Home and Online Management and Evaluation of Blood Pressure (HOME BP): Main results from a randomised controlled trial

Conference:

2020 SW SAPC Bristol

Talk Code:

3D.3

Presenter:

Richard McManus

Twitter:

@richardjmcmanus

Co-authors:

Paul Little, Beth Stuart, Katherine Morton, James Raftery, Jo Kelly, Katherine Bradbury, Jin Zhang, Shihua Zhu, Elizabeth Murray, Carl R May, Frances S Mair, Susan Michie, Peter Smith, Rebecca Band, Cathy Rice, Jacqui Nuttall, Adam Geraghty, Bryan Williams, Lucy Yardley

Author institutions:

Universities of Oxford, Southampton, Glasgow, London (UCL and LSHTM) and Bristol

Problem

High blood pressure is the leading risk factor for cardiovascular disease world wide yet remains poorly controlled in perhaps a third of individuals. We have previously shown that a manual method of patient self-management in hypertension is effective but it has proven hard to implement due to the training and paper work required. Digital interventions provide a potential means to improve chronic disease management cost-effectively whilst improving patient engagement. The HOME BP trial aimed to test such an intervention in the context of self-monitoring and guided self-management of hypertension.

Approach

622 patients with treated but poorly controlled hypertension (>140/90mmHg) were randomised to either self-monitoring of blood pressure (BP) with a digital intervention or usual care using clinic blood pressure. The digital intervention provided feedback of BP results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressures for hypertension, diabetes and over 80’s followed UK national guidelines. The primary outcome was difference in systolic blood pressure after one year, adjusted for baseline blood pressure, blood pressure target, age and practice, with multiple imputation for missing values.Registration: The HOME BP trial is registered at: ISRCTN13790648

Findings

After one year, data were available from 552 (88.6%). Blood pressure dropped from 151.7/86.4mmHg to 138.4/80.2mmHg in the intervention group and 151.7/85.3mmHg to 141.8/79.8mmHg in the usual care group giving a mean difference in blood pressure of -3.53 (95% confidence interval -6.19, -0.86) / -0.55 (-1.89, 0.80) mmHg. Results were similar in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of of £11 (6, 29) per mmHg reduction.

Consequences

A digital intervention for the management of hypertension utilising self-monitored blood pressure led to significantly lower blood pressure than usual care using clinic blood pressure at modest incremental cost. The HOME BP digital intervention, combined with self-monitoring, has the potential to provide cost-effective support for both patients and professionals in lowering blood pressure and is now suitable for widespread implementation in primary care.

Submitted by:

Richard McManus

Funding acknowledgement:

This work is part of a Programme Grant for Applied Health Research (RP-PG-1211-20001) and is funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.