Telemonitoring and protocolized case management for hypertensive community dwelling older adults (TECHNOMED): a randomized controlled trial. Issue 9 (22nd September 2022)

• Record Type: Journal Article
• Authors: Lau, Darren; Ringrose, Jennifer; McAlister, Finlay A.; Fradette, Miriam; Wood, Peter W.; Boulanger, Pierre; Klarenbach, Scott; Holroyd-Leduc, Jayna M.; Alagiakrishnan, Kannayiram; Rabi, Doreen; Padwal, Raj
• Is Part Of: Journal of hypertension. Volume 40:Issue 9(2022)
• Page Start: 1702
• Page End: 1712
• Publication Date: 2022-09-22
• Subjects: hypertension (qualifier: prevention and control) -- blood pressure monitoring -- ambulatory -- telemetry -- self-report -- case management -- aged -- aged 80 and over; Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/HJH.0000000000003202
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Background: Home blood pressure (BP) telemonitoring combined with case management leads to BP reductions in individuals with hypertension. However, its benefits are less clear in older (age ≥ 65 years) adults. Methods: Twelve-month, open-label, randomized trial of community-dwelling older adults comparing the combination of home BP telemonitoring (HBPM) and pharmacist-led case management, vs. enhanced usual care with HBPM alone. The primary outcome was the proportion achieving systolic BP targets on 24-h ambulatory BP monitoring (ABPM). Changes in HBPM were also examined. Logistic and linear regressions were used for analyses, adjusted for baseline BP. Results: Enrollment was stopped early due to coronavirus disease 2019. Participants randomized to intervention ( n = 61) and control ( n = 59) groups were mostly female (77%), with mean age 79.5 years. The adjusted odds ratio for ABPM BP target achievement was 1.48 (95% confidence interval 0.87–2.52, P = 0.15). At 12 months, the mean difference in BP changes between intervention and control groups was −1.6/−1.1 for ABPM ( P -value 0.26 for systolic BP and 0.10 for diastolic BP), and −4.9/−3.1 for HBPM ( P -value 0.04 for systolic BP and 0.01 for diastolic BP), favoring the intervention. Intervention group participants had hypotension (systolic BP < 110) more frequently (21% vs. 5%, P = 0.009), but no differences in orthostatic symptoms, syncope, non-mechanical falls, or emergency department visits. Conclusions: Home BP telemonitoring and pharmacist case management did not improve achievement of target range ambulatory BP, but did reduce home BP. It did not result in major adverse consequences. Abstract :