Uncontrolled hypertension is a leading contributor to cardiovascular disease. A cluster-randomized trial in 16 primary care clinics showed that 12 months of home blood pressure telemonitoring and pharmacist management lowered blood pressure more than usual care (UC) for 24 months. We report cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, hospitalized heart failure, coronary revascularization, and cardiovascular death) and costs over 5 years of follow-up. In the telemonitoring intervention (TI group, n=228), there were 15 cardiovascular events (5 myocardial infarction, 4 stroke, 5 heart failure, 1 cardiovascular death) among 10 patients. In UC group (n=222), there were 26 events (11 myocardial infarction, 12 stroke, 3 heart failure) among 19 patients. The cardiovascular composite end point incidence was 4.4% in the TI group versus 8.6% in the UC group (odds ratio, 0.49 [95% CI, 0.21–1.13], P=0.09). Including 2 coronary revascularizations in the TI group and 10 in the UC group, the secondary cardiovascular composite end point incidence was 5.3% in the TI group versus 10.4% in the UC group (odds ratio, 0.48 [95% CI, 0.22–1.08], P=0.08). Microsimulation modeling showed the difference in events far exceeded predictions based on observed blood pressure. Intervention costs (in 2017 US dollars) were $1511 per patient. Over 5 years, estimated event costs were $758 000 in the TI group and $1 538 000 in the UC group for a return on investment of 126% and a net cost savings of about $1900 per patient. Telemonitoring with pharmacist management lowered blood pressure and may have reduced costs by avoiding cardiovascular events over 5 years. Registration— URL: https://www.clinicaltrials.gov; Unique identifier: NCT00781365.

中文翻译：

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使用家庭血压远程监测和药剂师管理治疗不受控制的高血压的心血管事件和费用

不受控制的高血压是导致心血管疾病的主要原因。一项在 16 家初级保健诊所进行的整群随机试验表明，12 个月的家庭血压远程监测和药剂师管理比 24 个月的常规护理 (UC) 更能降低血压。我们报告了 5 年以上的心血管事件（非致死性心肌梗死、非致死性卒中、住院心力衰竭、冠状动脉血运重建和心血管死亡）和费用。在远程监测干预（TI 组，n=228）中，10 名患者中有 15 次心血管事件（5 次心肌梗死、4 次中风、5 次心力衰竭、1 次心血管死亡）。UC组（n=222）19例患者发生26次事件（心肌梗塞11例，脑卒中12例，心力衰竭3例）。心血管复合终点发生率为 4。TI 组为 4%，UC 组为 8.6%（优势比，0.49 [95% CI，0.21–1.13]，P=0.09）。包括 TI 组 2 次冠状动脉血运重建和 UC 组 10 次冠状动脉血运重建，TI 组次要心血管复合终点发生率为 5.3%，UC 组为 10.4%（优势比，0.48 [95% CI，0.22–1.08] ，P=0.08）。微观模拟模型显示事件的差异远远超过了基于观察到的血压的预测。干预费用（2017 年美元）为每位患者 1511 美元。5 年来，TI 组的估计事件成本为 758 000 美元，UC 组为 1 538 000 美元，投资回报率为 126%，每位患者净成本节省约 1900 美元。药剂师管理下的远程监测降低了血压，并可能通过避免 5 年以上的心血管事件来降低成本。注册——网址：https://www.clinicaltrials.gov; 唯一标识符：NCT00781365。