Home monitoring combined with online support lowers blood pressure

A new study from leading experts has found that home blood pressure monitoring combined with online support helps to lower blood pressure



A new study from the leading researchers on home blood pressure monitoring has found that monitoring blood pressure at home in combination with an online tool that connects them with their GPs lowers blood pressure more than usual care. After one year, the home-monitoring intervention led to a 3.4mmHg reduction in systolic blood pressure. This could translate into a 10-15% reduction in the risk of stroke and a 5-10% reduction in the risk of heart disease, making a major difference to the millions of people being treated for high blood pressure in the UK and worldwide.

The HOME BP trial (Home and Online Management and Evaluation of Blood Pressure) was published in the BMJ (British Medical Journal) this January. The authors conclude that home monitoring combined with digital interventions has the potential to provide cost-effective support for both patients and health professionals, and the next step is to put a strategy in place to use these tools in practice to benefit the whole population.

What did the study involve?
The study included 76 GP practices in the UK and over 600 people whose blood pressure was uncontrolled (>140/90 mm Hg) despite receiving treatment and who had access to the internet.

Those taking part were split into two groups. One group received their usual routine care which included appointments and changes to blood pressure medicines at the discretion of their GP.

The other group was given a home monitor and instructions on how to use it as well as information about the benefits of home monitoring. They were sent email reminders to measure their blood pressure and submit their readings online. Their GP was alerted when blood pressure remained high for two months, and medicines could then be adjusted with guidance from their GP if needed. GPs were also given expert support and information to assist them.

Patients also had the option of lifestyle support from a nurse or advisor if they wanted it, covering diet, activity, weight loss, salt and alcohol.

What were the results?
After one year, there were data available for 552 people. Average blood pressure dropped from 151.7/86.4mmHg to 138.4/80.2mmHg in the home monitoring group, and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group – a difference of 3.5mmHg for systolic blood pressure between the two groups.

Lead author, Richard McManus, Professor of Primary Care and GP said: “The reduction in systolic blood pressure of 3.4mm Hg between groups at the end of the trial was not expensive, at £11 per mm Hg and would be expected to result in a reduction of 10-15 % in stroke risk and a reduction of 5-10% in CHD risk.

“Those self-monitoring at home were more likely to have their treatment adjusted by their healthcare professional (optimised medication) but had no more side effects.”

What does this study add?
Home monitoring of blood pressure with adjustments to medicines has been shown to lower blood pressure and is cost effective, but has previously required a lot of record keeping plus expensive technology or time-consuming training. Digital interventions such as apps and other online tools, with guidance from a health professional, have the potential to support people to manage their own health. The study authors have previously shown that online tools work well for weight loss, but only small studies have been run for blood pressure.

This study combined the existing knowledge of home monitoring with digital reminders, pre-planned drug changes and lifestyle advice for lowering blood pressure. It showed that home monitoring with digital support can provide a cost-effective way to lower blood pressure and prevent serious disease. These interventions have the potential to be put into practice on a large scale in a cost-effective manner.

The authors note that putting these digital interventions into practice will involve integration into clinical workflows, and a system for putting them into practice (including integration with health records) is now needed.

Older people, who were less willing to be involved in the study, and people who are not online, also need to be considered.

Home monitoring and the pandemic
As well as the benefits for blood pressure management, home monitoring with online support offers a tool for keeping blood pressure controlled during the pandemic.

Professor Richard McManus explained: “At a time when it is harder to see patients face to face, this is more evidence that self-BP monitoring can form the centrepiece of CVD [cardiovascular disease] prevention in primary care.”