Cardiovascular Events and Costs With Home Blood Pressure Telemonitoring and Pharmacist Management for Uncontrolled Hypertension
Open accessAbstract
Uncontrolled hypertension is a leading contributor to cardiovascular disease. A cluster-randomized trial in 16 primary care clinics showed that 12 months of home blood pressure telemonitoring and pharmacist management lowered blood pressure more than usual care (UC) for 24 months. We report cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, hospitalized heart failure, coronary revascularization, and cardiovascular death) and costs over 5 years of follow-up. In the telemonitoring intervention (TI group, n=228), there were 15 cardiovascular events (5 myocardial infarction, 4 stroke, 5 heart failure, 1 cardiovascular death) among 10 patients. In UC group (n=222), there were 26 events (11 myocardial infarction, 12 stroke, 3 heart failure) among 19 patients. The cardiovascular composite end point incidence was 4.4% in the TI group versus 8.6% in the UC group (odds ratio, 0.49 [95% CI, 0.21–1.13], P =0.09). Including 2 coronary revascularizations in the TI group and 10 in the UC group, the secondary cardiovascular composite end point incidence was 5.3% in the TI group versus 10.4% in the UC group (odds ratio, 0.48 [95% CI, 0.22–1.08], P =0.08). Microsimulation modeling showed the difference in events far exceeded predictions based on observed blood pressure. Intervention costs (in 2017 US dollars) were $1511 per patient. Over 5 years, estimated event costs were $758 000 in the TI group and $1 538 000 in the UC group for a return on investment of 126% and a net cost savings of about $1900 per patient. Telemonitoring with pharmacist management lowered blood pressure and may have reduced costs by avoiding cardiovascular events over 5 years. Registration—: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00781365.
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A recent study showed that HBP telemonitoring accompanied with pharmacist management effectively lowered BP levels, with an estimation for a significant reduction in costs for the health system by avoiding cardiovascular events over 5 years.
“A recent study showed that HBP telemonitoring accompanied with pharmacist management effectively lowered BP levels, with an estimation for a significant reduction in costs for the health system by avoiding cardiovascular events over 5 years [263].”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [263]
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Experimental — accuracy not yet measuredPublished data on cost-effectiveness of HBPM have been conflicting.
“Published data on the cost-effectiveness of HBPM have been conflicting [259].”
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- Authors
- Margolis, K. L., Dehmer, S. P., Sperl-Hillen, J., O’Connor, P. J., Asche, S. E., Bergdall, A. R., Green, B. B., Nyboer, R. A., Pawloski, P. A., Trower, N. K., & Maciosek, M. V.
- Affiliations
- HealthPartners (US)
- From the HealthPartners Institute, Minneapolis, MN (K.L.M., S.P.D., J.S.-H., P.J.O., S.E.A., A.R.B., R.A.N., P.A.P., N.K.T., M.V.M.)
- Kaiser Permanente Washington Health Research Institute (US)
- ORCID
- Venue
- Hypertension
- Published
- 2020-10
- Volume
- 76
- Issue
- 4
- Pages
- 1097-1103
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC7484110
- OpenAlex
- W3081759464
- Cited by
- 48
- References
- 8
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 6 · 2023: 6 · 2022: 9 · 2021: 8
- FWCI
- 3.56
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL090965)
- 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
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Keywords
- uncontrolled hypertension, home blood pressure telemonitoring, pharmacist management, cardiovascular events, cardiovascular mortality, myocardial infarction, stroke, heart failure, coronary revascularization, cost-effectiveness, microsimulation, primary care, blood pressure control
- MeSH terms
- Aged, Antihypertensive Agents, Blood Pressure, Female, Humans, Hypertension, Male, Middle Aged, Pharmacists, Risk Factors, Health Care Costs, Blood Pressure Monitoring, Ambulatory
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