January/February 2023
Telehealth vs clinic-based care for patients with hypertension

Pharmacist-led telemonitoring and clinic- based management were equally effective at lowering blood pressure.

Hypertension is controlled inadequately in many patients. Novel approaches to this problem, includ­ing remote monitoring and team­based models of care, have gained traction in recent years, especially during the COVID­19 pandemic (JAMA Intern Med 2022; 182: 1005­-1006).

In this study from 21 primary care practices in the USA, researchers rando­mised 3000 adults with uncontrolled hypertension (mean baseline blood pressure [BP], about 160/90 mmHg) to either clinic­-based care or telehealth care. Clinic­-based care entailed face­-to­-face visits with primary care providers and medical assistants. Telehealth care involved telemonitoring (using devices that transmitted BP readings automatic­ ally to the electronic health record) along with care management by a doctoral­-level pharmacist. In both groups, clinicians followed protocols for hypertension treatment and reassessed BPs every two to four weeks until control was achieved.

During 12 months of follow up, these approaches were equally effective: in both groups, systolic BP declined by about 18 mmHg and diastolic BP declined by 10 mmHg. Patients appeared to prefer the telehealth approach: this group reported higher satisfaction with hypertension care, less inconvenience due to visits and more frequent self­-monitoring.

Comment: Both approaches led to substan­tial improvements in BP, probably due to practices such as automatic follow up of elevated readings and adherence to evidence­-based treatment protocols. These elements are challenging to incorporate into a busy primary care practice but often are more feasible via telehealth. In my Veterans Affairs primary care practice, I frequently engage pharmacists and telemonitoring for hypertension manage­ment; as in this trial, the results have been excellent.

Instructor in Medicine, University of Colorado, Boulder, USA.

Margolis KL, et al. Comparing pharmacist-led telehealth care and clinic-based care for uncontrolled high blood pressure: the Hyperlink 3 pragmatic cluster-randomized trial. Hypertension 2022; 79: 2708-2720.

This summary is taken from the following Journal Watch title: General Medicine