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Telehealth vs. Clinic Based Care for Hypertension

In short, according to the (NEJM Journal Watch)-Pharmacist-led telemonitoring and clinic-based management were equally effective at lowering BP.

In this study from 21 primary care practices in the U.S., researchers randomized 3,000 adults with uncontrolled HTN (mean baseline BP, ~160/90 mm Hg) to either clinic-based care or telehealth care. Clinic-based care entailed face-to-face visits with PCPs and medical assistants. Telehealth care involved telemonitoring (using devices that transmitted BP readings automatically to the electronic health record) along with care management by a doctoral-level pharmacist. In both groups, clinicians followed protocols for HTN tx and reassessed BPs every 2 to 4 weeks until control was achieved.

During 12 months of follow-up, these approaches were equally effective: In both groups, systolic BP declined by ~18 mm Hg and diastolic BP declined by 10 mm Hg.

Patients appeared to prefer the telehealth approach:

This group reported higher satisfaction with HTN care, less inconvenience due to visits, and more frequent self-monitoring.

Both approaches led to substantial improvements in

BP, likely due to practices such as automatic follow-up of elevated readings and adherence to evidence-based treatment protocols. These elements are challenging to incorporate into a busy primary care practice but often are more feasible via telehealth. In my Veterans Affairs primary care practice, I frequently engage pharmacists and telemonitoring for HTN management; as in this trial, the results have been excellent.



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