Telemonitoring in the management of high blood pressure.

High blood pressure (BP) is an important risk factor for stroke and ischaemic heart disease. Yet, despite the availability of effective drugs, it is generally poorly controlled. Partly this is because some patients do not adhere to treatment regimens and partly because clinicians either measure BP insufficiently frequently or are not rigorous in applying treatment guidelines. Additionally individual surgery measurements of BP provide a poor prediction of cardiovascular risk. Methods using multiple BP measures provide more accurate estimates of risk and response to treatment. Self-monitoring of blood pressure at home overcomes this problem, but alone has not been conclusively shown to lower BP. There is now strong evidence from several randomised controlled trials that using telemetry to communicate home BP measures to healthcare providers (telemonitoring) is associated with highly statistically and clinically significant reductions in BP. However the studies have been of relatively short duration and it is not known if these reductions would be sustained in the long term, nor have any of the studies been at large scale. While there are challenges to implementing telemonitoring at scale there is a need for large implementation trials over relatively prolonged periods to establish the efficacy of such an approach in routine care.