Online monitoring by pharmacists may keep hypertension under control

Two-thirds of Americans with hypertension do not keep their blood pressure in check, despite well-known dangers of strokes, heart attacks and other serious consequences.

But in a novel experiment, Seattle's Group Health Cooperative found that adding an extra level of care — monitoring by a pharmacist over the Web — significantly reduced the level of out-of-control hypertension cases.

The study, which appeared in today's issue of the Journal of the American Medical Association (JAMA), may be the first to demonstrate how a combination of Web-based care and patient access to electronic medical records can improve health without extra physician visits.

Investigators randomly assigned 778 Group Health members previously diagnosed with hypertension, or high blood pressure, to three groups.

One group received the "usual care" with an education pamphlet. People in this group were told their blood pressure remained too high and were advised to consult their doctors.

The second group received the usual care plus a free Omron-brand home blood-pressure monitor and training to check their blood pressure at least twice a week. They also were tutored in how to use Group Health's Web site to access their medical records and in how to send secure messages to their physicians.

The third group was identical to the second, except a pharmacist tracked participants' progress. Every two weeks, patients in this group sent their blood-pressure readings to pharmacists via secure messaging. The pharmacists had prescribing authority to adjust dosages and even to switch medications, if warranted.

Monitoring by pharmacists, it turned out, made a big difference. For patients in this group, the systolic reading — the first number in a blood-pressure reading — had dropped by an average of 14.2 points after one year.

Web tutoring and the free monitor, on the other hand, made little difference. Patients in that group had an average systolic blood-pressure drop of 8.2 points. That was better than the 5.3-point drop in the usual-care group but also could have resulted from chance.

In all, 56 percent of patients in the pharmacist-intervention group got their conditions under control, defined as average reading of below 140/90. That compared to 31 percent in the usual-care group and 36 percent in the tutoring-and-free-monitor group.

Pharmacists made the biggest relative difference among patients with highest blood pressure.

"What's exciting is that you can provide care without the patient coming into the office," said Dr. Beverly Green, the study's lead investigator and a Group Health family physician.

Investigators aren't sure exactly why pharmacists helped. Their patients took an average of 2.16 medications for high blood pressure daily, compared to 1.69 medications for the typical usual-care patient. Patients in the pharmacist group also stayed in touch more frequently with their doctors via secure messaging.

An accompanying editorial in JAMA, co-written by the president of the American Heart Association, cautioned that it may be difficult to replicate the Group Health study elsewhere. The co-op operates its own clinics and employs its own doctors, giving it both the integrated health records and financial incentives to manage chronic diseases.

Still, the editorial called the current "physician-centric model" for blood-pressure treatment inadequate and called the Group Health trial a promise of "significant turn for the better."

Kyung Song: 206-464-2423 or ksong@seattletimes.com