Home and Online Management and Evaluation of Blood Pressure using a digital intervention in poorly controlled hypertension (HOME BP): a randomised controlled trial

Richard McManus*, Paul Little, Beth Stuart, Katherine Morton, James Raftery, Jo Kelly, Katherine J. Bradbury, Jin Zhang, Shihua Zhu, Elizabeth Murray, Carl R May, Frances Mair, Susan F Michie, Peter Smith, Rebecca Band, Emma Ogburn, Julie Allen, Cathy Rice, Jacqui Nuttall, Bryan WilliamsLucy Yardley

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

Abstract

Study question:
Can a digital intervention for management of hypertension in primary care combining self-monitoring of blood pressure with guided self-management lead to lower systolic blood pressure (BP) after a year in people with poorly controlled hypertension.

Methods
People with poorly controlled hypertension (blood pressure greater or equal to 140/90mmHg were randomised to the HOME BP intervention or usual care. The intervention consisted of an integrated patient and healthcare practitioner online digital intervention, including training, BP self-monitoring with study provided monitors, health professional directed titration of anti-hypertensive medication and user-selected lifestyle modifications. Usual care was routine hypertension care, with appointments and medication changes made at the GP’s discretion. The primary outcome was difference in office systolic BP after one year, adjusted for baseline BP, BP target, age and practice, with multiple imputation for missing values.

Study Answer and limitations
After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 (11.4%). Office BP dropped from 151.7/86.4mmHg to 138.4/80.2mmHg in the intervention group and 151.7/85.3mmHg to 141.8/79.8mmHg in the usual care group giving a mean difference in BP of -3.5 (95% confidence interval -6.2 to -0.9) / -0.6 (-1.9 to 0.8) mmHg. The major limitations were that the intervention required online access and self-monitoring equipment which may not be available to all members of society and that sub group analysis suggested a reduction in effect in older people.

Funding, competing interests and data sharing
The trial was funded by the National Institute for Health Research (NIHR) (RP-PG-1211-20001). Omron provided the monitors used in the HOME BP study at reduced cost. RJM has received BP monitors for research from Omron and is collaborating with them on development of a telemonitoring system. Anonymised trial data are available on reasonable request via the corresponding author.
Original languageEnglish
JournalBMJ Open
Publication statusAccepted/In press - 16 Oct 2020

Structured keywords

  • Physical and Mental Health

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