S Rinfret, M. T Lussier, A Peirce, F Duhamel, S Cossette, L Lalonde, C Tremblay, M. C Guertin, J LeLorier, J Turgeon, P Hamet and for the LOYAL Study Investigators
Circulation: Cardiovascular Quality and Outcomes, 2009, 2(3), 170-177. DOI: 10.1161/CIRCOUTCOMES.108.823765
Background— Hypertension is a leading mortality risk factor yet inadequately controlled in most affected subjects. Effective programs to address this problem are lacking. We hypothesized that an information technology–supported management program could help improve blood pressure (BP) control.
Methods and Results— This randomized controlled trial included 223 primary care hypertensive subjects with mean 24-hour BP >130/80 and daytime BP >135/85 mm Hg measured with ambulatory monitoring (ABPM). Intervention subjects received a BP monitor and access to an information technology–supported adherence and BP monitoring system providing nurses, pharmacists, and physicians with monthly reports. Control subjects received usual care. The mean (±SD) follow-up was 348 (±78) and 349 (±84) days in the intervention and control group, respectively. The primary end point of the change in the mean 24-hour ambulatory BP was consistently greater in intervention subjects for both systolic (–11.9 versus –7.1 mm Hg; P<0.001) and diastolic BP (–6.6 versus –4.5 mm Hg; P=0.007). The proportion of subjects that achieved Canadian Guideline target BP (46.0% versus 28.6%) was also greater in the intervention group (P=0.006). We observed similar BP declines for ABPM and self-recorded home BP suggesting the latter could be an alternative for confirming BP control. The intervention was associated with more physician-driven antihypertensive dose adjustments or changes in agents (P=0.03), more antihypertensive classes at study end (P=0.007), and a trend toward improved adherence measured by prescription refills (P=0.07).
Conclusions— This multidisciplinary information technology–supported program that provided feedback to patients and healthcare providers significantly improved blood pressure levels in a primary care setting.