Blood pressure monitoring strategy works, until program ends

A telemonitoring program involving pharmacists and people with hypertension proved successful in helping patients of Bloomington-based HealthPartners reduce their blood pressure levels.

Until it didn't.

A study published this month showed that the patients achieved lower blood pressure levels after six and 12 months. But the improved levels went away after patients completed the program, in which they checked their blood pressure at home at least six times per week and regularly talked by phone with pharmacists about the results.

Five years after the pharmacist consultations ended, their blood pressure levels returned to the same levels as a comparison group of patients in the study who received only routine clinic care, according to the study results, released Friday in the publication JAMA Network Open.

Just checking blood pressure at home isn't the same, it turns out, as talking with medical professionals who can interpret the results and recommend tweaks to medications, said Dr. Karen Margolis, a lead author of the study and executive director of research at HealthPartners Institute.

"When you're looking at your numbers, and you have a therapeutic relationship with someone who has an interest in those numbers, I think it's easier to get off the dime and reach a decision about what to do," she said.

The research still validated the telemonitoring approach, she said. The first results from the project were published in 2013. They showed that after six months, patients in the telemonitoring group had average systolic blood pressure levels 10 points lower than the average levels of the comparison group.

That's significant, because elevated blood pressure, or hypertension, can lead to heart attacks, strokes and even dementia. And hypertension is a rapidly growing problem that is tied to the nation's growing obesity rate.

Minnesota has one of the nation's lowest hypertension rates, but still, one in four adults in the state has high blood pressure.

HealthPartners selected the telemonitoring approach when it started the study in 2008 — when participants had to have modems to submit blood pressure scores via computers. New wireless technology simplifies the process.

Inspired by the early HealthPartners results, a New Orleans hospital-clinic network known as the Ochsner Health System created a system allowing hypertension patients to use iPhones to automatically submit home blood pressure readings to their electronic medical records. The readings, along with other patient information in the system, determine when pharmacists or life coaches need to contact the patients.

Patients will remain in the support program as long as they are interested and have hypertension, said Dr. Richard Milani, a cardiologist in charge of Ochsner's digital medicine program. An improved score "doesn't mean it's going to be fixed in perpetuity. That's folly," he said.

The improved health and reduced costs of patients in the program convinced Blue Cross and Blue Shield of Louisiana to create a benefit plan that pays for their at-home blood pressure cuffs and waives copays for hypertension drugs.

Margolis said HealthPartners is learning from the success at Ochsner. Her research proved that benefits of a short-term support program can fade, but she said it is unclear how much reinforcement and support it would take to keep patients healthy for the long term. Her follow-up studies are targeting that question.

Single blood-pressure tests during clinic visits aren't always reliable, she said. High scores are sometimes dismissed by doctors on the theory that patients were rushed or under stress because of their appointments.

Allina Health doctors in Edina recently tested the use of take-home blood pressure-monitoring systems on 3,217 patients, who wore them for 24 hours and had their readings taken every 30 minutes. In a 2017 study, the doctors reported that this "ambulatory" monitoring resulted in the reclassification of the hypertension status of 43 percent of the patients.

More frequent monitoring and support is needed, because blood pressure is always changing with time and age, and treatment needs to change with it, Margolis said. "That's what it takes. I wouldn't say constant adjustments [are needed], but you have to tinker."