effects of two home-based interventions design ed to improve BP outcomes among high-risk African-American patients . Design Cluster r and omized controlled trial . Participants A total of 845 newly admitted patients with uncontrolled HTN ( JNC7 stages 1 or 2 ) . Interventions The “ basic ” intervention delivered key HTN information to clinicians and patients , and a home BP monitor to patients , while the patients received usual post-acute care . The “ augmented ” intervention provided more intensive and extensive HTN information , monitoring and feedback for 3 months beyond the index home care admission . Measures Primary : BP control . Secondary : reductions in mmHG SBP and DBP , improvements in proportions improving JNC7 stage or achieving clinical ly meaningful reductions in SBP and DBP . Methods Multivariate regression models . Key Results The basic intervention produced no significant BP improvements ; the augmented intervention significantly improved stage 2 patients ’ outcomes . Among stage 2 patients , the augmented intervention increased BP control by 8.7 percentage points relative to usual care ( 8.9 % vs. 17.6 % ; p = 0.01 ) , yielded an 8.3 mmHG relative reduction in SBP ( p = 0.01 ) , and increased the proportion achieving at least a 20 mmHG reduction in SBP by 16.4 percentage points ( p = 0.01 ) . Conclusion Among stage 2 patients , a nurse-led intervention providing additional HTN medication review and patient self-management support during the 3-month post-acute care period yielded significant improvements in 3-month BP control , plus improvements in secondary BP outcomes BACKGROUND Web-based interventions for weight control could promote more-widespread dissemination of weight-loss opportunities ; however , they remain limited in effectiveness . Incorporating weight-control practice s used by individuals with long-term weight-loss success ( " positive deviants " ) may improve the efficacy of web-based weight control interventions . PURPOSE To evaluate the efficacy of AchieveTogether , a web-based weight-loss intervention for adults based on user-generated weight-loss strategies from successful weight losers . DESIGN In 2009 - 2010 , participants were r and omized to either a 12-week  web-based intervention , AchieveTogether , or a wait-list control condition . SETTING / PARTICIPANTS 100 overweight or obese adults participated in the study . INTERVENTION AchieveTogether was design ed to help individuals implement weight control practice s used by others who successfully lost and maintained weight . MAIN OUTCOME MEASURES The primary outcome was change in weight . Secondary outcomes included blood pressure , daily caloric intake , quality of life , and use of weight control practice s. ANCOVA , with adjustment for baseline values on outcome measures , was used to assess differences between groups in primary and secondary outcomes . Statistical analyses were conducted in 2010 - 2011 . RESULTS Most participants were women ( 69.7 % ) and white ( 90.8 % ) , with a mean age of 50.3 years and baseline BMI of 33.2 ; 88 % completed post-program assessment s.  Mean weight loss among intervention participants was -1.4 kg ( 95 % CI= -2.2 , -0.5 ) , compared with a mean weight gain of 0.6 kg ( 95 % CI= -0.3 , 1.4 ) in control participants ( p<0.01 ) . CONCLUSIONS User-generated weight-loss practice s from " positive deviants " could promote weight control in web-based interventions ; however , further research is needed to improve program efficacy . TRIAL REGISTRATION This study is registered at Clinical Trials.govNCT00709501 The effectiveness of remote patient monitoring and physician care for the treatment of hypertension has not been demonstrated in a r and omized clinical trial . The objective of this study was to evaluate the effectiveness of remote patient monitoring with or without remote physician care in reducing office blood pressure in patients with hypertension . A total of 374 hypertensive patients over 20 years of age were r and omized into the following three groups : group ( 1 ) control , the patients received usual clinical care with home BP monitoring ; group ( 2 ) the patients were remotely monitored and received office follow-up ; and group ( 3 ) the patients received remote monitoring without physician office care using the remote monitoring device . For each group , in-office follow-up care was scheduled every 8 weeks for 24 weeks . The primary end point was the difference in sitting SBP at the 24-week follow-up . No difference between the three groups was observed in the primary end point ( adjusted mean sitting SBP was as follows : group 1 : −8.9±15.5 mm Hg , group 2 : −11.3±15.9 mm Hg , group 3 : −11.6±19.8 mm Hg , ( NS ) . Significant differences in achieving the target BP at the 24th week of follow-up were observed between groups 1 and 2 . The subjects over 55-years old had a significant decrease in the adjusted mean sitting SBP in groups 2 and 3 compared with that of the control group . Remote monitoring alone or remote monitoring coupled with remote physician care was as efficacious as the usual office care for reducing blood pressure with comparable safety and efficacy in hypertensive patients Background Only approximately half of patients with hypertension have their blood pressure controlled , due in large part to the tendency of primary care providers ( PCPs ) not to intensify treatment when blood pressure values are elevated . Objective This study tested the effect of an intervention design ed to help patients ask questions at the point of care to encourage PCPs to appropriately intensify blood pressure treatment . Methods PCPs and their patients with hypertension ( N=500 ) were recruited by letter and r and omized into 2 study groups : ( 1 ) intervention condition in which patients used a fully automated website each month to receive tailored messages suggesting questions to ask their PCP to improve blood pressure control  , and ( 2 ) control condition in which a similar tool suggested questions to ask about preventive services ( eg , cancer screening ) . The Web-based tool was design ed to be used during each of the 12 study months and before scheduled visits with PCPs . The primary outcome was the percentage of patients in both conditions with controlled blood pressure . Results Of 500 enrolled patients ( intervention condition : n=282 ; control condition : n=218 ) , 418 ( 83.6 % ) completed the 12-month follow-up visit . At baseline , 289 ( 61.5 % ) of participants had controlled blood pressure . Most ( 411/500 , 82.2 % ) participants used the intervention during at least 6 of 12 months and 222 ( 62.5 % ) reported asking questions directly from the Web-based tool . There were no group differences in asking about medication intensification and there were no differences in blood pressure control after 12 months between the intervention condition ( 201/282 , 71.3 % ) and control condition ( 143/218 , 65.6 % ; P=.27 ) groups . More intervention condition participants discussed having a creatinine test ( 92 , 52.6 % vs 49 , 35.5 % ; P=.02 ) and urine protein test ( 81 , 44.8 % vs 21 , 14.6 % ; P<.001 ) , but no group differences were observed in the rate of testing . The control condition participants reported more frequent discussion s about tetanus and pneumonia vaccines and reported more tetanus ( 30 , 13.8 % vs 15 , 5.3 % ; P=.02 ) and pneumonia ( 25 , 11.5 % vs 16 , 5.7 % ; P=.02 ) vaccinations after 12 months . Conclusions The use of an interactive website design ed to overcome clinical inertia for hypertension care did not lead to improvements in blood pressure control . Participant adherence to the intervention was high . The control intervention led to positive changes in the use of preventive services ( eg , tetanus immunization ) and the intervention condition led to more discussion s of hypertension-relevant tests ( eg , serum creatinine and urine protein ) . By providing patients with individually tailored questions to ask during PCP visits , this study demonstrated that participants were likely to discuss the questions with PCPs . These discussion s did not , however , lead to improvements in blood pressure control . Trial Registration Clinical Trials.gov NCT00377208 ; http:// clinical trials.gov/ct2/show/NCT00377208 ( Archived by WebCite at http://www.webcitation.org/6IqWiPLon ) Background —Hypertension is a leading risk factor for cardiovascular disease . Although control rates have improved over time , racial/ethnic disparities in hypertension control persist . Self-blood pressure monitoring , by itself , has been shown to be an effective tool in predominantly white population s , but less studied in minority , urban communities . These types of minimally intensive approaches are important to test in all population s , especially those experiencing related health disparities , for broad implementation with limited re sources . Methods and Results —The New York City Health Department in partnership with community clinic networks implemented a r and omized clinical trial ( n=900 , 450 per arm ) to investigate the effectiveness of self-blood pressure monitoring in medically underserved and largely black and Hispanic participants . Intervention participants received a home blood pressure monitor and training on use , whereas control participants received usual care . After 9 months , systolic blood pressure decreased ( intervention , 14.7 mm Hg ; control , 14.1 mm Hg ; P=0.70 ) . Similar results were observed when incorporating longitudinal data and calculating a mean slope over time . Control was achieved in 38.9 % of intervention and 39.1 % of control participants at the end of follow-up ; the time-to-event experience of achieving blood pressure control in the intervention versus control groups were not different from each other ( logrank P value = 0.91 ) . Conclusions —Self-blood pressure monitoring was not shown to improve control over usual care in this largely minority , urban population . The patient population in this study , which included a high proportion of Hispanics and uninsured persons , is understudied . Results indicate these groups may have additional meaningful barriers to achieving blood pressure control beyond access to the monitor itself . Clinical Trial Registration : http:// clinical trials.gov . Unique Identifier : Failing to reach blood pressure ( BP ) goals is one of the main problems in hypertension management . Especially in high-risk patients , intensive monitoring including frequently office visits or new techniques to monitor home BP is required . A total of 60 patients with uncontrolled hypertension were included and r and omized into a group with  telemetric BP monitoring ( TBPM ) ( n=30 ) and a control group receiving st and ard care ( n=30 ) . During the 3-month study period , patients received in addition to their antihypertensive pre-treatment up to 2 × 300 mg irbesartan to achieve the required target BP . All patients were instructed to measure their BP once daily in the morning . In the TBPM group automatic alerts were generated by the central data base server using pre-defined algorithms and patients were subsequently contacted by the physician . At baseline mean 24-h ambulant BP monitoring ( ABPM ) was 143.3±11.1/82.6±9.9 mm Hg in the TBPM group and 141.4±12.6/82.1±6.5 mm Hg in the st and ard care group . During treatment mean systolic BP showed a more intensive decrease in the TBPM vs control group ( −17.0±11.1 mm Hg vs −9.8±13.7 mm Hg ; P=0.032 ) . Patients in the TBPM group had a more pronounced night dipping and a higher reduction of mean pulse pressure than controls ( −8.1±5.9 mm Hg vs −2.8±7.4 mm Hg , P=0.004 ) . After 3 months , TBPM-treated patients were given a higher mean daily dose of irbesartan ( 375±187 mg vs 222±147 mg in controls ; P=<0.001 ) . We demonstrated that with TBPM a more effective and faster titration of the antihypertensive agent is possible . The alarm criteria chosen were useful to improve BP control IMPORTANCE Only about half of patients with high blood pressure ( BP ) in the United States have their BP controlled . Practical , robust , and sustainable models are needed to improve BP control in patients with uncontrolled hypertension . OBJECTIVES To determine whether an intervention combining home BP telemonitoring with pharmacist case management improves BP control compared with usual care and to determine whether BP control is maintained after the intervention is stopped . DESIGN , SETTING , AND PATIENTS A cluster r and omized clinical trial of 450 adults with uncontrolled BP recruited from 14,692 patients with electronic medical records across 16 primary care clinics in an integrated health system in Minneapolis-St Paul , Minnesota , with 12 months of intervention and 6 months of postintervention follow-up . INTERVENTIONS Eight clinics were r and omized to provide usual care to patients ( n = 222 ) and 8 clinics were r and omized to provide a telemonitoring intervention ( n = 228 ) . Intervention patients received home BP telemonitors and transmitted BP data to pharmacists who adjusted antihypertensive therapy accordingly . MAIN OUTCOMES AND MEASURES Control of systolic BP to less than 140 mm Hg and diastolic BP to less than 90 mm Hg ( < 130/80 mm Hg in patients with diabetes or chronic kidney disease ) at 6 and 12 months . Secondary outcomes were change in BP , patient satisfaction , and BP control at 18 months ( 6 months after intervention stopped ) . RESULTS At baseline , enrollees were 45 % women , 82 % white , mean ( SD ) age was 61.1 ( 12.0 ) years , and mean systolic BP was 148 mm Hg and diastolic BP was 85 mm Hg .  Blood pressure was controlled at both 6 and 12 months in 57.2 % ( 95 % CI , 44.8 % to 68.7 % ) of patients in the telemonitoring intervention group vs 30.0 % ( 95 % CI , 23.2 % to 37.8 % ) of patients in the usual care group ( P = .001 ) . At 18 months ( 6 months of postintervention follow-up ) , BP was controlled in 71.8 % ( 95 % CI , 65.0 % to 77.8 % ) of patients in the telemonitoring intervention group vs 57.1 % ( 95 % CI , 51.5 % to 62.6 % ) of patients in the usual care group ( P = .003 ) . Compared with the usual care group , systolic BP decreased more from baseline among patients in the telemonitoring intervention group at 6 months ( -10.7 mm Hg [ 95 % CI , -14.3 to -7.3 mm Hg ] ; P<.001 ) , at 12 months ( -9.7 mm Hg [ 95 % CI , -13.4 to -6.0 mm Hg ] ; P<.001 ) , and at 18 months ( -6.6 mm Hg [ 95 % CI , -10.7 to -2.5 mm Hg ] ; P = .004 ) . Compared with the usual care group , diastolic BP decreased more from baseline among patients in the telemonitoring intervention group at 6 months ( -6.0 mm Hg [ 95 % CI , -8.6 to -3.4 mm Hg ] ; P<.001 ) , at 12 months ( -5.1 mm Hg [ 95 % CI , -7.4 to -2.8 mm Hg ] ; P<.001 ) , and at 18 months ( -3.0 mm Hg [ 95 % CI , -6.3 to 0.3 mm Hg ] ; P = .07 ) . CONCLUSIONS AND RELEVANCE Home BP telemonitoring and pharmacist case management achieved better BP control compared with usual care during 12 months of intervention that persisted during 6 months of postintervention follow-up . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00781365 The relationship between ambulatory blood pressure and mortality in a general Western population is unknown . Therefore , we conducted this prospect i ve study of a r and om sample of 1700 Danish men and women , aged 41 to 72 years , without major cardiovascular diseases . At baseline , ambulatory blood pressure , office blood pressure , and other risk factors were recorded . After a mean period of 9.5 years , 174 had died : 63 were cardiovascular deaths . In multivariate proportional hazards models , adjusted for other risk factors of significance , the relative risk of cardiovascular mortality ( 95 % confidence interval ) associated with 10 mm Hg increments in systolic and 5 mm Hg increments in diastolic ambulatory blood pressure were 1.51 ( 1.28 to 1.77 ) and 1.43 ( 1.26 to 1.61 ) . The corresponding figures for all cause mortality were 1.18 ( 1.06 to 1.31 ) and 1.18 ( 1.09 to 1.28 ) . The relative risks of cardiovascular mortality were lower for office  blood pressure  , and office blood pressure did not predict all cause mortality . When ambulatory and office blood pressures were entered in the same multivariate models , only the ambulatory blood pressures were significant predictors of all cause mortality and cardiovascular mortality . The relationship between ambulatory blood pressures  and risk of mortality was log-linear , with no indication of a threshold . The absolute risk of mortality was also dependent on age and smoking status , and an upper “ acceptable ” ambulatory blood pressure based on risk of mortality could only be defined when other risk factors were taken into account . In conclusion ,  ambulatory blood pressure  provided prognostic information on mortality above and beyond that of office blood pressure PURPOSE The present study evaluated whether an intervention using a short message service ( SMS ) by personal cellular phone and Internet would reduce cardiovascular risk factors in post-menopausal women with abdominal obesity over 12 weeks . METHODS This is a quasi-experimental design with pre and post tests . Participants were recruited from the gynecology outpatient and family medicine departments of a tertiary care hospital located in an urban city of South Korea . Only 67 subjects completed the entire study , 34 in the intervention group and 33 controls . The goal of intervention was to reduce waist circumference ( WC ) , body weight ( BW ) and blood pressure ( BP ) levels . Before the intervention , demographic variables , WC , BW , BP , fasting plasma glucose ( FPG ) and serum lipids were measured as pre-test data . The WC , BW , BP , FPG and serum lipids were measured again 12 weeks later . Patients in the intervention group were requested to record their WC , BW , BP , type and amount of diet and exercise  in a weekly web-based diary through the Internet or by cellular phone . The research ers sent weekly recommendations on diet and exercise as an intervention to each patient , by both cellular phone and Internet . The intervention was applied for 12 weeks . RESULTS WC and BW significantly decreased by 3.0 cm and 2.0 kg , respectively , at 12 weeks compared with the baseline in the intervention group . However , the mean changes in the control group significantly increased by 0.9 cm and 0.7 kg . Systolic BP ( SBP ) and diastolic BP ( DBP ) significantly decreased by 6.5 and 4.6 mmHg in the intervention group , respectively . The mean changes in the control group were not significant in either SBP or DBP . A significant mean decrease in total cholesterol ( TC ) was observed for the intervention group by 12.9 mg/dl , while the control group showed a significant mean increase by 1.5mg/dl . Low-density lipoprotein-cholesterol ( LDL-C ) for the intervention group showed a significant mean decrease 11.3mg/dl . The mean change in the control group was , however , not significant . CONCLUSION Web-based individual intervention using both SMS and Internet improved WC , BW , BP , TC , and LDL-C during 12 weeks in post-menopausal women with abdominal obesity 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 r and omized 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/m(2 ) , 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 result ed in significant BP reduction . Telemedicine for nondiabetic patients result ed in a greater reduction in systolic BP compared with usual care . Telemedicine may be a useful tool for managing hypertension particularly among nondiabetic subjects Aim . To compare the effectiveness of antihypertensive treatment based on telemonitoring of home blood pressure ( BP ) and conventional monitoring of office BP . Methods . Hypertensive patients ( n = 236 ) participated in a r and omized , controlled study . In the intervention group , antihypertensive treatment was based on home BP monitoring . BP readings were registered by a PDA and automatically transmitted to a server , by which the patient and doctor could communicate . In the control group , patients received usual care with office visits to adjust antihypertensive treatment as needed . Primary outcome was difference in systolic daytime ambulatory BP monitoring ( ABPM ) change between baseline and 6 months . Results . In both groups , systolic daytime ABPM decreased significantly from baseline to follow‐up . The decrease in systolic daytime ABPM was −11.9 mmHg in the intervention group and −9.6 mmHg in the control group ( mean difference −2.3 [ 95 % CI −6.1 to −1.5 ] , p = 0.225 ) . The likelihood of daytime ABPM normalization was similar in the two groups [ 32/113 ( 28 % ) vs 46/123 ( 37 % ) , p = 0.139 ] . Conclusion . Antihypertensive treatment based on telemonitoring of home BP was as effective as usual monitoring of office BP with regards to reduction of BP . Trial registration : Clinical Trials.gov identifier : NCT00282334 The evaluation in real-life setting s of services for the follow-up and control of hypertensive patients is a complex intervention , which still needs analysis of the roles , tasks , and re sources involved in the basic items : patient , healthcare professional , and the interaction between the two . To evaluate the impact of patient-general practitioner ( GP ) short-messages-based interaction , isolated from other items , on the degree of hypertension control in the follow-up of medium-to-low-risk patients in primary care , a r and omized controlled trial has been performed : 38 GPs enrolled 285 hypertensive patients who recorded the results of self-blood-pressure ( BP ) monitoring , heart rate , and body weight , and completed an optional question naire in an identical manner over a six-month period . The telemedicine group ( TmG ) sent the data to a telemedicine-based system that enabled patient-GP interaction ; the control group ( CG ) recorded the data on paper and could only deliver it to their GP personally in the routine visits . In the TmG , the results were better , but not significantly so , for : 1 ) degree of hypertension control , in terms of the percentage of uncontrolled hypertensives at the final visit ( TmG versus CG : 31.7 % versus 35.6 % ; p = 0.47 ) ; 2 ) reduction in hypertension during follow-up , comparing measurements ( performed by a professional ) at the initial and final visits of systolic BP ( 15.5 versus 11.9 ; p = 0.13 ) and diastolic BP ( 9.6 versus 4.4 ; p = 0.40 ) ; and 3 ) adherence to the protocol within compliance levels of interest in a real-life follow-up service : Gt50 % ( 84.8 % versus 73.3 % ) and Gt25 % ( 92.4.8 % versus 75.4 % ) ( p = 0.053 ) . Other factors such as average values of self-measured systolic BP , diastolic BP and heart rate , acceptability of the protocol , and median number of consultations and hospital admissions were similar in both groups . Outcomes show that , taken alone , the patient-GP short-messages-based interaction has very little impact on the degree of hypertension control in patients with this profile . In complex interventions , to discriminate the impact of each of its components in isolation will enable us to design an efficient follow-up service , little dem and ing in terms of healthcare professional dedication , and optimized in other basic aspects Background —To determine whether a pharmacist-led , Heart360-enabled , home blood pressure monitoring ( HBPM ) intervention  improves blood pressure ( BP ) control compared with usual care ( UC ) . Methods and Results —This r and omized , controlled trial was conducted in 10 Kaiser Permanente Colorado clinics . Overall , 348 patients with BP above recommended levels were r and omized to the HBPM  ( n=175 ) or UC ( n=173 ) groups . There were no statistically significant differences in baseline characteristics between the groups ; however , there was a trend toward a higher baseline BP for the HBPM group compared with the UC group ( 148.8 versus 145.5 mm Hg for systolic BP ; 89.6 versus 88.0 mm Hg for diastolic BP ) . At 6 months , the proportion of patients achieving BP goal was significantly higher in the HBPM group ( 54.1 % ) than in the UC group ( 35.4 % ; P<0.001 ) . Compared with the UC group , the HBPM group experienced a −12.4-mm Hg larger ( 95 % confidence interval , −16.3 to −8.6 ) reduction in systolic BP and a −5.7-mm Hg larger ( 95 % confidence interval , −7.8 to −3.6 ) reduction in diastolic BP . The impact of the intervention on BP reduction was even larger for the subgroup of patients with diabetes mellitus or chronic kidney disease . The HBPM group had more e-mail and telephone contacts and greater medication regimen intensification . The proportion of patients reporting high satisfaction with hypertension care was significantly greater in the HBPM group ( 58 % ) than in the UC group ( 42 % ) , P<0.001 . Conclusions —A pharmacist-led , Heart360-supported , home BP monitoring intervention led to greater BP reductions , superior BP control , and higher patient satisfaction than UC . Clinical Trial Registration —URL : http://www . clinical trials.gov/ct2/show/NCT01162759 . Unique identifier : NCT01162759 Background Good blood pressure ( BP ) control reduces the risk of recurrence of stroke/transient ischaemic attack ( TIA ) . Although there is strong evidence that BP telemonitoring helps achieve good control , none of the major trials have considered the effectiveness in stroke/TIA survivors . We therefore conducted a feasibility study for a trial of BP telemonitoring for stroke/TIA survivors with uncontrolled BP in primary care . Method Phase 1 was a pilot trial involving 55 patients stratified by stroke/TIA r and omised 3:1 to BP telemonitoring for 6 months or usual care . Phase 2 was a qualitative evaluation and comprised semi-structured interviews with 16 trial participants who received telemonitoring and 3 focus groups with 23 members of stroke support groups and 7 carers . Results Overall , 125 patients ( 60 stroke patients , 65 TIA patients ) were approached and 55 ( 44 % ) patients were r and omised including 27 stroke patients and 28 TIA patients . Fifty-two participants ( 95 % ) attended the 6-month follow-up appointment , but one declined the second daytime ambulatory blood pressure monitoring ( ABPM ) measurement result ing in a 93 % completion rate for ABPM − the proposed primary outcome measure for a full trial . Adherence to  telemonitoring  was good ; of the 40 participants who were  telemonitoring  , 38 continued to provide readings throughout the 6 months . There was a mean reduction of 10.1 mmHg in systolic ABPM in the telemonitoring group compared with 3.8 mmHg in the control group , which suggested the potential for a substantial effect from telemonitoring . Our qualitative analysis found that many stroke patients were concerned about their BP and telemonitoring increased their engagement , was easy , convenient and reassuring . Conclusions A full-scale trial is feasible , likely to recruit well and have good rates of compliance and follow-up . Trial Registration IS RCT N61528726 15/12/2011 CONTEXT Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions and lower access to care . OBJECTIVES To examine the effectiveness of a telemedicine intervention to achieve clinical management goals in older , ethnically diverse , medically underserved patients with diabetes . DESIGN , Setting , and Patients A r and omized controlled trial was conducted , comparing telemedicine case management to usual care , with blinded outcome evaluation , in 1,665 Medicare recipients with diabetes , aged > /= 55 years , residing in federally design ated medically underserved areas of New York State . Interventions Home telemedicine unit with nurse case management versus usual care . Main Outcome Measures The primary endpoints assessed over 5 years of follow-up were hemoglobin A1c ( HgbA1c ) , low density lipoprotein ( LDL ) cholesterol , and blood pressure levels . RESULTS Intention-to-treat mixed models showed that telemedicine achieved net overall reductions over five years of follow-up in the primary endpoints ( HgbA1c , p = 0.001 ; LDL , p < 0.001 ; systolic and diastolic blood pressure , p = 0.024 ; p < 0.001 ) . Estimated differences ( 95 % CI ) in year 5 were 0.29 ( 0.12 , 0.46)% for HgbA1c , 3.84 ( -0.08 , 7.77 ) mg/dL for LDL cholesterol , and 4.32 ( 1.93 , 6.72 ) mm Hg for systolic and 2.64 ( 1.53 , 3.74 ) mm Hg for diastolic blood pressure . There were 176 deaths in the intervention group and 169 in the usual care group ( hazard ratio 1.01 [ 0.82 , 1.24 ] ) . CONCLUSIONS Telemedicine case management result ed in net improvements in HgbA1c , LDL-cholesterol and blood pressure levels over 5 years in medically underserved Medicare beneficiaries . Mortality was not different between the groups , although power was limited . Trial Registration http:// clinical trials.gov Identifier : NCT00271739 OBJECTIVE Hypertension and other noncommunicable diseases represent a growing threat to low/middle-income countries ( LMICs ) . Mobile health technologies may improve noncommunicable disease outcomes , but LMICs lack re sources to provide these services . We evaluated the efficacy of a cloud computing model using automated self-management calls plus home blood pressure ( BP ) monitoring as a strategy for improving systolic BPs ( SBPs ) and other outcomes of hypertensive patients in two LMICs . SUBJECTS AND METHODS This was a r and omized trial with a 6-week follow-up . Participants with high SBPs ( ≥140 mm Hg if nondiabetic and ≥130 mm Hg if diabetic ) were enrolled from clinics in Honduras and Mexico . Intervention patients received weekly automated monitoring and behavior change telephone calls sent from a server in the United States , plus a home BP monitor . At baseline , control patients received BP results , hypertension information , and usual healthcare . The primary outcome , SBP , was examined for all patients in addition to a preplanned subgroup with low literacy or high hypertension information needs . Secondary outcomes included perceived health status and medication-related problems . RESULTS Of the 200 patients recruited , 181 ( 90 % ) completed follow-up , and 117 of 181 had low literacy or high hypertension information needs . The median annual income was $ 2,900 USD , and average educational attainment was 6.5 years . At follow-up intervention patients ' SBPs decreased 4.2 mm Hg relative to controls ( 95 % confidence interval -9.1 , 0.7 ; p=0.09 ) . In the subgroup with high information needs , intervention patients ' average SBPs decreased 8.8 mm Hg ( -14.2 , -3.4 , p=0.002 ) . Compared with controls , intervention patients at follow-up reported fewer depressive symptoms ( p=0.004 ) , fewer medication problems ( p<0.0001 ) , better general health ( p<0.0001 ) , and greater satisfaction with care ( p≤0.004 ) . CONCLUSIONS Automated telephone care management plus home BP monitors can improve outcomes for hypertensive patients in LMICs . A cloud computing model within regional telecommunication centers could make these services available in areas with limited infrastructure for patient-focused informatics support BACKGROUND Control of blood pressure is a key component of cardiovascular disease prevention , but is difficult to achieve and until recently has been the sole preserve of health professionals . This study assessed whether self-management by people with poorly controlled hypertension result ed in better blood pressure control compared with usual care . METHODS This r and omised controlled trial was undertaken in 24 general practice s in the UK . Patients aged 35 - 85 years were eligible for enrolment if they had blood pressure more than 140/90 mm Hg despite antihypertensive treatment and were willing to self-manage their hypertension . Participants were r and omly assigned in a 1:1 ratio to self-management , consisting of self-monitoring of blood pressure and self-titration of antihypertensive drugs , combined with telemonitoring of home blood pressure measurements or to usual care . R and omisation was done by use of a central web-based system and was stratified by general practice with minimisation for sex , baseline systolic blood pressure , and presence or absence of diabetes or chronic kidney disease . Neither participants nor investigators were masked to group assignment . The primary endpoint was change in mean systolic blood pressure between baseline and each follow-up point ( 6 months and 12 months ) . All r and omised patients who attended follow-up visits at 6 months and 12 months and had complete data for the primary outcome were included in the analysis , without imputation for missing data . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N17585681 . FINDINGS 527 participants were r and omly assigned to self-management ( n=263 ) or control ( n=264 ) , of whom 480 ( 91 % ; self-management , n=234 ; control , n=246 ) were included in the primary analysis . Mean systolic blood pressure decreased by 12.9 mm Hg ( 95 % CI 10.4 - 15.5 ) from baseline to 6 months in the self-management group and by 9.2 mm Hg ( 6.7 - 11.8 ) in the control group ( difference between groups 3.7 mm Hg , 0.8 - 6.6 ; p=0.013 ) . From baseline to 12 months , systolic blood pressure decreased by 17.6 mm Hg ( 14.9 - 20.3 ) in the self-management group and by 12.2 mm Hg ( 9.5 - 14.9 ) in the control group ( difference between groups 5.4 mm Hg , 2.4 - 8.5 ; p=0.0004 ) . Frequency of most side-effects did not differ between groups , apart from leg swelling ( self-management , 74 patients [ 32 % ] ; control , 55 patients [ 22 % ] ; p=0.022 ) . INTERPRETATION Self-management of hypertension in combination with telemonitoring of  blood pressure measurements represents an important new addition to control of hypertension in primary care . FUNDING Department of Health Policy Research Programme , National Coordinating Centre for Research Capacity Development , and Midl and s Research Practice s Consortium PURPOSE The present study evaluated whether an intervention using a short message service ( SMS ) by cellular phone and Internet would improve blood pressure , weight control , and serum lipids of obese patients with hypertension during 8 weeks . METHODS This is a quasi-experimental design with pre- and follow-up tests . Participants were recruited from the family medicine outpatient department of tertiary care hospital located in an urban city of South Korea . Twenty-eight patients were assigned to an intervention group and 21 to a control group . The goal of intervention was to bring blood pressure , body weight , and serum lipids levels close to normal ranges . Patients in the intervention group were requested to record their blood pressure and body weight in a weekly web based diary through the Internet or by cellular phones . The research ers sent optimal recommendations as an intervention to each patient , by both cellular phone and Internet weekly . The intervention was applied for 8 weeks . RESULTS Systolic ( SBP ) and diastolic blood pressures ( DBP ) significantly decreased by 9.1 and 7.2 mmHg respectively at 8 weeks from the baseline in the intervention group ( p<0.05 ) . However , after 8 weeks from the baseline both SBP and DBP in the control group had not changed significantly . Yet , There were significant mean decreases in body weight and waist circumference by 1.6 kg ( p<0.05 ) and 2.8 cm ( p<0.05 ) in the intervention group , respectively . In the control group increases in body weight and waist circumference ( p<0.05 ) mean changes were also significant . High density lipoprotein cholesterol ( HDL-C ) significantly increased , with a mean change of 3.7 mg/dl at 8 weeks from baseline in the intervention group ( p<0.05 ) . The mean change of HDL-C in the control group was , however , not significant . CONCLUSION During 8 weeks using this web-based intervention by way of cellular phone and Internet SMS improved blood pressure , body weight , waist circumference , and HDL-C in patients with obese hypertension IMPORTANCE Self-monitoring of blood pressure with self-titration of antihypertensives ( self-management ) results in lower blood pressure in patients with hypertension , but there are no data about patients in high-risk groups . OBJECTIVE To determine the effect of self-monitoring with self-titration of antihypertensive medication compared with usual care on systolic blood pressure among patients with cardiovascular disease , diabetes , or chronic kidney disease . DESIGN , SETTING , AND PATIENTS A primary care , unblinded , r and omized clinical trial involving 552 patients who were aged at least 35 years with a history of stroke , coronary heart disease , diabetes , or chronic kidney disease and with baseline blood pressure of at least 130/80 mm Hg being treated at 59 UK primary care practice s was conducted between March 2011 and January 2013 . INTERVENTIONS Self-monitoring of blood pressure combined with an individualized self-titration algorithm . During the study period , the office visit blood pressure measurement target was 130/80 mm Hg and the home measurement target was 120/75 mm Hg . Control patients received usual care consisting of seeing their health care clinician for routine blood pressure measurement and adjustment of medication if necessary . MAIN OUTCOMES AND MEASURES The primary outcome was the difference in systolic blood pressure between intervention and control groups at the 12-month office visit . RESULTS Primary outcome data were available from 450 patients ( 81 % ) . The mean baseline blood pressure was 143.1/80.5 mm Hg in the intervention group and 143.6/79.5 mm Hg in the control group . After 12 months , the mean blood pressure had decreased to 128.2/73.8 mm Hg in the intervention group and to 137.8/76.3 mm Hg in the control group , a difference of 9.2 mm Hg ( 95 % CI , 5.7 - 12.7 ) in systolic and 3.4 mm Hg ( 95 % CI , 1.8 - 5.0 ) in diastolic blood pressure following correction for baseline blood pressure . Multiple imputation for missing values gave similar results : the mean baseline was 143.5/80.2 mm Hg in the intervention group vs 144.2/79.9 mm Hg in the control group , and at 12 months , the mean was 128.6/73.6 mm Hg in the intervention group vs 138.2/76.4 mm Hg in the control group , with a difference of 8.8 mm Hg ( 95 % CI , 4.9 - 12.7 ) for systolic and 3.1 mm Hg ( 95 % CI , 0.7 - 5.5 ) for diastolic blood pressure between groups . These results were comparable in all subgroups , without excessive adverse events . CONCLUSIONS AND RELEVANCE Among patients with hypertension at high risk of cardiovascular disease , self-monitoring with self-titration of antihypertensive medication compared with usual care result ed in lower systolic blood pressure at 12 months . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N87171227 BACKGROUND Hypertension is a major risk factor for the long-term complications of diabetes . Mobile , self-measurement of blood pressure is emerging as a method to manage blood pressure in general , but its impact in patients with diabetes is unclear . METHODS We r and omized 137 patients with diabetes and hypertension to either  mobile telemonitoring  ( n = 72 ) or usual care ( n = 65 ) . Clinic blood pressure was recorded at baseline and after 6 months . Patients in the intervention arm transmitted weekly blood pressure readings wirelessly , using adapted sensors via mobile phones to a central server . Clinicians received the data in real-time and using a web-based application provided management advice to the patient and their physicians . RESULTS Systolic blood pressure fell significantly in the patients in the intervention group ( mean [ 95 % confidence interval ] , -6.5 [ -0.8 to -12.2 ] mm Hg ; P = 0.027 ) and remained unchanged in the control group ( 2.1 [ 9.3 to -5.0 ] mm Hg ; P = 0.57 ) . Patients within the intervention arm of African origin seemed to benefit more from the intervention . In addition , those who achieved a systolic blood pressure of < 120 mm Hg had lower average blood sugars than those with higher readings ( 7.8 [ SD 1.6 ] vs. 8.9 [ SD 2.2 ] mmol/L ; P = 0.02 ) . CONCLUSIONS In patients with diabetes , mobile telemonitoring has potential for delivering intensified care to improve blood pressure control , and its use may be associated with reduced exposure to hyperglycemia BACKGROUND The emergence of the World Wide Web in the last decade has made it feasible for the Internet to be a vehicle for chronic disease management . METHODS A r and omized controlled trial ( n = 62 ) testing the effects of a 6-month web-based intervention plus usual care , compared with usual care alone , among adults 60 years of age and older with diabetes . The outcomes were hemoglobin A1c ( HbA1c ) , blood pressure , weight , cholesterol , and high-density lipoprotein ( HDL ) levels . RESULTS A multivariate analysis of covariance controlling for all baseline outcome variables , age , gender , and number of years with diabetes showed significant ( P = 0.001 ) reductions in HbA1c , weight , and cholesterol level and significant improvement in HDL levels in the intervention versus the control group . CONCLUSIONS Findings show a web-based intervention was effective in improving HbA1c , weight , cholesterol , and HDL levels at a 6-month follow-up . Future research is needed to investigate the long-term effectiveness of web-based interventions AIMS The rapidly increasing prevalence of chronic diseases is an important challenge to healthcare systems worldwide . To improve the quality and efficiency of chronic disease care , we investigated the effectiveness and applicability of the Ubiquitous Chronic Disease Care ( UCDC ) system using cellular phones and the internet for overweight patients with both Type 2 diabetes and hypertension . METHODS We conducted a r and omized , controlled clinical trial over 3 months that included 123 patients at a university hospital and a community public health centre . RESULTS After 12 weeks , there were significant improvements in HbA(1c ) in the intervention group ( 7.6 + /- 0.9 % to 7.1 + /- 0.8 % , P < 0.001 ) compared with the control group ( 7.4 + /- 0.9 % to 7.6 + /- 1.0 % , P = 0.03 ) . Furthermore , we observed a significant reduction in systolic and diastolic blood pressure , as well as improvements in total cholesterol , low-density lipoprotein-cholesterol and triglyceride levels in the intervention group . Furthermore , there was a significant increase in adiponectin levels in the intervention group compared with the control group , although high-sensitivity C-reactive protein and interleukin-6 levels did not change in either group . CONCLUSIONS The novel UCDC system presented in this paper improved multiple metabolic parameters simultaneously in overweight patients with both Type 2 diabetes and hypertension Background : Nearly one in three adults in the United States has hypertension . Hypertension is one of the largest risk factors for cardiovascular diseases , and it is growing in prevalence , especially among African Americans . Objectives : To test the hypothesis that individuals who participate in usual care ( UC ) plus blood pressure ( BP ) telemonitoring ( TM ) will have a greater reduction in BP from baseline to 12-month follow-up than would individuals who receive UC only . Methods : A two-group , experimental , longitudinal design with block stratified r and omization for antihypertensive medication use was used . African Americans with hypertension were recruited through free BP screenings offered in the community . Data were collected through a structured interview and brief physical exam . Cross tabs , repeated measures analysis of variance , and independent t tests were used to analyze the study 's hypothesis . Results : The TM intervention group had a greater reduction in systolic BP ( 13.0 mm Hg ) than the enhanced UC group ( 7.5 mm Hg ; t = −2.09 , p = .04 ) from baseline to the 12-month follow-up . Although the TM intervention group had a greater reduction in diastolic BP ( 6.3 mm Hg ) compared with the enhanced UC group ( 4.1 mm Hg ) , the differences were not statistically significant ( t = −1.56 , p = .12 ) . Discussion : Telemonitoring of BP result ed in clinical ly and statistically significant reductions in systolic BP over a 12-month period ; if maintained over a longer period of time , the reductions could improve care and outcomes significantly for African Americans with hypertension BACKGROUND To determine which of 3 interventions was most effective in improving  blood pressure ( BP ) control , we performed a 4-arm r and omized trial with 18-month follow-up at the primary care clinics at a Veterans Affairs Medical Center . METHODS Eligible patients were r and omized to either usual care or 1 of 3 telephone-based intervention groups : ( 1 ) nurse-administered behavioral management , ( 2 ) nurse- and physician-administered medication management , or ( 3 ) a combination of both . Of the 1551 eligible patients , 593 individuals were r and omized ; 48 % were African American . The intervention telephone calls were triggered based on home BP values transmitted via telemonitoring devices . Behavioral management involved promotion of health behaviors . Medication management involved adjustment of medications by a study physician and nurse based on hypertension treatment guidelines . RESULTS The primary outcome was change in BP control measured at 6-month intervals over 18 months . Both the behavioral management and medication management alone showed significant improvements at 12 months-12.8 % ( 95 % confidence interval [ CI ] , 1.6%-24.1 % ) and 12.5 % ( 95 % CI , 1.3%-23.6 % ) , respectively-but not at 18 months . In subgroup analyses , among those with poor baseline BP control , systolic BP decreased in the combined intervention group by 14.8 mm Hg ( 95 % CI , -21.8 to -7.8 mm Hg ) at 12 months and 8.0 mm Hg ( 95 % CI , -15.5 to -0.5 mm Hg ) at 18 months , relative to usual care . CONCLUSIONS Overall intervention effects were moderate , but among individuals with poor BP control at baseline , the effects were larger . This study indicates the importance of identifying individuals most likely to benefit from potentially re source intensive programs . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00237692 OBJECTIVE To determine if a multimodal intervention composed of patient education , home blood pressure ( BP ) monitoring , BP measurement reporting to an interactive voice response ( IVR ) phone system , and clinical pharmacist follow-up improves BP control compared with usual care . STUDY DESIGN Prospect i ve study with patient enrollment , medication consultation and adjustment , remote BP monitoring , and follow-up at 6 months . METHODS This r and omized controlled trial was conducted at 3 healthcare systems in Denver , Colorado , including a large health maintenance organization , a Veterans Affairs medical center , and a county hospital . At each site , patients with uncontrolled BP were r and omized to the multimodal intervention vs usual care for 6 months , with the primary end point of BP reduction . RESULTS Of 338 patients r and omized , 283 ( 84 % ) completed the study , including 138 intervention patients and 145 usual care patients .  Baseline BP was higher in the intervention group vs the usual care group ( 150.5/89.4 vs 143.8/85.3 mm Hg ) . At 6 months , BPs were similar in the intervention group vs the usual care group ( 137.4 vs 136.7 mm Hg , P = .85 for systolic ; 82.9 vs 81.1 mm Hg , P = .14 for diastolic ) . However , BP reductions were greater in the intervention group vs the usual care group ( −13.1 vs −7.1 mm Hg , P = .006 for systolic ; −6.5 vs −4.2 mm Hg , P = .07 for diastolic ) . Adherence to medications was similar between the 2 groups , but intervention patients had a greater increase in medication regimen intensity . CONCLUSIONS A multimodal intervention of patient education , home BP monitoring , BP measurement reporting to an IVR system , and clinical pharmacist follow-up achieved greater reductions in BP compared with usual care Abstract Effective antihypertensive care is not possible without regular and reliable blood pressure measurements . The use of blood pressure home measurement has increased a lot during the last years . Various methods have been used in communication between the patients and physicians . In a r and omized study we compared traditional office-based hypertension treatment protocol ( n=68 ) to the home-based blood pressure measurement protocol ( n=89 ) in which the patient mailed their home-measured BP diary in a letter to the office of their physician . The studied home-based antihypertensive care system was not more effective than the ordinary office-based treatment . The results highlight the importance of continuous home measurement data interpretation by the physician . The system based on mailing the results to the physician office does not seem to be a suitable method in communication between the patient and the physician . Online or other telemedicine-aided means of communication might yield better antihypertensive control This study was conducted to evaluate the effect of automated telephone patient monitoring and counseling on patient adherence to antihypertensive medications and on blood pressure control . A r and omized controlled trial was conducted in 29 greater Boston communities . The study subjects were 267 patients recruited from community sites who were > or= 60 years of age , on antihypertensive medication , with a systolic blood pressure ( SBP ) of > or= 160 mm Hg and /or a diastolic blood pressure ( DBP ) of > or= 90 mm Hg . The study compared subjects who received usual medical care  with those who used a computer-controlled telephone system in addition to their usual medical care during a period of 6 months . Weekly , subjects in the telephone group reported self-measured blood pressures , knowledge and adherence to antihypertensive medication regimens , and medication side-effects . This information was sent to their physicians regularly . The main study outcome measures were change in antihypertensive medication adherence , SBP and DBP during 6 months , satisfaction of patient users , perceived utility for physicians , and cost-effectiveness .  The mean age of the study population was 76.0 years ; 77 % were women ; 11 % were black .  Mean antihypertensive medication adherence improved 17.7 % for telephone system users and 11.7 % for controls ( P = .03 ) . Mean DBP decreased 5.2 mm Hg in users compared to 0.8 mm Hg in controls ( P = .02 ) . Among nonadherent subjects , mean DBP decreased 6.0 mm Hg for telephone users , but increased 2.8 mm Hg for controls ( P = .01 ) . For telephone system users , mean DBP decreased more if their medication adherence improved ( P = .03 ) . The majority of telephone system users were satisfied with the system . Most physicians integrated it into their practice s. The system was cost-effective , especially for nonadherent patient users . Therefore , weekly use of an automated telephone system improved medication adherence and blood pressure control in hypertension patients . This system can be used to monitor patients with hypertension or with other chronic diseases , and is likely to improve health outcomes and reduce health services utilization and costs BACKGROUND Increased emphasis is being placed on the critical need to control hypertension ( HTN ) in patients with diabetes . OBJECTIVE The objective of this study was to evaluate the efficacy of a nurse-managed home telehealth intervention to improve outcomes in veterans with comorbid diabetes and HTN . DESIGN A single-center , r and omized , controlled clinical trial design comparing two remote monitoring intensity levels and usual care in patients with type 2 diabetes and HTN being treated in primary care was used . MEASUREMENTS Primary outcomes were hemoglobin A1c and systolic blood pressure ( SBP ) ; secondary outcome was adherence . RESULTS Intervention subjects experienced decreased A1c during the 6-month intervention period compared with the control group , but 6 months after the intervention was withdrawn , the intervention groups were comparable with the control group . For SBP , the high-intensity subjects had a significant decrease in SBP compared with the other groups at 6 months and this pattern was maintained at 12 months . Adherence improved over time for all groups , but there were no differences among the three groups . LIMITATIONS Subjects had relatively good baseline control for A1c and SBP ; minorities and women were underrepresented . CONCLUSIONS Home telehealth provides an innovative and pragmatic approach to enhance earlier detection of key clinical symptoms requiring intervention . Transmission of education and advice to the patient on an ongoing basis with close surveillance by nurses can improve clinical outcomes in patients with comorbid chronic illness BACKGROUND African Americans have a higher prevalence and greater severity of hypertension than do other minorities and whites . This fact is particularly problematic when one realizes that the rate of control and treatment of hypertension in the US population is getting worse rather than better . Alternative strategies to promote blood pressure control need to be tested . OBJECTIVES The purpose of this pilot study was to test the following hypothesis : Persons who participate in nurse-managed home telemonitoring ( HT ) plus usual care or who participate in nurse-managed community-based monitoring ( CBM ) plus usual care will have greater improvement in blood pressure from baseline to 3 months ' follow-up than will persons who receive usual care only . METHODS This study used a r and omized controlled design ; participants were r and omly assigned to 1 of 3 groups that were stratified by use or nonuse of antihypertension medication . One-way analysis of variance ( ANOVA ) and analysis of covariance ( ANCOVA ) controlling for age and body weight were used to determine changes in blood pressure from baseline to 3 months . The sample contained 26 African Americans with a mean age of 59 years . RESULTS Both the HT group and the CBM group had clinical ly and statistically significant ( P < .05 ) drops in systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) at 3 months ' follow-up , with participants in the HT group demonstrating the greatest improvement ( HT : baseline SBP 148.8 + /- 13.8 , DBP 90.2 + /- 5.79 ; 3 months ' follow-up SBP 124.1 + /- 13.82 , DBP 75.58 + /- 11.4 ; CBM : baseline SBP 155.25 + /- 17.014 , DBP 89.42 + /- 10.95 ; 3 months ' follow-up SBP 142.3 + /- 12.1 , DBP 78.25 + /- 6.86 ) . There was little change in SBP or DBP at 3 months ' follow-up in the usual care only group . CONCLUSION These are important pilot results , which if replicated in a larger sample will significantly improve care for urban African Americans with hypertension The objective of this study was to determine whether a hypertension management program in which patients monitor their own blood pressure ( BF ) at home can reduce costs without compromising BP control . The prospect i ve , r and omized , controlled 1-year clinical trial was conducted at four medical centers of the Kaiser Permanente Medical Care Program in the San Francisco Bay Area . Of 467 patients with uncomplicated hypertension who were referred by their physicians , 37 declined to participate in the study ; 215 were r and omly assigned to a Usual Care ( UC ) group and 215 to a Home BP group . Twenty-five UC patients and 15 Home BP patients did not return for year-end BP measurements . Patients in the UC group were referred back to their physicians . Patients in the Home BP group were trained to measure their own BP and return the readings by mail . Patients were given a st and ard procedure to follow in case of unusually high or low BP readings at home . The number and type of outpatient medical services used were obtained from patient medical records for the study year and the prior year . Costs of care for hypertension were calculated by assigning relative value units to each outpatient service . Trained technicians measured each patient 's BP at entry into the study and 1 year later . Home BP patients made 1.2 fewer hypertension-related office visits than UC patients during the study year ( 95 % confidence interval ( CI ) : 0.8,1.7 ) . Mean adjusted cost for physician visits , telephone calls , and laboratory tests associated with hypertension care was $ 88.76 per patient per year in the Home BP group , 29 % less than in the UC group ( 95 % CI : $ 16.11 , $ 54.74 ) . The annualized cost of implementing the home BP system was approximately $ 28 per patient during the study year and would currently be approximately $ 15 . After 1 year , BP control in men in the Home BP group was better than in men in the UC group ; BP control was equally good in women in both groups . Management of uncomplicated hypertension based on periodic home BP reports can achieve BP control with fewer physician visits , result ing in substantial cost savings Many Korean American persons have hypertension , but competing life priorities often prevent them from attending health-promotion educational activities . Using principles of community-based participatory research , the authors conducted a prospect i ve clinical trial to determine the effectiveness of a mailed vs an in-class culturally tailored education intervention . A total of 380 hypertensive Korean American persons from the Baltimore/Washington area were assigned to a more intense in-class education group or a less intensive mail education group . Evaluation of postintervention blood pressure ( BP ) outcomes revealed that significant reductions in systolic BP ( 13.3 mm Hg and 16.1 mm Hg , respectively ) and diastolic BP ( 9.5 mm Hg and 10.9 mm Hg ) and increases in BP control rates ( 42.3 % and 54.3 % ) were achieved in both groups . No significant differences in BP outcomes between groups , however , were found . In conclusion , education by mail was an effective strategy for improving BP control and may be a viable approach for other immigrant groups if the education material s address their cultural needs Objective Older adults with chronic kidney disease have a high rate of uncontrolled hypertension . Home monitoring of  blood pressure ( BP ) is an integral part of management , but requires that patients bring records to clinic visits . Telemonitoring interventions , however , have not targeted older , less technologically-skilled population s. Methods Veterans with stage 3 or greater chronic kidney disease and uncontrolled hypertension were r and omized to a novel telemonitoring device pairing a Bluetooth-enabled BP cuff with an Internet-enabled hub , which wirelessly transmitted readings ( n=28 ) , or usual care ( n=15 ) . Home recordings were review ed weekly and telemonitoring participants were contacted if BP was above goal . The prespecified primary endpoints were improved data exchange and device acceptability . Secondary endpoint was BP change . Results Forty-three participants ( average age 68 years , 75 % white ) completed the 6-month study . Average start-of- study BP was 147/78 mmHg . Those in the intervention arm had a median of 29 ( IQR 22 , 53 ) transmitted BP readings per month , with 78 % continuing to use the device regularly , whereas only 20 % of those in the usual care group brought readings to in-person visits . The median number of telephone contacts triggered by the wireless monitoring was 2 ( IQR 1 , 4 ) per patient . Both groups had a significant improvement in systolic BP ( P<0.05 , for both changes ) ; systolic BP fell a median of 13 mmHg in monitored participants compared with 8.5 mmHg in usual care participants ( P for comparison 0.31 ) . Conclusion This low-cost wireless monitoring strategy led to greater sharing of data between patients and clinic and produced a trend toward improvements in BP control over usual care at 6 months Objective To determine if an intervention consisting of telemonitoring and supervision by usual primary care clinicians of home self measured blood pressure and optional patient decision support leads to clinical ly important reductions in daytime systolic and diastolic ambulatory blood pressure in patients with uncontrolled blood pressure . Design Multicentre r and omised controlled trial . Setting 20 primary care practice s in south east Scotl and . Participants 401 people aged 29 - 95 years with uncontrolled blood pressure ( mean daytime ambulatory measurement ≥135/85 mm Hg but ≤210/135 mm Hg ) . Intervention Self measurement and transmission of blood pressure readings to a secure website for review by the attending nurse or doctor and participant , with optional automated patient decision support by text or email for six months . Main outcome measures Blinded assessment of mean daytime systolic ambulatory blood pressure six months after r and omisation . Results 200 participants were r and omised to the intervention and 201 to usual care ; primary outcome data were available for 90 % of participants ( 182 and 177 , respectively ) . The mean difference in daytime systolic ambulatory blood pressure adjusted for baseline and minimisation factors between intervention and usual care was 4.3 mm Hg ( 95 % confidence interval 2.0 to 6.5 ; P=0.0002 ) and for daytime diastolic ambulatory blood pressure was 2.3 mm Hg ( 0.9 to 3.6 ; P=0.001 ) , with higher values in the usual care group . The intervention was associated with a mean increase of one general practitioner ( 95 % confidence interval 0.5 to 1.6 ; P=0.0002 ) and 0.6 ( 0.1 to 1.0 ; P=0.01 ) practice nurse consultations during the course of the study . Conclusions Supported self monitoring by telemonitoring is an effective method for achieving clinical ly important reductions in blood pressure in patients with uncontrolled hypertension in primary care setting s. However , it was associated with increase in use of National Health Service re sources . Further research is required to determine if the reduction in blood pressure is maintained in the longer term and if the intervention is cost effective . Trial registration Current Controlled Trials IS RCT N72614272 OBJECTIVE The purpose of this study was to evaluate the short-term motivational effect of a technology-based weight reduction program for obese adults . METHODS One hundred and eleven obese ( 37.0+/-5.8 kg/m(2 ) ) middle aged ( 45.5+/-10.8 years ) adults ( 62 % female ) were r and omly assigned to a usual care or experimental ( SMART : self-monitoring and resting metabolic rate technology ) group . The usual care group received a st and ard nutritional program in accordance to national guidelines . All participants received a comprehensive weight management program consisting of motivational interviewing ( MI ) sessions and automated e-mail behavioral newsletters .  Bodyweight , arterial blood pressure , and psychobehavioral constructs were assessed over 12 weeks . RESULTS Completer analysis ( n=80 ) indicated a significant improvement in bodyweight ( -3.9 % ) , systolic arterial pressure ( -4 mmHg ) , and all motivational constructs following the 12-week study ( p < or=.05 ) . However , there were no significant differences between groups at any time period . CONCLUSION Based on these data , a 12-week comprehensive weight reduction program consisting of MI and automated e-mail behavioral newsletters with or without SMART is efficacious in treating obese adults . PRACTICE IMPLICATION S Although both treatment programs were equally effective , clinicians should consider a treatment program that meets the need of the patient . This study was registered at Clinical Trials.gov NCT00750022 BACKGROUND Pharmacist- or nurse-led team care decreases  patient blood pressure ( BP ) and cardiovascular disease ( CVD ) risk . PURPOSE To evaluate whether a Web-based dietitian-led ( WD ) team care intervention was feasible and result ed in decreased BP , CVD risk , and weight compared to usual care ( UC ) . METHODS Electronic health record ( EHR ) data identified patients aged 30 - 69 years with BMI > 26 , elevated BP , and 10%-25 % 10-year Framingham CVD risk who were registered patient website users . Patients with uncontrolled BP at screening were r and omized to UC or WD , which included a home BP monitor , scale , and dietitian team care . WD participants had a single in-person dietitian visit to obtain baseline information and create a plan to reduce CVD risk . Planned follow-up occurred via secure messaging to report BP , weight , and fruit and vegetable intake and receive ongoing feedback . If needed , dietitians encouraged patients and their physicians to intensify antihypertensive and lipid-lowering medications . Primary outcomes were change in systolic BP and weight loss ≥4 kg at 6 months . Feasibility outcomes included intervention utilization and satisfaction . RESULTS Between 2010 and 2011 , a total of 90 of 101 participants completed 6-month follow-ups . The WD group had higher rates of secure messaging utilization and patient satisfaction . The WD group lost significantly more weight than the UC group ( adjusted net difference=-3.2 kg , 95 % CI=-5.0 , -1.5 , p<0.001 ) and was more likely to lose ≥4 kg ( adjusted relative risk [RRadj]=2.96 , 95 % CI=1.16 , 7.53 ) . BP control and CVD risk reduction were greater in WD than UC , but differences were not statistically significant . CONCLUSIONS WD intervention was feasible and result ed in decreased weight , BP , and CVD risk . A larger trial is justified . TRIAL REGISTRATION NUMBER Trial Registration Number : NCT01077388 Objective To evaluate the efficacy of a programme of home blood pressure measurement ( HBPM ) on therapeutic compliance in mild-to-moderate hypertension . Design A prospect i ve controlled multicentre clinical trial . Setting Forty primary care centres in Spain , with a duration of 6 months . Patients A total of 250 patients with newly diagnosed or uncontrolled hypertension were included . Interventions The patients were r and omly selected and distributed in two groups : ( 1 ) the control group ( CG ) who received st and ard health intervention ; ( 2 ) the intervention group ( IG ) : the patients in this group received an OMRON in their homes for a programme of HBPM . Main outcome measure Four visits were scheduled , for the measurement of blood pressure ( BP ) . They were provided with an electronic monitor for measuring compliance ( monitoring events medication system ; MEMS ) . Therapeutic compliance was defined as a drug consumption of 80–110 % . A number of variables were calculated using the MEMS . The mean BP were calculated and the percentage of controlled patients . Results A total of 200 patients completed the study ( 100 in each group ) .  Compliance was observed in 74 and 92 % , respectively , in the CG and IG [ 95 % confidence interval ( CI ) 63.9–84.1 and 86.7–97.3 ; P = 0.0001 ] , the mean percentage compliances were 87.6 and 93.5 % ( 95 % CI 81.2–94 and 80.7–98.3 ; P = 0.0001 ) , the percentages of correct days were 83.6 and 89.4 % , the percentages of subjects who took the medication at the prescribed time were 79.89 and 88.06 % , and the levels of therapeutic cover were 86.7 and 93.1 % . The number needed to treat to avoid one case of non-compliance was 5.6 patients . The differences in the mean decreases in BP were significant for diastolic BP , with a greater decrease observed in the IG . Conclusions An HBPM programme using electronic monitors is effective in improving compliance in arterial hypertension , measured using the MEMS Although the use of telecommunication systems in medicine has been increasing , few trials have assessed the efficacy of such technology for improving blood pressure in patients with essential hypertension ( 1 , 2 ) . Friedman and colleagues ( 1 ) found that when hypertensive patients used a telephone-linked computer system to report blood pressure , diastolic blood pressure decreased significantly . Bondmass and colleagues ( 2 ) also found a significant decrease in both diastolic and systolic blood pressure , although their trial lacked controls . In these studies and in other trials of home monitoring , self-report of blood pressure was the basic mechanism for transmission of information to physicians ( 1 - 8 ) . This may have consequences for patient care , since it has recently been shown that patients often erroneously report blood pressure , especially patients whose blood pressure is uncontrolled ( 9 ) . Johnson and colleagues ( 9 ) found that in approximately 20 % of instances , self-report of blood pressure differed from the electronic reading by more than 10 mm Hg . Another limitation of previous trials is accurate assessment of the outcome . In some studies , the outcome was determined by one or two blood pressure readings taken during an office visit or by a technician in the home setting ( 1 , 4 - 7 ) . Only one study of 31 patients used  automatic ambulatory blood pressure monitoring ( ABPM )  to assess usual blood pressure at baseline and exit ( 3 ) . Twenty-fourhour ABPM recordings yield a more reliable assessment of usual blood pressure levels during the course of daily activities ( 10 ) . To improve on the previous studies , we design ed a r and omized , controlled trial that used 24-hour ABPM measurements at baseline and at exit to determine change in blood pressure more accurately . The intervention was a service provided to physicians that used electronic transmission of results and did not rely on  self-report of blood pressure . Methods Study Protocol From May 1999 to April 2000 , five internists from the Department of Medicine at the State University of New York Upstate Medical University in Syracuse recruited patients from internal medicine outpatient practice s affiliated with the general medicine division . Out patients seen by these physicians were covered by private insurance plans or Medicare . Eligible patients were adults who had previously received a diagnosis of essential hypertension and were under evaluation for a change in antihypertensive therapy because of 1 ) elevated blood pressure [ systolic pressure 140 or diastolic pressure 90 mm Hg ] despite current antihypertensive therapy , 2 ) undesirable side effects of current antihypertensive medication , or 3 ) office systolic pressure of at least 180 mm Hg or diastolic pressure of at least 110 mm Hg with no current use of antihypertensive medication . For patients with diabetes mellitus , heart disease , stroke , nephropathy , peripheral arterial disease , or hypertensive retinopathy , an office systolic pressure of at least 130 mm Hg or an office diastolic pressure of at least 85 mm Hg was a criterion for eligibility . Patients who were younger than 18 years of age , were pregnant , had secondary hypertension , or did not have the mental or physical capacity to monitor blood pressure at home were excluded . All patients were informed of the study procedures , the risks and benefits of participation , confidentiality , rights , and personnel to contact for additional information . The institutional review board at Upstate Medical University approved the trial , and all patients gave written consent before participation . Patients received printed educational material s on nonpharmacologic approaches to blood pressure  control from the National Heart , Lung , and Blood Institute ( 11 ) . These approaches included reducing weight , increasing physical activity , and changing diet if necessary . At baseline , height and weight were recorded at the clinic for all patients . Body mass index was calculated as kg/m2 . Printed information on the treatment of hypertension from the Sixth Report of the Joint National Committee on Prevention , Detection , Evaluation , and Treatment of High Blood Pressure ( National High Blood Pressure Education Program ) ( 12 ) was available at each clinical site as a reference for physicians and clinical staff . Study Group Assignment We conducted a r and omized trial with concurrent controls . The two study groups were home service and usual care .  To ensure an equal number of patients in both study groups , we used a blocking procedure with r and om permuted blocks of varying size to reduce predictability . R and omization was stratified by the number of prescription medications patients were taking ( 0 to 2 or 3 ) at study entry , which served as a general indicator of morbidity . Sequentially numbered , sealed , opaque envelopes were used for assignment . The r and omization procedure was concealed to physicians and clinical research staff , but physicians , investigators , and patients were aware of group assignment when r and omization was complete . In addition , adherence to the protocol was monitored independently of the clinicians . A priori sample size was calculated to detect a mean ( SD ) difference in blood pressure of 3 5 mm Hg between the two study groups . This yielded 60 patients per group with 90 % power ( = 0.05 [ two-tailed ] ) . Intervention The intervention was a telecommunication service consisting of three components : automatic blood pressure recording at home , central processing , and electronic reports provided weekly to the primary physician and patient . We used a home blood pressure monitoring device that transmitted data over analog telephone lines ( Model 52500 , Welch Allyn , Inc. , Skaneateles Falls , New York ) and was vali date d according to the st and ards of the American National St and ard Institute , Inc. , and the Association for the Advancement of Medical Instrumentation ( 13 ) . The oscillometric device ( 16.26 cm 10.92 cm 6.6 cm ) had a digital display for blood pressure and pulse and used automatic pressurization and exhaust for cuff inflation and deflation . Patients were instructed to take their blood pressure three times in the morning before eating or drinking and three times in the evening before going to bed . After each reading , the device automatically dialed the Service and Support Center at Welch Allyn and transmitted the data . Patients were asked to conduct this routine at least three days each week for a minimum of 8 weeks and could take additional readings if they desired . A computer program was developed to display the results in a report form , which was then faxed to each patient 's physician . The report form contained information on the mean systolic pressure , mean diastolic pressure , and heart rate ( overall , morning , and evening ) . It also graphed the pressure by date and displayed individual readings in tabular form . Both physicians and patients received a report form each week , as well as a summary report form at the end of the trial . When physicians received report forms that indicated elevated pressure , they adjusted antihypertensive medications through a telephone call , an office visit , or both . At the time of the trial , the service cost $ 24.95 per month . Patients assigned to usual care were treated for hypertension according to the guidelines of the Joint National Committee on Prevention , Detection , and Treatment of High Blood Pressure ( 12 ) . Question naire Information Information about patients ' medical histories , past diagnoses of disease , and use of medications was obtained from question naires . The Baecke question naire of habitual physical activity was used to assess usual activity levels ( 14 ) . Subscales included a work index , a sports index , and a nonsports leisure index , as well as a total physical activity score . Dietary intake was estimated by using the Block screening question naire , which consists of two subscales : intake of highly saturated fatty foods and intake of fruit , vegetables , and high-fiber grains ( 15 ) . Questions about smoking and stress were taken from the previously vali date d Health Habits and History Question naire ( 16 ) . The study question naire was collected at the time of the second 24-hour ambulatory readings . Outcome Measures The primary end point was the change in mean arterial pressure during the trial ( baseline to exit ) for home service compared with usual care . A clinical research nurse ( the study manager ) fitted participants with a 24-hour ABPM device at baseline and at exit . The nurse gave the patients detailed instructions for using the device . The ABPM device automatically recorded blood pressure every half-hour from 7:00 a.m. to 11:00 p.m. and every hour from 11:00 p.m. to 7:00 a.m. Information from baseline and exit ABPM readings was given to physicians only after the patient exited the trial . All blood pressure measurements indicated in this report refer to these 24-hour readings . Means and SDs were recorded for systolic pressure , diastolic pressure , arterial pressure , and heart rate by using 24-hour ABPM . Mean arterial pressure was measured as ( diastolic pressure + 1/3 [ systolic pressure diastolic pressure ] ) . The ABPM device also recorded the percentage of readings above the desired target levels ( 140 mm Hg systolic or 90 mm Hg diastolic for patients without target organ damage ; 130 mm Hg systolic or 85 mm Hg diastolic for patients with target organ damage ) . Patients were scheduled to remain in the trial for a minimum of 8 weeks . During the sixth and seventh weeks , appointments were made to schedule second 24-hour ABPM sessions . For both the home service and usual care groups , the median time from baseline to exit was 11 weeks . The final patient receiving usual care exited at 20 weeks , and the final patient receiving home service exited at 28 weeks . Statistical Analysis All information was entered into an Excel data base ( Microsoft Corp. , Redmond , Washington ) and was manually rechecked for errors . Statistical analyses were conducted by using STATISTICA software ( Home blood pressure monitoring ( HBPM ) overcomes many of the limitations of traditional office blood pressure ( BP ) measurement and is both cheaper and easier to perform than ambulatory BP monitoring . Monitors that use the oscillometric method are currently available that are accurate , reliable , easy to use , and relatively inexpensive . An increasing number of patients are using them regularly to check their BP at home , but although this has been endorsed by national and international guidelines , detailed recommendations for their use have been lacking . There is a rapidly growing literature showing that measurements taken by patients at home are often lower than readings taken in the office and closer to the average BP recorded by 24-hour ambulatory monitors , which is the BP that best predicts cardiovascular risk . Because of the larger numbers of readings that can be taken by HBPM than in the office and the elimination of the white-coat effect ( the increase of BP during an office visit ) , home readings are more reproducible than office readings and show better correlations with measures of target organ damage . In addition , prospect i ve studies that have used multiple home readings to express the true BP have found that home BP predicts risk better than office BP ( Class IIa ; Level of Evidence A ) . This call-to-action article makes the following recommendations : ( 1 ) It is recommended that HBPM should become a routine component of BP measurement in the majority of patients with known or suspected hypertension ; ( 2 ) Patients should be advised to purchase oscillometric monitors that measure BP on the upper arm with an appropriate cuff size and that have been shown to be accurate according to st and ard international protocol s. They should be shown how to use them by their healthcare providers ; ( 3 ) Two to 3 readings should be taken while the subject is resting in the seated position , both in the morning and at night , over a period of 1 week . A total of ≥12 readings are recommended for making clinical decisions ; ( 4 ) HBPM is indicated in patients with newly diagnosed or suspected hypertension , in whom it may distinguish between white-coat and sustained hypertension . If the results are equivocal ,  ambulatory BP  monitoring may help to establish the diagnosis ; ( 5 ) In patients with prehypertension , HBPM may be useful for detecting masked hypertension ; ( 6 ) HBPM is recommended for evaluating the response to any type of antihypertensive treatment and may improve adherence ; ( 7 ) The target HBPM goal for treatment is < 135/85 mm Hg or < 130/80 mm Hg in high-risk patients ; ( 8) HBPM is useful in the elderly , in whom both BP variability and the white-coat effect are increased ; ( 9 ) HBPM is of value in patients with diabetes , in whom tight BP control is of paramount importance ; ( 10 ) Other population s in whom HBPM may be beneficial include pregnant women , children , and patients with kidney disease ; and ( 11 ) HBPM has the potential to improve the quality of care while reducing costs and should be reimbursed CONTEXT Treating hypertension decreases mortality and disability from cardiovascular disease , but most hypertension remains inadequately controlled . OBJECTIVE To determine if a new model of care that uses patient Web services , home blood pressure ( BP ) monitoring , and pharmacist-assisted care improves BP control . DESIGN , SETTING , AND PARTICIPANTS A 3-group r and omized controlled trial , the Electronic Communications and Home Blood Pressure Monitoring study was based on the Chronic Care Model . The trial was conducted at an integrated group practice in Washington state , enrolling 778 participants aged 25 to 75 years with uncontrolled essential hypertension and Internet access . Care was delivered over a secure patient Web site from June 2005 to December 2007 . INTERVENTIONS Participants were r and omly assigned to usual care , home BP monitoring and secure patient Web site training only , or home BP monitoring and secure patient Web site training plus pharmacist care management delivered through Web communications . MAIN OUTCOME MEASURES Percentage of patients with controlled BP ( < 140/90 mm Hg ) and changes in systolic and diastolic BP at 12 months . RESULTS Of 778 patients , 730 ( 94 % ) completed the 1-year follow-up visit . Patients assigned to the home BP monitoring and Web training only group had a nonsignificant increase in the percentage of patients with controlled BP ( < 140/90 mm Hg ) compared with usual care ( 36 % [ 95 % confidence interval { CI } , 30%-42 % ] vs 31 % [ 95 % CI , 25%-37 % ] ; P = .21 ) . Adding Web-based pharmacist care to home BP monitoring and Web training significantly increased the percentage of patients with controlled BP ( 56 % ; 95 % CI , 49%-62 % ) compared with usual care ( P < .001 ) and home BP monitoring and Web training only ( P < .001 ) . Systolic BP was decreased stepwise from usual care to home BP monitoring and Web training only to home BP monitoring and Web training plus pharmacist care . Diastolic BP was decreased only in the pharmacist care group compared with both the usual care and home BP monitoring and Web training only groups . Compared with usual care , the patients who had baseline systolic BP of 160 mm Hg or higher and received home BP monitoring and Web training plus pharmacist care had a greater net reduction in systolic BP ( -13.2 mm Hg [ 95 % CI , -19.2 to -7.1 ] ; P < .001 ) and diastolic BP ( -4.6 mm Hg [ 95 % CI , -8.0 to -1.2 ] ; P < .001 ) , and improved BP control ( relative risk , 3.32 [ 95 % CI , 1.86 to 5.94 ] ; P<.001 ) . CONCLUSION Pharmacist care management delivered through secure patient Web communications improved BP control  in patients with hypertension . Trial Registration clinical trials.gov Identifier : NCT00158639 Self-monitoring of blood glucose is an integral part of diabetes care which may be extended to other biometrics . Cellular and short range communication technologies will be important for the routine usage of these systems . However , the issues of follow-up and patient compliance with these emerging systems have not been yet studied evaluated but could be critical to the adoption of these technologies . We evaluated the impact of mobile telemonitoring on the intensification of care on blood pressure control and exposure to hyperglycaemia in patients with diabetes . We r and omised 137 patients with diabetes to either mobile telemonitoring  ( n = 3D72 ) or usual care patients ( n = 3D65 ) for 9 months . In this paper we present some of the clinical results with focus on blood pressure control hypertension and highlight some of the technical and compliance issues that were encountered
target: For those surrogate outcomes , low-strength evidence failed to show difference .
  In subgroup analysis , high strength evidence supported a lower BP with HBPT that lasted for 6 or 12 months and was accompanied with counselling support from study personnel .
  HBPT can improve BP control in the hypertensive patients .
  It may be more efficacious when a proactive additional support is provided during the intervention process
background: To summarise evidence about the effectiveness of home blood pressure telemonitoring ( HBPT )  and identify the key components of intervention .