Abstract
Background/Aims In the Electronic Communications and Home Blood Pressure Trial (e-BP) patients with uncontrolled blood pressure (BP) were registered to use an existing patient shared electronic health record (EHR) and secure e-mail and randomly assigned to: (1) usual care (UC); (2) home BP monitoring (BPM) and website training; or (3) this plus pharmacist team-care delivered via the web (Pharm). At the end of intervention and one year later (1 and 2 years after randomization) Pharm patients were more likely to have controlled BP. The objective here was to determine if BP control improvements persisted longer term.
Methods The primary outcomes were change in systolic and diastolic BP and percent with BP control based on BP measures from the 4.5 year study visit. Modified Poisson regression estimated adjusted RR of BP control. Adjusted spline curves were used to evaluate blood pressures in the EHR.
Results BP control was 67%, 60%, and 65% in the UC, BPM, and Pharm groups respectively (adjusted RR 0.98; 95% CI (0.85, 1.13), Pharm vs. UC) at 4.5 years. For those with more severe systolic HTN (>160 mmHg) at baseline, BP control was 52%, 46%, and 55% (adjusted RR 1.05(0.70, 1.57), Pharm vs. UC) Analysis of BPs from the EHR showed similar results.
Conclusions Almost two thirds of patients with uncontrolled BP at baseline had controlled hypertension at 4.5 years. Group differences seen after the 1-year intervention did not persist long-term, with all groups improving. Longer-term or booster interventions may be needed. EHR BPs can be used to track group differences after a trial ends, but with some important caveats.
