Reuters (7/3, Pittman) reports that a study that appeared Tuesday in the Journal of the American Medical Association found that patients with hypertension who were involved in a telemonitoring program were able to keep their systolic and diastolic blood pressure readings down compared to others who received “usual treatment.” Dr. Karen Margolis from HealthPartners Institute for Education and Research in Minneapolis and her colleagues followed a group of people with uncontrolled blood pressure and had them utilize home pressure monitors to measure readings at home and then call in the readings to the pharmacist.
At the end of the program, researchers found 71% of participants involved in the telemonitoring program had their blood pressure in the recommended range, compared to only 53% of participants in the control group.
BLOGFINGER MEDICAL COMMENTARY: By Paul Goldfinger, MD, FACC. This article was originally posted here in 2013, but it is still valid.
In this small study of 450 adult patients with poorly controlled high blood pressure reported on July 3 in the Journal of the American Medical Association, it is suggested that home blood pressure readings coupled with pharmacists’ monitoring the results and adjusting medications could produce better blood pressure control in hypertensive patients whose target readings were not achieved under the care of primary doctors (i.e. “usual treatment.”)
Large trials have shown that there are millions of patients with poorly controlled hypertension in the US, but only half have achieved the goal of BP under 140/90. The reason for the unacceptable stats is not that we need pharmacists to take over care; it’s because the usual and customary care in the hands of primary physicians has not worked well.
This particular study gave no long term results and no evidence that pharmacists are better for the job than real doctors doing the job correctly. The main lesson of this trial has been known for some time: Home BP measurements are an excellent tool to achieve better control. Home readings are superior to office readings in managing hypertension.
Doctors can produce excellent results in their office practices if they organize their procedures better. The idea that hypertension care should be “pharmed out” to pharmacists is nonsense and potentially risky to patients. There are too many potential problems in these cases to allow the care to slide downhill to the corner Rite-Aid. It is not enough to simply focus on the BP reading. The care of such patients is complicated, and fragmenting that care is not conducive to therapeutic success.
The hazards inherent in caring for hypertensives include failure to identify complications such as drug reactions/interactions and side effects that affect other body systems. For example, drug therapy for hypertension can promote kidney malfunction, worrisome low blood pressure, and metabolic disturbances. Hypertension is a major risk factor for stroke and heart attacks, so turning over the job to pharmacists is just a political gimmick to further disrupt the doctor-patient relationship. Physicians are not doing the job well now, but that can be fixed by a new healthcare system.
In my own practice, I achieved nearly perfect BP control for my patients by using home BP devices, education and careful/detailed record keeping by patients, and supervision by our cardiac trained RN’s who helped me with the process. We encouraged necessary life style changes including weight control, diet, salt advice, exercise, and paying attention to emotional factors such as stress. Controlling high blood pressure is usually not difficult, but it can be expensive (as with all good medical care) and it requires commitment on the part of the doctors and their office management personnel. It does not require yet another category of pseudo-doctors.
I say that physicians are the best choice to do the job and they can do it with a team approach in their practices, better technology (especially, tele-transmission of results and accurate and easy to use home monitors), practice guidelines created by doctors, success- based reimbursements for physicians, and insurance coverage of qualified office staff and necessary equipment including the home BP machines and transmission devices.