Page 2 CirculationCardiovascularQualityandOutcomes

Original Article

A Pharmacist-Led, American Heart Association Heart360
Web-Enabled Home Blood Pressure Monitoring Program

David J. Magid, MD, MPH; Kari L. Olson, BSc(Pharm), PharmD; Sarah J. Billups, PharmD; Nicole
M. Wagner, MPH; Ella E. Lyons, MS; Beverly A. Kroner, PharmD

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 randomized, controlled trial was conducted in 10 Kaiser Permanente Colorado clinics. Overall, 348
patients with BP above recommended levels were randomized 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 Trials Registration—URL: http://www.clinicaltrials.gov/ct2/show/NCT01162759. Unique identifier: NCT01162759.
(Circ Cardiovasc Qual Outcomes. 2013;6:0-0.)
Key Words: blood pressure ◼ home blood pressure monitoring ◼ hypertension ◼ randomized controlled trials
◼ treatment effectiveness

D espite well-established evidence-based medication and Additionally, previous studies required healthcare providers
to reach out to patients at regular intervals, to manually obtain
behavioral therapies to treat hypertension, major gaps
1–3
in blood pressure (BP) control remain. Of the 76 million the home BP readings of the patients, and to manually calcu-
US adults with hypertension, more than half have uncon- late the averages before determining which patients required
1
trolled BP. Uncontrolled hypertension is associated with an further intervention. For HBPM and interventions to be suc-
increased risk of acute myocardial infarction, stroke, kidney cessful at a population level, innovative methods to streamline
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failure, and congestive heart failure. Lowering BP to recom- data into user-friendly reports that allow providers to focus
mended levels has been shown to reduce the occurrence of care delivery will be important.
these events. 4 The objective of this pragmatic, randomized, controlled
To improve BP treatment and control rates, home BP moni- trial was to evaluate the effectiveness of a pharmacist-led,
toring (HBPM) has been suggested as an adjunct to traditional American Heart Association Heart360 Web-enabled HBPM
outpatient hypertension care. 5–12 Previous studies involving intervention compared with usual care (UC) for patients
pharmacist- or nurse-led HBPM programs have demonstrated with uncontrolled hypertension. The HBPM intervention,
improvements in BP control. 6,8,13,14 However, the applicabil- which was delivered by regular clinical staff, used a simple
ity of these interventions to routine practice may be limited HBPM protocol, did not require patients to make office
by reliance on complex HBPM protocols, a requirement for visits, included high-risk patients with DM and CKD, and
patients to make prescribed office visits in addition to HBPM, used Heart360 (www.heart360.org), a widely available and
the exclusion of high-risk patients such as those with diabetes free Web-enabled software for HBPM. We hypothesized
mellitus (DM) or chronic kidney disease (CKD), or the use that patients randomized to the HBPM group would achieve
of expensive, proprietary software to support telemonitoring. greater BP control than patients randomized to UC.
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Received July 23, 2012; accepted December 31, 2012.
From the Kaiser Permanente Colorado, Denver (D.J.M., K.L.O., S.J.B., N.M.W., E.E.L., B.A.K.); University of Colorado–Denver, Denver (D.J.M.); and
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (K.L.O., S.J.B.,.B.A.K.).
The online-only Data Supplement is available at http://circoutcomes.ahajournals.org/lookup/suppl/doi: 10.1161/CIRCOUTCOMES.112.968172/-/DC1.
Correspondence to David Magid, 10065 E Harvard Ave, Ste 300, Denver, CO 80231. E-mail david.j.magid@kp.org
© 2013 American Heart Association, Inc.
Circ Cardiovasc Qual Outcomes is available at http://circoutcomes.ahajournals.org DOI: 10.1161/CIRCOUTCOMES.112.968172
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