New blood pressure treatments emerging

Patients who monitor their blood pressure at home and discuss the results with a pharmacist can make dramatic progress against the disease, according to a Minnesota study that could chart a new course in treating the nation's most common and costly chronic ailment.

Among people using the new technique, 57 percent brought their blood pressure within a healthy range, compared to 30 percent in a control group, according to a study conducted by Bloomington-based HealthPartners and published Wednesday in the Journal of the American Medical Association.

Patients using "telemonitors" — a device which allowed them to take their own blood pressure six times a week and transmit the results to a pharmacist — also kept their blood pressure under control for six months after the experiment ended.

"The telemonitors allowed patients to work with their pharmacist over the phone instead of coming to the [doctor's] office," said Dr. Karen Margolis, a senior investigator at the HealthPartners Institute for Education and Research. As a result, she said, "they were able to get a lot more done" in treating their condition.

Margolis said some patients also came away with a better understanding of hypertension, felt they could communicate more effectively with their health care team and felt more confident monitoring their condition.

High blood pressure is one of the leading causes of death in the United States and can lead to other ailments such as heart disease and stroke. The condition affects nearly one in three adult Americans, with costs estimated at more than $50 billion annually.

The study used 450 patients who receive care from Health Partners Medical Group clinics — some with other underlying conditions such as diabetes and kidney disease. One group was sent home with telemonitors, with pharmacists interpreting those results to make adjustments in the patients' medication levels and answer patients' questions. Patients in the second group received their usual hypertension care, with no home-based follow-up.

A follow-up study will be conducted to explore how much money the program could cost. It could be some time before HealthPartners extensively adopts the technique.

An accompanying editorial in JAMA said the study shows hope for modernizing medicine much the way ATMs changed banking a generation ago. "It is clear that bringing hypertension care out of the office and into patients' homes works," it said.

The editorial also urged health insurers to change their reimbursement practices to cover the cost of home blood-pressure monitors and compensate clinics for services related to home monitoring — both practices pioneered by the U.S. Veterans Health Administration.

The HealthPartners study is the latest in a series of efforts to increase "patient engagement" in their own care, on the theory that some conditions are beyond the direct control of a doctor or nurse and that patients do better when they understand their illnesses and treatment.

Margolis said it was a former mentor at Hennepin County Medical Center who sparked the idea for the experiment.