英国牛津大学Richard J McManus团队研究了家庭和在线血压管理和评估（HOME BP）使用数字干预治疗控制不佳的高血压的效果。2021年1月20日，该研究发表在《英国医学杂志》上。

HOME BP（家庭和在线血压管理和评估）试验旨在通过将血压的自我监测与指导性的自我管理相结合来检测对初级保健机构中高血压管理的数字干预。

研究组设计了一项自动确定主要终点的非盲、随机对照试验，在英国制定了76种常规实践，共招募622人接受治疗，但血压控制不佳（> 140/90 mm Hg），均可访问互联网获得数据。将参与者随机分组，其中305名通过数字干预、317名通过常规护理来自我监测血压。数字干预通过可选的生活方式建议和激励支持，为患者和专业人员反馈血压结果。高血压、糖尿病和80岁以上人群的目标血压遵循英国国家指南。主要结局是一年后收缩压的差异。

一年后，共有552名参与者（88.6％）获得了可用数据，研究组对剩余的70名参与者（11.4％）数据进行了估算。干预组的平均血压从151.7 / 86.4降至138.4 / 80.2 mm Hg，常规护理组的平均血压从151.6 / 85.3降至141.8 / 79.8 mm Hg，收缩压平均差为-3.4 mm Hg，舒张压平均差为-0.5 mm Hg。完整病例分析的结果具有可比性，两组之间的不良反应相似。在试验成本范围内，降低每毫米汞柱的成本效益比增加了11英镑。

研究结果表明，通过使用自我监测血压对高血压进行控制的HOME BP数字干预，与常规护理相比，在一年后可更好地控制收缩压，且增加成本较低。

附：英文原文

Title: Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

Author: Richard J McManus, Paul Little, Beth Stuart, Katherine Morton, James Raftery, Jo Kelly, Katherine Bradbury, Jin Zhang, Shihua Zhu, Elizabeth Murray, Carl R May, Frances S Mair, Susan Michie, Peter Smith, Rebecca Band, Emma Ogburn, Julie Allen, Cathy Rice, Jacqui Nuttall, Bryan Williams, Lucy Yardley

Issue&Volume: 2021/01/20

Abstract:

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.

Design Unmasked randomised controlled trial with automated ascertainment of primary endpoint.

Setting 76 general practices in the United Kingdom.

Participants 622 people with treated but poorly controlled hypertension (>140/90 mmHg) and access to the internet.

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). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines.

Main outcome measures The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values.

Results After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mmHg in the intervention group and from 151.6/85.3 to 141.8/79.8 mmHg in the usual care group, giving a mean difference in systolic blood pressure of 3.4 mmHg (95% confidence interval 6.1 to 0.8 mmHg) and a mean difference in diastolic blood pressure of 0.5 mmHg (1.9 to 0.9 mmHg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of ￡11 ($15, €12; 95% confidence interval ￡6 to ￡29) per mmHg reduction.

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. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded.

DOI: 10.1136/bmj.m4858

Source: https://www.bmj.com/content/372/bmj.m4858