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Home Monitoring Service Improves Mean Arterial Pressure in Patients with Essential Hypertension: A Randomized, Controlled Trial

Mary A.M. Rogers, PhD, MS; David Small, MD; Debra A. Buchan, MD; Carl A. Butch, MD; Christine M. Stewart, BA, BS, RN; Barbara E. Krenzer, MD; and Harold L. Husovsky, MD
[+] Article and Author Information

From State University of New York Upstate Medical University, Syracuse, New York.


Acknowledgments: The authors thank Deborah Mickinkle for technical support.

Grant Support: By Welch Allyn, Inc.

Requests for Single Reprints: Mary A.M. Rogers, PhD, MS, Department of Medicine, 322 CWB, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210.

Current Author Addresses: Dr. Rogers: Department of Medicine, 322 CWB, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210.

Drs. Small, Buchan, Krenzer, and Husovsky: Department of Medicine, State University of New York Upstate Medical University, 550 Harrison Center, Suite 200, Syracuse, NY 13210.

Dr. Butch: Internists Associates, 739 Irving Avenue, Suite 200, Syracuse, NY 13210.

Ms. Stewart: Department of Medicine, 325 CWB, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210.

Author Contributions: Conception and design: M.A.M. Rogers, D. Small.

Analysis and interpretation of the data: M.A.M. Rogers, D.A. Buchan, C.A. Butch, C.M. Stewart, B.E. Krenzer, H.L. Husovsky.

Drafting of the article: M.A.M. Rogers.

Critical revision of the article for important intellectual content: M.A.M. Rogers, D. Small, D.A. Buchan, C.A. Butch, C.M. Stewart, B.E. Krenzer, H.L. Husovsky.

Final approval of the article: M.A.M. Rogers, D. Small, D.A. Buchan, C.A. Butch, B.E. Krenzer, H.L. Husovsky.

Provision of study materials or patients: D. Small, D.A. Buchan, C.A. Butch, C.M. Stewart, B.E. Krenzer, H.L. Husovsky.

Statistical expertise: M.A.M. Rogers.

Obtaining of funding: M.A.M. Rogers.

Administrative, technical, or logistic support: M.A.M. Rogers, D. Small, C.M. Stewart.

Collection and assembly of data: C.M. Stewart.


Ann Intern Med. 2001;134(11):1024-1032. doi:10.7326/0003-4819-134-11-200106050-00008
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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 (12). 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 (18). 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.

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Figures

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Figure 1.
Patient accrual.

ABPM = ambulatory blood pressure monitoring.

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Figure 2.
Change in mean diastolic, systolic, and arterial pressures from baseline to exit using 24-hour ambulatory monitoring in patients receiving home service and those receiving usual care.P

Data points represent the mean, shaded areas represent the mean ± SE, and error bars represent the mean ± SD.  = 0.012, 0.047, and 0.013 for differences in mean diastolic, systolic, and arterial pressure, respectively, between patients receiving usual care and those receiving home service.

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Figure 3.
Difference in mean arterial pressure from baseline to exit using 24-hour ambulatory monitoring in the usual care and home service groups according to age, sex, and body mass index.
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Figure 4.
Difference in mean arterial pressure from baseline to exit using 24-hour ambulatory monitoring in the usual care and home service groups according to change in antihypertensive medication.

Data points represent the mean, shaded areas represent the mean (±SE), and error bars represent the mean (±SD).

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Summary for Patients

Home Monitoring Service Improves Blood Pressure Control in Patients with High Blood Pressure

The summary below is from the full report titled “Home Monitoring Service Improves Mean Arterial Pressure in Patients with Essential Hypertension. A Randomized, Controlled Trial.” It is in the 5 June 2001 issue of Annals of Internal Medicine (volume 134, pages 1024-1032). The authors are MAM Rogers, D Small, DA Buchan, CA Butch, CM Stewart, BE Krenzer, and HL Husovsky.

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