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Cited by 199Blood Pressure and Hypertension StudiesTelemedicine and Telehealth ImplementationMobile Health and mHealth Applications

Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial

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McKinstry, B., Hanley, J., Wild, S., Pagliari, C., Paterson, M., Lewis, S., Sheikh, A., Krishan, A. +2 more·2013·BMJ
DOI 10.1136/bmj.f3030PMC PMC3663293
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Abstract

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 clinically important reductions in daytime systolic and diastolic ambulatory blood pressure in patients with uncontrolled blood pressure. DESIGN: Multicentre randomised controlled trial. SETTING: 20 primary care practices in south east Scotland. 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 randomisation. RESULTS: 200 participants were randomised 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 clinically important reductions in blood pressure in patients with uncontrolled hypertension in primary care settings. However, it was associated with increase in use of National Health Service resources. 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 ISRCTN72614272.

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Authors
McKinstry, B., Hanley, J., Wild, S., Pagliari, C., Paterson, M., Lewis, S., Sheikh, A., Krishan, A., Stoddart, A., & Padfield, P.
Affiliations
  • University of Edinburgh (GB)
  • Edinburgh Napier University (GB)
  • Scottish Government (GB)
Corresponding author
McKinstry, B.
ORCID
Venue
BMJ
Publisher
BMJ
Published
2013-05-24
Volume
346
Issue
may24 4
Pages
f3030-f3030
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj.f3030
PMC
PMC3663293
OpenAlex
W2084930541
Cited by
199
References
12
Citations by year
2026: 10 · 2025: 11 · 2024: 15 · 2023: 14 · 2022: 15 · 2021: 16 · 2020: 12 · 2019: 15 · 2018: 20 · 2017: 17 · 2016: 18 · 2015: 20 · 2014: 10 · 2013: 6
FWCI
12.25
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Edinburgh Napier Research Repository (Edinburgh Napier University) (acceptedVersion, cc-by-nc)
  • Research Explorer (The University of Manchester) (submittedVersion, other-oa)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
Funders
  • McKnight Foundation
  • Wellcome Trust
  • Bupa Foundation
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords
remote patient monitoring, uncontrolled hypertension, home blood pressure monitoring, ambulatory blood pressure, patient decision support, primary care, nursing supervision, service redesign, health care utilization
MeSH terms
Adult, Aged, Aged, 80 and over, Analysis of Variance, Antihypertensive Agents, Female, Humans, Hypertension, Male, Middle Aged, Primary Health Care, Self Care, Program Evaluation, Telemedicine, Blood Pressure Monitoring, Ambulatory, Disease Management, Decision Support Systems, Clinical

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