Page 7 CirculationCardiovascularQualityandOutcomes

6 Circ Cardiovasc Qual Outcomes March 2013

Table 2. Medication Used at 6 Months
Home Blood Pressure
Characteristics Usual Care (n=164) Monitoring (n=162) P
No medication, n (%) 15 (9.2) 6 (3.7) 0.05
Diuretic, n (%) 77 (47.0) 109 (67.3) <0.001
ACE inhibitor/ARB, n (%) 109 (66.5) 123 (75.9) 0.06
β-Blocker, n (%) 55 (33.5) 54 (33.3) 0.97
Calcium channel blocker (%) 40 (24.4) 74 (45.7) <0.001
Other, n (%) 11 (6.7) 16 (9.9) 0.30
Patients with ≥1 medications added, n (%) 41 (25) 113 (70) <0.001
Patients with ≥1 medication dose increases, n (%) 20 (12) 69 (43) <0.001
Change in medication intensity score from baseline to 6 mo, mean (SD) 0.15 (0.82) 1.35 (1.37) <0.001
ACE indicates angiotensin-converting enzyme; and ARB, angiotensin receptor blocker.

This findings of the study are consistent with previous antihypertensive medications, and to order laboratory tests
studies showing that pharmacist- or nurse-led HBPM inter- to monitor for adverse effects. Second, the Heart360 Web
ventions can lead to higher rates of BP control and greater application provided intervention patients with a simple and
BP reductions than UC. 6,8,13,14 Our study goes beyond previ- efficient way to transmit BP measurements to their clinical
ous studies by demonstrating that improved BP control can be pharmacy specialist while keeping patients engaged by pro-
achieved with a relatively simple home monitoring protocol viding them with feedback on their progress toward attain-
and without requiring patients to make additional office visits. ing BP control and easy-to-read educational information.
Previous studies have often relied on the use of expensive, pro- Finally, the BP summary reports enabled clinical pharmacy
prietary software to support monitoring of BP measurements. specialists to focus medication intensification efforts on
In contrast, our study used the freely available Heart360 Web those individuals with elevated home BP readings, whereas
application for BP monitoring. An additional advancement the remaining patients could view graphic representations of
was the use of BP summary reports that provided pharmacists their controlled BP readings through the Heart360 Web appli-
with data on individual BP measurements and the average of cation and required contact with the healthcare team only if
the home BP readings and categorized patients as either con- their home BP readings increased above goal.
trolled or uncontrolled on the basis of their specific BP target It was not possible for UC patients to access the Heart360
goal. The reports streamlined care and improved efficiency Web application during the study period. However, because
because providers could focus their time on those patients HBPM and UC subjects could be treated by the same pri-
with elevated home BP readings. Finally, the generalizabil- mary care providers, it is possible that physicians caring for
ity of the study results is enhanced by the use of a pragmatic UC patients may have been more aggressive than usual in
study design in which the intervention was delivered by regu- addressing elevated BP. However, we would expect that the
lar clinical staff to a broadly representative patient population impact of such contamination would be to bias the results
with uncontrolled hypertension that included participants with toward the null, suggesting that, if anything, the benefits of the
DM and CKD, high-risk groups that have been excluded in HBPM intervention maybe larger than what we have reported.
previous HBPM studies. 8 Primary care physicians consulted pharmacists on the hyper-
We believe the success of the HBPM intervention can be tension medication regimen for 22 of the UC patients (14%)
attributed to several factors. First, clinical pharmacy spe- because this type of interaction is part of UC at KPCO. A
cialists are ideally suited to deliver the intervention because chart review of these consultations demonstrates that in each
of their expertise in medication therapy management. instance the pharmacist provided appropriate guideline-based
Collaborative drug therapy management protocols allow them care that was similar to the recommendations that were made
to make necessary dose adjustments, to add or discontinue for the patients in the HBPM group.

Table 3. Health Care Used
Home Blood Pressure
Characteristics Usual Care (n=164), n (%) Monitoring (n=162), n (%) P
Clinic visits 3.1 (2.3) 3.3 (2.5) 0.16
ED visits 0.05 (0.23) 0.04 (0.19) 0.44
Hospitalizations 0.04 (0.20) 0.03 (0.17) 0.57
Telephone encounters 3.5 (3.8) 5.3 (4.5) 0.02
E-mail encounters 2.4 (3.2) 6.0 (5.5) <0.01
ED indicates emergency department. Values are mean (SD).

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