Reducing high blood pressure by electronic messaging

High blood pressure is a major cause of cardiovascular disease and stroke. In the UK, 31% of the adult population has high blood pressure, and it’s estimated that poor control of the condition contributes to 62,000 avoidable deaths each year. 

But it’s now widely recognised that telemonitoring – where the patient measures their own blood pressure at home regularly and shares the results electronically with their GP or nurse – can directly improve blood pressure management, providing more reliable results over time and enabling follow up action where needed.

Research led by Dr Janet Hanley and colleagues has directly contributed to this knowledge and helped to change international clinical guidance. A series of trials conducted in 2009-13 showed that telemonitoring of blood pressure got measurably better results – a 4.3mmHg lowering of systolic blood pressure - than standard care. This difference would potentially reduce stroke incidence by 15% and cardiovascular disease by 10%.

Scale Up BP’, was successfully piloted in Lothian in 2015 with 80% of GP practices in the region taking up the opportunity to join the service.

More reliable results

Dr Hanley explains: “In a doctor’s surgery setting, some patients will get ‘white coat hypertension’; by contrast others will have consistently lower than average blood pressure. Neither patients nor doctors had faith in surgery readings; and both sides were reluctant to increase medication. But when people were seeing their own blood pressure regularly it empowered them to take the initiative and make their own appointments. They felt they could discuss it on a more informed basis with their practice nurse or GP - and the professionals knew the readings were more reliable.”

The trials were conducted by Edinburgh Napier in a collaboration with the University of Edinburgh and NHS Lothian known as Telescot. Following feedback from doctors and practice nurses, who found the existing web interface for the results inconvenient and time-consuming, the Telescot researchers redesigned the system to deliver patients’ reports through a GP practice’s usual document management system, meaning the results could appear on the same system used for lab results and hospital records.

The resulting telemonitoring service, ‘Scale Up BP’, was successfully piloted in Lothian in 2015 with 80% of GP practices in the region taking up the opportunity to join the service.

National roll-out

The service is now being rolled out nationally with Scottish government funding, with a target of an additional 20,000 people using the system and adoption by 50% of all GP practices in Scotland. The initiative was awarded the Clinical Improvement Award at the UK General Practice Awards and has also been shortlisted for the prestigious British Medical Journal Awards.

Dr Hanley, funded by British Heart Foundation Scotland, is currently leading the evaluation of the service, using clinical records to see if a predicted reduction in major cardiovascular events of up to 12% does take effect. She will also be monitoring the take-up of the programme by different patient groups, as well as looking at the effect on reducing face-to-face appointments.

She comments:

High BP is known as a ‘silent killer’ but while it is closely linked to age and obesity, evidence shows that lowering it directly reduces the incidence of these major cardiovascular events.