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Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

Richard J McManus Orcid Logo, 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, Becky Band Orcid Logo, Emma Ogburn, Julie Allen, Cathy Rice, Jacqui Nuttall, Bryan Williams, Lucy Yardley

BMJ, Volume: 2021, Issue: 372, Start page: m4858

Swansea University Author: Becky Band Orcid Logo

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DOI (Published version): 10.1136/bmj.m4858

Abstract

Objective The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management.Design Unmasked randomised controlled trial with autom...

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Published in: BMJ
ISSN: 1756-1833
Published: BMJ 2021
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URI: https://cronfa.swan.ac.uk/Record/cronfa67027
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Abstract: Objective The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management.Design Unmasked randomised controlled trial with automated ascertainment of primary endpoint.Setting 76 general practices in the United Kingdom.Participants 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet.Interventions Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines.Main outcome measures The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values.Results After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction.Conclusions The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded.
Item Description: CCBYNC Open accessCorrections: Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial available at https://doi.org/10.1136/bmj.m2216
College: Faculty of Medicine, Health and Life Sciences
Funders: This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research (PGfAR) Programme (grant reference No RP-PG-1211-20001). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. RJM was funded by an NIHR Research Professorship 2013-18 (NIHR-RP-R2-12-015) and is now an NIHR senior investigator. LY is an NIHR senior investigator and her research programme is partly supported by NIHR Applied Research Collaboration (ARC)-West, NIHR Health Protection Research Unit (HPRU) for Behavioural Science and Evaluation, and the NIHR Southampton Biomedical Research Centre (BRC). The funders and sponsor of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report, or in the decision to submit for publication. The corresponding author (RJM) together with LY, BS, and JR had full access to all the data in the study. RJM had final responsibility for the decision to submit for publication.
Issue: 372
Start Page: m4858

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