People with diabetes: less than 135/75 mm Hg. 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 lead author (RJM) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. Cathy Rice joined as a patient and public contributor during the trial and has remained extensively involved, including optimising many patient facing documents and intervention training content, authorship of this paper and assisting in dissemination. Health Survey for England 2017 Trend Tables. Furthermore, 214/305 (70%) were still monitoring in the last three months of participation (of 12 month study). Julian plays a character called Russell (a.k.a. Furthermore, we found some evidence of increased uptake of physical activity in the younger group, which might partly explain the findings (to be reported elsewhere). Number of drugs and dose changes in usual care and intervention groups. Of the subsample of 243 participants with a body mass index greater than 25, 46 (19%) registered on the online weight loss programme. A sample size of 244 patients for each group was required to have 90% power to detect a difference in systolic blood pressure of 5 mm Hg (standard deviation 17 mm Hg) between the intervention and usual care groups based on the findings from the TASMINH-2 study.22 Allowing for a 15% participant dropout, 287 participants were required for each group, resulting in a total sample size of 574 participants. In commemoration of the anniversary of the Montgomery Bus Boycott, today’s post comes from Sarah Basilion, an intern in the National Archives History Office. Helps you prepare job interviews and practice interview skills and techniques. Additionally, the upper confidence interval crosses our prespecified clinically important level of 5 mm Hg.9 As with our previous work, the results at 12 months showed greater divergence than at six months, which suggests that the intervention might have ongoing impact. A post hoc analysis showed that blood pressure dropped by at least 5 mm Hg in 201/270 (74.4%) of the intervention group compared with 170/282 (60.3%) of those receiving usual care: adjusted odds ratio for a 5 mm Hg drop: 1.9 (95% confidence interval 1.3 to 2.8; controlling for practice level clustering and stratification factors). Relatively few studies have been performed that combine self-monitoring with a digitally delivered cointervention, and none has shown a major effect in an adequately powered trial over a year.7 The HOME BP trial provides evidence that a digitally delivered intervention for hypertension can be successful over 12 months, with engagement from clinicians and patients. However, this approach requires extensive manual record keeping, which makes implementation difficult.9101112 Therefore, a digital intervention that combines our previous knowledge of self-management of hypertension with digital support and lifestyle changes might result in lower blood pressure with associated lifestyle changes, including weight management. The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Surveys suggest that most general practitioners are drawing on self-monitoring in their hypertension management, and that at least one third of patients with hypertension are self-monitoring.4950 Over and above the clinical benefit from the HOME BP digital intervention, the ability to manage blood pressure remotely at scale has never been so important as during the current crisis.13 Therefore, implementation of a cost effective digital intervention that leads to lower blood pressure would now seem to be appropriate. 2018. Study nurses measured participants’ blood pressure after five minutes’ rest using a standardised technique with a validated electronic automated sphygmomanometer (BP TRU BPM 200).15 Six blood pressure readings were taken at intervals of one minute. Given the low marginal cost, such an effect could make a major difference to the millions of people being treated for hypertension in the UK and worldwide. Quality of life measured by using EuroQoL-5D-5L in usual care and intervention groups. Data are numbers (percentages). The small proportions choosing behavioural support might seem counterintuitive, but as has been pointed out before, enabled patients do not always make the decisions that clinicians or public health physicians would like them to.48. Results were comparable in the complete case analysis and adverse effects were similar between groups. In 2018, the youngster revealed what it was like working with Ryan during an interview on Channel Nine's Today Extra. After 12 months, primary endpoint data were available from 271 (89%) participants in the intervention group and 282 (89%) in the usual care group (fig 1). The corresponding author (RJM) together with LY, BS, and JR had full access to all the data in the study. These curves show the intervention had high (90%) probability of being cost effective at willingness to pay above £20 per unit reduction. Results for other subgroups, including sex, baseline blood pressure, deprivation, and history of self-monitoring, were similar between groups; however, it is possible that those with comorbidities gained less from the intervention (systolic blood pressure difference, controlled for age—no comorbidity: −5.1 mm Hg, −8.4 to −1.8 mm Hg; one comorbidity: −0.6 mm Hg, −5.8 to 4.5 mm Hg; multiple comorbidities: −2.0 mm Hg, −11.1 to 7.2 mm Hg). Analyses were on an intention-to-treat basis and used 100 multiple imputations by chained equations for missing data. At full application stage these contributors were joined by Keith Manship and Shelley Mason. If mean home blood pressure was controlled for three consecutive months (defined as 100-134/≤84 mm Hg), patients were advised to reduce blood pressure monitoring to once every eight weeks; monitoring reverted back to every month if mean blood pressure subsequently increased above 135/85 mm Hg. If you are unable to import citations, please contact Baseline characteristics of usual care and intervention groups in the HOME BP trial. The mean age of people declining to take part was 73, and the commonest reason cited was lack of internet access, mirroring Ofcom’s latest data showing a reduction in computer access by socioeconomic status and age.34 While online access is increasing year on year in all age groups and societal stratums, suggesting this barrier could be reduced in the future, it will remain important to better understand barriers to uptake by those in more deprived areas.35 Investment in specific measures will be needed to enable the most vulnerable to engage with digital health initiatives and mitigate the risk that digital health contributes to a widening of health inequality, particularly as deprivation did not modify the effects of intervention. New Zealand actor Julian Dennison, 14, to make... SNP vows to UNILATERALLY hold a second Scottish independence referendum if Sturgeon wins May election - and... We can vaccinate ALL teachers, say schools: Heads send Boris a plan for huge seven-day operation  to... Disney+ blocks under-sevens from watching 'racist' Peter Pan, Dumbo and The Aristocats for breaching... We're sadder, poorer... and fatter: Mail on Sunday survey finds Britain is suffering under lockdown - but... PETER HITCHENS: So is this really an epidemic of despair? Post hoc analyses are stated. Setting 76 general practices in the United Kingdom. At the end of the trial a medical record review captured prescription of antihypertensive drugs (including any changes) and within trial primary healthcare resource use (primary care and secondary care, including outpatient and inpatient visits). 2018 (accessed 24/01/2020). This finding is reflected in the cost of £11/mm Hg reduction, which compares well with £25.66/mm Hg in the HITS trial in Scotland that used a propriety telemonitoring system.47 We would expect such a blood pressure reduction to lead to a longer term impact on cardiovascular events. 2020. By Sam Joseph Semon For Dailymail.com. The difference in mean cost per patient was £38 ($51.3, €41.9; 95% confidence interval £27 to £47), which along with the decrease in systolic blood pressure, gave an incremental cost per mm Hg blood pressure reduction of £11 (£6 to £29; table 7). Office for National Statistics. The 18-year-old raps to a remixed version of the famous theme song to 1990s sitcom The Fresh Prince of Bel-Air. Curtis LB, A. Julian said of feeling star-struck among his famous colleagues. However, too few studies of digital interventions in hypertension have been published to assess whether it is a particular issue with the type of intervention.737 Furthermore, the ageing population also influences rising levels of multimorbidity, and so the suspicion that those with comorbidities gained less from the intervention also merits further investigation.4142 Our process evaluation, which is published in detail elsewhere, has not found evidence of access or engagement problems, or of explanatory characteristics in older people or their clinicians, but the results might have been confounded by the differential blood pressure target for those older than 80 years (145 mm Hg).43 Given the inclusion criteria included a systolic blood pressure of more than 140 mm Hg, older people would not have been prompted to change drugs until their blood pressure rose 10 mm Hg higher than the younger group. A digital intervention enabling self-management of hypertension, including self-monitoring, titration based on self-monitored blood pressure, lifestyle advice, and behavioural support for patients and healthcare professionals, resulted in a worthwhile reduction of systolic blood pressure achieved at modest cost. Minimisation factors were participants’ baseline systolic blood pressure, age, diabetes status, and practice. We followed all the rules': Devastated fiancée of man, 32, who died of Covid begs Britons... MAIL ON SUNDAY COMMENT: A spectacular and public-spirited offer Boris Johnson should accept. The patient enablement score showed a reduction over time (that is, increased enablement) in the self-management group. Proof the Pfizer Covid vaccine works in the real world? Ethical approval: Ethical approval was granted from NRES Hampshire A, 19 March 2015, reference 15/SC/0082, and research governance approval was gained from the relevant NHS bodies. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. KM, KB, JZ, and RB developed the intervention, supported its implementation, contributed to designing the study and carried out the process evaluation. The study compared a digital intervention for hypertension management and self-monitoring of blood pressure with usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner). Post hoc we decided to present antihypertensive drugs as the number of dose changes and drug changes rather than as defined daily dose (which combines dose and number of drugs) to show the specific type of changes more clearly. By recruiting from a large number of general practices, we ensured generalisability in terms of healthcare professionals. Similarly, considering the primary outcome data as repeated measures over the 12 months and controlling for baseline, a significant difference remained between groups in favour of the HOME BP intervention: −2.9 mm Hg (95% confidence interval −4.8 to −1.1 mm Hg) for systolic blood pressure and −0.6 mm Hg (−1.6 to 0.5 mm Hg) for diastolic blood pressure. Data sharing: The HOME BP trial is a member of the BP SMART consortium of randomised controlled trials of self-monitoring in hypertension and data will be included in future meta-analyses. The actor is best known for his roles in Hunt for the Wilderpeople and Deadpool 2. Overall, this digital intervention for the management of hypertension that uses self-monitored blood pressure and behavioural techniques has led to better control of blood pressure than usual care. We do not capture any email address. 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. Eligible participants were randomised using an online system (https://www.lifeguideonline.org) in a 1:1 ratio to receive usual care or the HOME BP intervention with optional nurse support. This intervention could be more easily integrated into clinical care by patients and healthcare professionals, and would allow remote monitoring, an important consideration when people are restricted to staying home because of disability or to avoid exposure to infection. Unit costs of Health and Social Care. Patient and public contributors were involved from the outline application stage (Samantha Hall and Mark Stafford-Watson). For patients allocated to the intervention group, prescribers were asked to select and agree an individualised drug titration plan (including three potential drug changes if blood pressure remained above target).10 Participating clinicians were given information about the National Institute for Health and Care Excellence (NICE) guidance within the HOME BP intervention but were not asked to follow set algorithms for drugs. The HOME BP intervention included elements designed to motivate and support healthy behaviours. Flowchart of HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial. A key barrier to achieving such buy-in and professional usability is probably the lack of integration of the HOME BP digital intervention into electronic health records. Planned subgroup analyses included blood pressure target groups, older versus younger participants (67 as threshold), men versus women, lower index of multiple deprivation scores versus higher scores, and blood pressure better controlled at baseline versus worse controlled at baseline (above or below median systolic blood pressure). Hypertension: clinical management of primary hypertension in adults. Most participants were white British (94%), just over half were men, and time since diagnosis averaged around 11 years. However, other work using such methods suggests that self-monitoring improves adherence.36 Taking into account all our observations, it appears likely that increased antihypertensive drug use drove lower blood pressure. See: http://creativecommons.org/licenses/by/4.0/. The HOME BP intervention for the self-management of high blood pressure consisted of an integrated patient and healthcare practitioner online digital intervention, blood pressure self-monitoring, healthcare practitioner directed and supervised titration of antihypertensive drugs, and user selected lifestyle modifications. Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from NIHR for the submitted work; Omron provided the monitors used in the HOME BP study at reduced cost; RJM received BP monitors for research from Omron and is collaborating with them on development of a telemonitoring system as part of the NIHR Oxford and Thames Valley Applied Research Consortium; RJM receives occasional travel and accommodation reimbursement for talks; he does not personally receive any honorariums or consultancy payments; no other relationships or activities that could appear to have influenced the submitted work. Bodleian Libraries. Previous self-monitoring interventions have proven to be cost effective in the long term within standard parameters.1112, Interestingly, the patient enablement instrument showed that patients were enabled to be more active in controlling their hypertension. Of 11 399 invitation letters sent out, 1389 (12%) potential participants from 76 general practices responded positively and were screened for eligibility. The groups were well matched, with a mean age of 66 years and mean baseline clinical blood pressure of 151.6/85.3 mm Hg and 151.7/86.4 mm Hg (usual care and intervention, respectively; table 1). The Hunt for the Wilderpeople star dons a green and yellow jacket and jeans, as he sings: 'This is a story about how fast food got flipped turned upside down. Participants 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. Participants were not prevented from self-monitoring; data on self-monitoring practices were collected at the end of the trial from patients and practitioners. UK National Health Service resource use costs included those due to the intervention and those due to changes in drugs and use of other relevant NHS resources. 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