A study involving 348 Colorado patients with hypertension could change the way doctors across the country monitor patients with high blood pressure, diabetes and perhaps a host of other diseases.
The study patients were randomly split into two groups ??? half were sent home with blood-pressure cuffs that could download readings online, while the other half stuck to monthly or so doctors??? appointments to get checked.
The difference in outcomes was significant.
At the end of six months, 38 percent of the standard patients had their hypertension under control. But 58 percent of the patients submitting their readings online almost daily had their blood pressure under control.
???People get excited about a 2- or 3-percent difference in blood-pressure control,??? said Dr. David Magid, lead investigator for the Kaiser Permanente Colorado study and an emergency physician at Saint Joseph Hospital in Denver. ???A 20-percent difference is huge.???
Put another way, patients in the home-monitoring group were 50 percent more likely to have their blood pressure controlled compared with the other group.
The positive outcome for patients was much more pronounced than previous studies about how changes in diet and exercise improve hypertension, Magid said. But diet and exercise did play a role in this study.
Nathalie Cole, like most people, used to find out in her doctor???s office whether her blood pressure was out of control.
After six months, taking her blood pressure about four times per week, the Golden, Colo., woman became her own expert.
Cole knew when she was eating too much sodium-laden processed food. She wasn???t surprised when, through readings on the computer, her doctor???s office changed her medication.
In the end, Cole???s blood pressure was within normal range.
???I???ve changed my diet a lot since all of this,??? she said. ???More fresh stuff, less salt. The only thing I even salt anymore is meat, and that???s very rare.???
Even though her part in the study is over, Cole, 44, still has the blood-pressure cuff and downloads the readings onto her computer. Mostly, she wants to know whether the stress of holding down two jobs and the recent death or her father is causing her numbers to spike.
The readings take less than 10 minutes to record and send online, and she doesn???t have to write anything down.
The electronic cuff stores several readings, then through a cord similar to the one on a digital camera, sends them via the Internet to her doctors.
A clinician at her doctor???s office reviews the numbers and lets her know whether she needs a new prescription.
Kaiser partnered with Microsoft to develop the technology for the research.
As many as 73 million Americans have high blood pressure, which can lead to heart disease, heart attack, stroke and kidney disease. But it is often difficult to control because patients don???t necessarily feel symptoms and don???t see a doctor.
National data shows only about one-third of people with hypertension receive treatment and have it under control.
Dr. Larry Hergott, who is director of general cardiology at University of Colorado medical school and was not part of the study, called the results ???phenomenal.???
Controlling hypertension reduces the risk of a heart attack by 25 percent and stroke by 40 percent, he said.
It makes sense for patients to take their own blood pressure at home because anxiety about being on an exam table often causes higher readings, he said.
Hergott, however, pointed out the study is based on a specific population ??? people who have insurance and can afford a computer in their home.
Before the study, Kaiser doctors learned from patients who attended focus groups that it wasn???t the price of medications keeping them from controlling their blood pressure ??? it was the annoyance of having to go to the doctor every few weeks to get checked.
???They have to take off a fair bit of time from busy lives, from work, go to the doctor, go to the pharmacy,??? Magid said.
???They are willing to do that once or twice, but sometimes it takes quite a while, multiple medicines and multiple dose changes. We thought maybe it would be better to have a self-management approach,??? he said.
Magid said he is hopeful the whole Kaiser system, and other doctors across the country, will begin to use home-monitoring systems for hypertension patients.
Diabetics could use a similar system by pricking their finger and downloading glucose levels online, Magid said.
???When you involve patients in their care, then I think they are more committed to taking care of their disease,??? Magid said. ???We???d like to spread this throughout the country because we think this is really a wonderful model for care.???
Kaiser researchers recently presented their findings at the American Heart Association???s forum on cardiovascular disease and stroke.
By Jennifer Brown
THE DENVER POST