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

Objective The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. Design Unmasked randomised controlled trial with automated ascertainment of primary endpoint. setting 76 general practices in the United Kingdom. ParticiPants 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. interventiOns Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction.

[1]  A. Sheikh,et al.  Telemonitoring at scale for hypertension in primary care: An implementation study , 2020, PLoS medicine.

[2]  R. Stevens,et al.  Accuracy of blood-pressure monitors owned by patients with hypertension (ACCU-RATE study): a cross-sectional, observational study in central England , 2020, The British journal of general practice : the journal of the Royal College of General Practitioners.

[3]  Dorairaj Prabhakaran,et al.  2020 International Society of Hypertension Global Hypertension Practice Guidelines. , 2020, Hypertension.

[4]  J. Thornton.  Covid-19: how coronavirus will change the face of general practice forever , 2020, BMJ.

[5]  K. Morrissey,et al.  Trends in multimorbidity, complex multimorbidity and multiple functional limitations in the ageing population of England, 2002–2015 , 2019, Journal of comorbidity.

[6]  M. Prince,et al.  Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies , 2019, Journal of comorbidity.

[7]  John Powell,et al.  What is an appropriate level of evidence for a digital health intervention? , 2018, The Lancet.

[8]  L. Yardley,et al.  Using the Person-Based Approach to optimise a digital intervention for the management of hypertension , 2018, PloS one.

[9]  Lucy Yardley,et al.  Qualitative process study to explore the perceived burdens and benefits of a digital intervention for self-managing high blood pressure in Primary Care in the UK , 2018, BMJ Open.

[10]  Karim Ladha,et al.  Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial , 2018, The Lancet.

[11]  B. Carlberg,et al.  Association of Blood Pressure Lowering With Mortality and Cardiovascular Disease Across Blood Pressure Levels: A Systematic Review and Meta-analysis , 2018, JAMA internal medicine.

[12]  Bonnie J Wakefield,et al.  Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis , 2017, PLoS medicine.

[13]  Elizabeth Murray,et al.  Using digital interventions for self-management of chronic physical health conditions: A meta-ethnography review of published studies. , 2017, Patient education and counseling.

[14]  F. Mair,et al.  Intervention planning for a digital intervention for self-management of hypertension: a theory-, evidence- and person-based approach , 2017, Implementation Science.

[15]  Alison M. Devlin,et al.  Readiness for Delivering Digital Health at Scale: Lessons From a Longitudinal Qualitative Evaluation of a National Digital Health Innovation Program in the United Kingdom , 2017, Journal of medical Internet research.

[16]  Lucy Yardley,et al.  Understanding how primary care practitioners perceive an online intervention for the management of hypertension , 2017, BMC Medical Informatics and Decision Making.

[17]  Emma P Bray,et al.  Self-monitoring blood pressure in patients with hypertension: an internet-based survey of UK GPs. , 2016, The British journal of general practice : the journal of the Royal College of General Practitioners.

[18]  J. Raftery,et al.  Home and Online Management and Evaluation of Blood Pressure (HOME BP) digital intervention for self-management of uncontrolled, essential hypertension: a protocol for the randomised controlled HOME BP trial , 2016, BMJ Open.

[19]  Maria Cristina Peñaloza-Ramos,et al.  Cost-effectiveness of self-management of blood pressure in hypertensive patients over 70 years with suboptimal control and established cardiovascular disease or additional cardiovascular risk diseases (TASMIN-SR) , 2016, European journal of preventive cardiology.

[20]  Elizabeth Murray,et al.  Digital interventions to promote self-management in adults with hypertension systematic review and meta-analysis , 2016, Journal of hypertension.

[21]  L. Hinton,et al.  The Effect of Self-Monitoring of Blood Pressure on Medication Adherence and Lifestyle Factors: A Systematic Review and Meta-Analysis. , 2015, American journal of hypertension.

[22]  L. Yardley,et al.  The Person-Based Approach to Intervention Development: Application to Digital Health-Related Behavior Change Interventions , 2015, Journal of medical Internet research.

[23]  Emma P Bray,et al.  Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial. , 2014, JAMA.

[24]  Aziz Sheikh,et al.  Telemonitoring-based service redesign for the management of uncontrolled hypertension (HITS): cost and cost-effectiveness analysis of a randomised controlled trial , 2013, BMJ Open.

[25]  Alan D. Lopez,et al.  A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 , 2012, The Lancet.

[26]  G. Colditz,et al.  Obesity treatment for socioeconomically disadvantaged patients in primary care practice. , 2012, Archives of internal medicine.

[27]  W. Elliott.  NICE clinical guideline 127: Hypertension: Clinical management of primary hypertension in adults , 2012 .

[28]  Matthew J. Crowley,et al.  Treatment Intensification in a Hypertension Telemanagement Trial: Clinical Inertia or Good Clinical Judgment? , 2011, Hypertension.

[29]  C. Dowrick,et al.  Complex interventions , 2022, International Review of Sport and Exercise Psychology.

[30]  Richard J McManus,et al.  Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial , 2010, The Lancet.

[31]  R. Asmar,et al.  Validation of three automatic devices for self-measurement of blood pressure according to the International Protocol: The Omron M3 Intellisense (HEM-7051-E), the Omron M2 Compact (HEM 7102-E), and the Omron R3-I Plus (HEM 6022-E) , 2010, Blood pressure monitoring.

[32]  Debbie Sharp,et al.  Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain , 2008, BMJ : British Medical Journal.

[33]  Ryusuke Inoue,et al.  Prediction of Stroke by Home “Morning” Versus “Evening” Blood Pressure Values: The Ohasama Study , 2006, Hypertension.

[34]  J F Potter,et al.  Extract from : , 2009 .

[35]  James M Wright,et al.  Overall accuracy of the BpTRU™—an automated electronic blood pressure device , 2004, Blood pressure monitoring.

[36]  D. Quinton,et al.  Unit Costs of Health and Social Care 2004 , 2004 .

[37]  Richard Smith,et al.  The discomfort of patient power , 2002, BMJ : British Medical Journal.

[38]  Keith Petrie,et al.  The Revised Illness Perception Questionnaire (IPQ-R) , 2002 .

[39]  J. Wofford.  Clinical inertia. , 2002, Annals of internal medicine.

[40]  J. Weinman,et al.  Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. , 1999, Journal of psychosomatic research.

[41]  D. Heaney,et al.  A comparison of a Patient Enablement Instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultations. , 1998, Family practice.

[42]  A. Kasuya.  EuroQol--a new facility for the measurement of health-related quality of life. , 1990, Health policy.

[43]  A randomised controlled trial of a web-based intervention (POWeR+) with brief nurse support to manage obesity in primary care. , 2022 .