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Linking clinic and home: a randomized, controlled clinical effectiveness trial of real-time, wireless blood pressure monitoring for older patients with kidney disease and hypertension.
MedLine Citation:
PMID:  23275313     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: Older adults with chronic kidney disease have a high rate of uncontrolled hypertension. Home monitoring of blood pressure (BP) is an integral part of management, but requires that patients bring records to clinic visits. Telemonitoring interventions, however, have not targeted older, less technologically-skilled populations.
METHODS: Veterans with stage 3 or greater chronic kidney disease and uncontrolled hypertension were randomized to a novel telemonitoring device pairing a Bluetooth-enabled BP cuff with an Internet-enabled hub, which wirelessly transmitted readings (n=28), or usual care (n=15). Home recordings were reviewed weekly and telemonitoring participants were contacted if BP was above goal. The prespecified primary endpoints were improved data exchange and device acceptability. Secondary endpoint was BP change.
RESULTS: Forty-three participants (average age 68 years, 75% white) completed the 6-month study. Average start-of-study BP was 147/78 mmHg. Those in the intervention arm had a median of 29 (IQR 22, 53) transmitted BP readings per month, with 78% continuing to use the device regularly, whereas only 20% of those in the usual care group brought readings to in-person visits. The median number of telephone contacts triggered by the wireless monitoring was 2 (IQR 1, 4) per patient. Both groups had a significant improvement in systolic BP (P<0.05, for both changes); systolic BP fell a median of 13 mmHg in monitored participants compared with 8.5 mmHg in usual care participants (P for comparison 0.31).
CONCLUSION: This low-cost wireless monitoring strategy led to greater sharing of data between patients and clinic and produced a trend toward improvements in BP control over usual care at 6 months.
Authors:
Dena E Rifkin; Joseph A Abdelmalek; Cynthia M Miracle; Chai Low; Ryan Barsotti; Phil Rios; Carl Stepnowsky; Zia Agha
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Blood pressure monitoring     Volume:  18     ISSN:  1473-5725     ISO Abbreviation:  Blood Press Monit     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2012-12-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9606438     Medline TA:  Blood Press Monit     Country:  England    
Other Details:
Languages:  eng     Pagination:  8-15     Citation Subset:  IM    
Affiliation:
Divisions of aNephrology bFamily and Preventive Medicine cCal-IT2, University of California dHealth Services Research and Development eVeterans' Affairs Healthcare System, San Diego, California, USA.
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