Controlling Hypertension with Web-Based Communication

Only one third of patients with clinically significant hypertension achieve adequate control. A solution to this problem might lie in Web-based care. Researchers at a large integrated group practice recruited 730 patients (mean age, 59; mostly white and well educated) with Internet access and uncontrolled hypertension (diastolic blood pressure [BP] between 90 and 109 mm Hg, or systolic BP between 140 and 199 mm Hg; generally taking at least one hypertension medication). They were randomized to usual care, to home BP monitoring (with Web-based communication, or to the latter intervention plus involvement of a pharmacist. Web-based communication included secure e-mail, e-prescribing, and resources about lifestyle modification. Pharmacists provided telephone and Web-based consultations and prepared medication action plans.

At 12 months of follow-up, investigators observed no difference in BP control between usual-care patients and those who received home BP monitoring and Web-based support: In both groups, roughly 30% to 35% of patients attained BPs of ≤140/90 mm Hg. In contrast, 56% of patients who received pharmacist care achieved this degree of control, which was a significant improvement over the other groups. Mean systolic and diastolic BP decreased by 14 and 7 mm Hg, respectively, in the pharmacist-care group, compared with 5 to 8 mm Hg and 4 mm Hg, respectively, in the other groups.