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. HOME BP is registered as ISRCTN13790648 (https://doi.org/10.1186/ISRCTN13790648). Of the subsample of 243 participants with a body mass index greater than 25, 46 (19%) registered on the online weight loss programme. After randomisation, all patients received a blood pressure drug review from a general practitioner or nurse prescriber (prescribers). This research would not have been possible without the support and encouragement of all patients and practice staff from the 76 participating practices. All authors commented on drafts of this paper. The primary analysis used general linear modelling to compare systolic blood pressure in the intervention and usual care groups at follow-up, adjusting for baseline blood pressure, practice (as a random effect to take into account clustering), blood pressure target levels, and sex. The patient enablement score showed a reduction over time (that is, increased enablement) in the self-management group. The HOME BP intervention also aimed to build healthcare practitioner motivation, knowledge, and skills to reduce clinical inertia.17 This objective was achieved by presenting evidence of efficacy and addressing concerns about patient titration acceptance, the reliability of home blood pressure readings, and study procedures. Conclusions The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Julian said of feeling star-struck among his famous colleagues. 'On burgs and fries we were born and raised... until a couple of guys who were up to some good started selling fresh in my neighbourhood,' he adds. Additional outcomes that will be published elsewhere included long term economic modelling and a detailed process evaluation. Engagement with the digital intervention was high, with 281/305 (92%) participants completing the two core training sessions, 268/305 (88%) completing a week of practice blood pressure readings, and 243/305 (80%) completing at least three weeks of blood pressure entries (table A5). NICE. Adults’ media use and attitudes report 2018. Julian plays a character called Russell (a.k.a. Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). More participants in the intervention group reported weight loss (29/243, 11.9% v 57/251, 22.7%; P=0.002), but this was not borne out by the objective weight data (mean difference −0.36 kg, 95% confidence interval −1.10 to 0.38 kg; table A4). Except for an increase in sample size as documented above, no other substantive changes were made to the protocol after the start of the 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. Copyright © 2021 BMJ Publishing Group Ltd 京ICP备15042040号-3, A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010, Association of blood pressure lowering with mortality and cardiovascular disease across blood pressure levels: a systematic review and meta-analysis. New Zealand-born actor Julian Dennison has starred in a hilarious new advertisement for American fast-food franchise Subway. The actor is best known for his roles inÂ Hunt for the Wilderpeople and Deadpool 2. Job interview questions and sample answers list, tips, guide and advice. We are immensely grateful for the input of all of our public contributors. Published: 23:59 GMT, 11 January 2021 | Updated: 06:57 GMT, 12 January 2021. The effect did not seem to be caused by the higher target for people older than 80 years, which has not previously been observed in other trials of self-monitoring. We used practices from the National Institute for Health Research Clinical Research Network (https://www.nihr.ac.uk/explore-nihr/support/clinical-research-network.htm). Furthermore, 214/305 (70%) were still monitoring in the last three months of participation (of 12 month study). 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. Julian then stands in a skate park while holding a Subway sandwich in one hand. At the clinic, eligibility was established, informed consent was obtained from people who wished to participate, and their baseline clinical data were collected. For the digital intervention, participants needed to be willing to self-monitor and have access to the internet (with support from a family member if needed). JR, EM, CRM, SM, FSM, PS, and BW provided senior expertise and leadership, contributing to designing the study, securing funding and supervising the conduct of the study. During the trial, we decided to increase the sample size to 610 to allow for a 20% dropout rate because of concerns about higher than expected initial dropout (which later proved unfounded). 2018 (accessed 24/01/2020). The most deprived group accounted for 63/622 (10%), with the least deprived group accounting for 326/622 (52%). All training for the intervention was delivered online, meaning implementation can also be cost effective. Analyses were on an intention-to-treat basis and used 100 multiple imputations by chained equations for missing data. 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. Results were comparable in the complete case analysis and adverse effects were similar between groups. PETER WALKER: Are slim people ALWAYS fitter than fatties? Israeli healthcare group says coronavirus infections... Milly Dowler's killer Levi Bellfield 'is offered Covid jab at high-security jail before most of the rest of... Boris Johnson will 'force travellers from high-risk Covid countries to quarantine in hotels for ten days' in... DAN HODGES: The truth Boris haters can't bear to admit - he has a plan to fight coronavirus and it's... Britons will refuse to live 'like Troglodytes' under indefinite lockdowns, says rebel Tory MP as he urges No... ‘It's a nightmare. The effect size observed from this intervention could be expected to result in a reduction of 10-15% in patients having a stroke and a reduction of 5-10% in patients having coronary events. Information was presented about the health related benefits of self-monitoring, about reducing blood pressure through drugs, and addressing common patient concerns about the side effects of drugs. At full application stage these contributors were joined by Keith Manship and Shelley Mason. The primary outcome of the trial was the difference in clinic systolic blood pressure (mean of second and third readings) at 12 month follow-up between the intervention and usual care groups, adjusting for baseline blood pressure, practice, blood pressure target levels, and sex. Key aspects contributed to were the development of the intervention, commenting on trial documentation, and taking part in the steering group meetings. Proof the Pfizer Covid vaccine works in the real world? 2019. 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? Interventions Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). Fifteen people (2%) who did not fulfil the inclusion criteria because their blood pressure was out of range were randomised in error (in 10 people blood pressure was too high; in five people blood pressure was too low). Sensitivity analyses used complete cases and also a repeated measures technique. 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. 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. KM, KB, JZ, and RB developed the intervention, supported its implementation, contributed to designing the study and carried out the process evaluation. Previous trials of self-monitoring and self-management have shown effectiveness in reducing blood pressure, but have often relied on relatively expensive technology or time consuming training packages to realise any benefit, Short term trials of digital interventions have shown potential to improve blood pressure control, but have not provided sufficient evidence for widespread implementation, Home and Online Management and Evaluation of Blood Pressure (HOME BP) is a digital intervention comprising self-monitoring of blood pressure with reminders and predetermined drug changes combined with lifestyle change support for the self-management of high blood pressure, HOME BP resulted in better control of systolic blood pressure after one year than usual care and at low incremental cost; adverse events were similar to usual care, Digital interventions such as HOME BP have the potential to be implemented at scale in a cost effective manner. 2018. However, less than one third of participants chose to register on one of the optional lifestyle change modules. After we discussed the issue with the sponsor and with the relevant general practitioners, we decided to keep these people in the trial unless they wished to withdraw, and they have been included in the intention-to-treat analysis. 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. Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial, Telemonitoring-based service redesign for the management of uncontrolled hypertension (HITS): cost and cost-effectiveness analysis of a randomised controlled trial, Self-monitoring blood pressure in patients with hypertension: an internet-based survey of UK GPs, Accuracy of blood-pressure monitors owned by patients with hypertension (ACCU-RATE study): a cross-sectional, observational study in central England, Normalisation process theory: a framework for developing, evaluating and implementing complex interventions, Telemonitoring at scale for hypertension in primary care: An implementation study, Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial, https://www.nihr.ac.uk/explore-nihr/support/clinical-research-network.htm, http://creativecommons.org/licenses/by/4.0/, https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2017, https://www.pssru.ac.uk/project-pages/unit-costs/unit-costs-2018/, https://improvement.nhs.uk/resources/developing-the-national-tariff/, https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/demographics/age-groups/latest#age-profile-by-ethnicity, https://www.ofcom.org.uk/__data/assets/pdf_file/0011/113222/Adults-Media-Use-and-Attitudes-Report-2018.pdf, Kent and Medway NHS & Social Care Partnership Trust: Consultant Psychiatrist - The Beacon, Tolsey Surgery: GP Partner in Rural North Wiltshire, H&F Partnership: Salaried GP, West London, 4 to 8 sessions, Royal Devon and Exeter NHS Foundation Trust: Substantive Consultant Physicians in Acute Medicine, Women’s, children’s & adolescents’ health. Joint Formulary Committee. In 2018, the youngster revealed what it was like working with Ryan during an interview on Channel Nine's Today Extra. the , . During the late 19th and early 20th centuries Holyoke saw an influx of Franco-Americans (French: les Holyokais franco-américains, lit. People with diabetes: less than 135/75 mm Hg. Patient and public contributors were involved from the outline application stage (Samantha Hall and Mark Stafford-Watson). Miscegenation comes from the Latin miscere, "to mix" and genus, "kind". 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. *Partial withdrawals withdrew from the intervention but consented to be followed up. The 18-year-old raps to a â¦ Stream Babert - Boogie Oogie (Original Mix) by L.O.Dee from desktop or your mobile device. 2018. LY is an NIHR senior investigator and her research programme is partly supported by NIHR Applied Research Collaboration (ARC)-West, NIHR Health Protection Research Unit (HPRU) for Behavioural Science and Evaluation, and the NIHR Southampton Biomedical Research Centre (BRC). Treatment intensification in a hypertension telemanagement trial: clinical inertia or good clinical judgment? Optional additional behavioural support for self-monitoring and lifestyle modifications was available to intervention participants through practice nurses or healthcare assistants (referred to as supporters) by using the CARE (congratulate, ask, reassure, encourage) approach.17 This support comprised up to six brief face-to-face, telephone, or email contacts addressing difficulties associated with self-monitoring or lifestyle change, with additional monthly email support provided by using prewritten templates. British National Formulary. Data are mean (standard deviation) unless stated otherwise, Costs, systolic blood pressure reduction from baseline, and incremental cost per blood pressure reduction by using bootstrap methods based on imputed blood pressure data. Bodleian Libraries. BMJ Open 2018; 8: e020843. Curtis LB, A. Big break:Â The actor is best known for his roles in Hunt for the Wilderpeople and Deadpool 2, starringÂ Ryan Reynolds (pictured). Trials of self-monitoring blood pressure appear to work best with relatively intensive cointerventions (such as telemonitoring, educational advice, or pharmacist input) and the current study fits with that literature.37 In the context of the current trial, we are not able to distinguish the relative importance of the different parts of the digital intervention. Exploratory subgroup analyses (fig 2, table A3) suggested that participants aged 67 or older had a smaller effect size (−0.4 mm Hg, 95% confidence interval −3.9 to 3.0 mm Hg) than those younger than 67 (−7.7 mm Hg, −11.9 to −3.5 mm Hg). However, the behavioural aspects of the intervention were less successful and were only taken up by a small proportion of participants. 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. Please note: your email address is provided to the journal, which may use this information for marketing purposes. The imputation model included all outcome and stratification variables. 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). BS carried out the statistical analysis, and JR and SZ carried out the economic analysis. Participants who used the digital intervention were more likely to have their antihypertensive drugs adjusted during the study; this included more changes in dose (relative risk of a dose change, intervention v usual care: 2.0, 95% confidence interval 1.5 to 2.7) and more changes in drugs (relative risk of a drug change, intervention v usual care: 1.5, 1.1 to 1.9; table 4). 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. doi: 10.1136/bmjopen-2017-020843. Princess Beatrice's husband Edoardo Mapelli Mozzi sports a personalized baseball cap as they go food... Susanna Reid, 50, fears being left alone in her 'empty nest' when all three of her sons go off to university. 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