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Hypertension management using mobile technology and home blood pressure monitoring: results of a randomized trial in two low/middle-income countries.

Piette JD, Datwani H, Gaudioso S, Foster SM, Westphal J, Perry W, Rodríguez-Saldaña J, Mendoza-Avelares MO, Marinec N. Hypertension management using mobile technology and home blood pressure monitoring: results of a randomized trial in two low/middle-income countries. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2012 Oct 1; 18(8):613-20.

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OBJECTIVE: Hypertension and other noncommunicable diseases represent a growing threat to low/middle-income countries (LMICs). Mobile health technologies may improve noncommunicable disease outcomes, but LMICs lack resources to provide these services. We evaluated the efficacy of a cloud computing model using automated self-management calls plus home blood pressure (BP) monitoring as a strategy for improving systolic BPs (SBPs) and other outcomes of hypertensive patients in two LMICs. SUBJECTS AND METHODS: This was a randomized trial with a 6-week follow-up. Participants with high SBPs ( = 140?mm Hg if nondiabetic and = 130?mm Hg if diabetic) were enrolled from clinics in Honduras and Mexico. Intervention patients received weekly automated monitoring and behavior change telephone calls sent from a server in the United States, plus a home BP monitor. At baseline, control patients received BP results, hypertension information, and usual healthcare. The primary outcome, SBP, was examined for all patients in addition to a preplanned subgroup with low literacy or high hypertension information needs. Secondary outcomes included perceived health status and medication-related problems. RESULTS: Of the 200 patients recruited, 181 (90%) completed follow-up, and 117 of 181 had low literacy or high hypertension information needs. The median annual income was $2,900 USD, and average educational attainment was 6.5 years. At follow-up intervention patients'' SBPs decreased 4.2?mm Hg relative to controls (95% confidence interval -9.1, 0.7; p = 0.09). In the subgroup with high information needs, intervention patients'' average SBPs decreased 8.8?mm Hg (-14.2, -3.4, p = 0.002). Compared with controls, intervention patients at follow-up reported fewer depressive symptoms (p = 0.004), fewer medication problems (p < 0.0001), better general health (p < 0.0001), and greater satisfaction with care (p = 0.004). CONCLUSIONS: Automated telephone care management plus home BP monitors can improve outcomes for hypertensive patients in LMICs. A cloud computing model within regional telecommunication centers could make these services available in areas with limited infrastructure for patient-focused informatics support.

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