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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

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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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ISSN: 1756-1833
Published: BMJ 2021
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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.</abstract><type>Journal Article</type><journal>BMJ</journal><volume>2021</volume><journalNumber>372</journalNumber><paginationStart>m4858</paginationStart><paginationEnd/><publisher>BMJ</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1756-1833</issnElectronic><keywords/><publishedDay>19</publishedDay><publishedMonth>1</publishedMonth><publishedYear>2021</publishedYear><publishedDate>2021-01-19</publishedDate><doi>10.1136/bmj.m4858</doi><url/><notes>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</notes><college>COLLEGE NANME</college><department>Health and Social Care School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HSOC</DepartmentCode><institution>Swansea University</institution><apcterm/><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.</funders><projectreference/><lastEdited>2024-09-02T14:58:19.1307499</lastEdited><Created>2024-07-09T15:22:51.2751233</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Psychology</level></path><authors><author><firstname>Richard J</firstname><surname>McManus</surname><orcid>0000-0003-3638-028x</orcid><order>1</order></author><author><firstname>Paul</firstname><surname>Little</surname><order>2</order></author><author><firstname>Beth</firstname><surname>Stuart</surname><order>3</order></author><author><firstname>Katherine</firstname><surname>Morton</surname><order>4</order></author><author><firstname>James</firstname><surname>Raftery</surname><order>5</order></author><author><firstname>Jo</firstname><surname>Kelly</surname><order>6</order></author><author><firstname>Katherine</firstname><surname>Bradbury</surname><order>7</order></author><author><firstname>Jin</firstname><surname>Zhang</surname><order>8</order></author><author><firstname>Shihua</firstname><surname>Zhu</surname><order>9</order></author><author><firstname>Elizabeth</firstname><surname>Murray</surname><order>10</order></author><author><firstname>Carl R</firstname><surname>May</surname><order>11</order></author><author><firstname>Frances S</firstname><surname>Mair</surname><order>12</order></author><author><firstname>Susan</firstname><surname>Michie</surname><order>13</order></author><author><firstname>Peter</firstname><surname>Smith</surname><order>14</order></author><author><firstname>Becky</firstname><surname>Band</surname><orcid>0000-0001-5403-1708</orcid><order>15</order></author><author><firstname>Emma</firstname><surname>Ogburn</surname><order>16</order></author><author><firstname>Julie</firstname><surname>Allen</surname><order>17</order></author><author><firstname>Cathy</firstname><surname>Rice</surname><order>18</order></author><author><firstname>Jacqui</firstname><surname>Nuttall</surname><order>19</order></author><author><firstname>Bryan</firstname><surname>Williams</surname><order>20</order></author><author><firstname>Lucy</firstname><surname>Yardley</surname><order>21</order></author></authors><documents><document><filename>67027__31226__6123dde03a7b4e32b97305c98c20539d.pdf</filename><originalFilename>67027.VoR.pdf</originalFilename><uploaded>2024-09-02T14:57:23.9052213</uploaded><type>Output</type><contentLength>503002</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling v2 67027 2024-07-09 Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial 06b53a31f254b004de8649a376ce2fbd 0000-0001-5403-1708 Becky Band Becky Band true false 2024-07-09 HSOC 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. Journal Article BMJ 2021 372 m4858 BMJ 1756-1833 19 1 2021 2021-01-19 10.1136/bmj.m4858 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 NANME Health and Social Care School COLLEGE CODE HSOC Swansea University 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. 2024-09-02T14:58:19.1307499 2024-07-09T15:22:51.2751233 Faculty of Medicine, Health and Life Sciences School of Psychology Richard J McManus 0000-0003-3638-028x 1 Paul Little 2 Beth Stuart 3 Katherine Morton 4 James Raftery 5 Jo Kelly 6 Katherine Bradbury 7 Jin Zhang 8 Shihua Zhu 9 Elizabeth Murray 10 Carl R May 11 Frances S Mair 12 Susan Michie 13 Peter Smith 14 Becky Band 0000-0001-5403-1708 15 Emma Ogburn 16 Julie Allen 17 Cathy Rice 18 Jacqui Nuttall 19 Bryan Williams 20 Lucy Yardley 21 67027__31226__6123dde03a7b4e32b97305c98c20539d.pdf 67027.VoR.pdf 2024-09-02T14:57:23.9052213 Output 503002 application/pdf Version of Record true This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license. true eng http://creativecommons.org/licenses/by/4.0/
title Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial
spellingShingle Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial
Becky Band
title_short Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial
title_full Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial
title_fullStr Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial
title_full_unstemmed Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial
title_sort Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial
author_id_str_mv 06b53a31f254b004de8649a376ce2fbd
author_id_fullname_str_mv 06b53a31f254b004de8649a376ce2fbd_***_Becky Band
author Becky Band
author2 Richard J McManus
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
Emma Ogburn
Julie Allen
Cathy Rice
Jacqui Nuttall
Bryan Williams
Lucy Yardley
format Journal article
container_title BMJ
container_volume 2021
container_issue 372
container_start_page m4858
publishDate 2021
institution Swansea University
issn 1756-1833
doi_str_mv 10.1136/bmj.m4858
publisher BMJ
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Psychology{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Psychology
document_store_str 1
active_str 0
description 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.
published_date 2021-01-19T14:58:17Z
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