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. However, we have no evidence that randomisation concealment was affected. BS carried out the statistical analysis, and JR and SZ carried out the economic analysis. Provenance and peer review: Provenance and peer review: Not commissioned; externally peer reviewed. Examples of this are beginning to emerge; for example, general practitioners in Scotland can now get home blood pressure readings sent to their Docman electronic record system (PCTI Solutions, UK), although the underlying telemonitoring is SMS based and lacks much of the functionality included in the HOME BP digital intervention.52 Further work might evaluate such implementation to ensure that predicted benefits are achieved and to allow further development of the intervention, particularly for older people and those from more disadvantaged backgrounds. Sixty years ago, Rosa Parks, a 42-year-old black woman, refused to give up her seat to a white passenger on a Montgomery, Alabama, public bus. This research would not have been possible without the support and encouragement of all patients and practice staff from the 76 participating practices. The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. 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. The most commonly selected responses were not having access to the internet (982, 41%), not wanting to be part of a research trial (617, 25%), not wanting to participate in an internet study (543, 22%), and not wanting to change drugs (535, 22%; table A1). These participants received routine hypertension care that typically consisted of clinic blood pressure monitoring to titrate drugs, with appointments and drug changes made at the discretion of the general practitioner. The Hunt for the Wilderpeople star dons a green and yellow jacket and jeans, as he sings: 'This is a story about how fast food got flipped turned upside down. See: http://creativecommons.org/licenses/by/4.0/. Clinic blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group after 12 months, and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group; this gave a mean difference of −3.4 mm Hg (95% confidence interval −6.1 to −0.8) in systolic blood pressure and −0.5 mm Hg (−1.9 to 0.9) in diastolic blood pressure (table 2). 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). The comments below have not been moderated. 2019. Many chose to do this through drugs only, whereas a small number chose to include behavioural or lifestyle modifications as part of blood pressure management. Surveys suggest that most general practitioners are drawing on self-monitoring in their hypertension management, and that at least one third of patients with hypertension are self-monitoring.4950 Over and above the clinical benefit from the HOME BP digital intervention, the ability to manage blood pressure remotely at scale has never been so important as during the current crisis.13 Therefore, implementation of a cost effective digital intervention that leads to lower blood pressure would now seem to be appropriate. Julian then stands in a skate park while holding a Subway sandwich in one hand. However, some evidence was found of preferential recruitment of those with higher socioeconomic status, although we found no evidence that socioeconomic status mediated outcomes. By recruiting from a large number of general practices, we ensured generalisability in terms of healthcare professionals. 'I'd like to take a minute and just sit right here and tell you how to ditch the fries and eat fresh everywhere,' he continues. The HOME BP trial aimed to evaluate whether a digital intervention comprising self-monitoring of blood pressure with reminders and predetermined drug changes combined with lifestyle change support resulted in lower systolic blood pressure in people receiving treatment for hypertension that was poorly controlled, and whether this approach was cost effective. 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. 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. However, the behavioural aspects of the intervention were less successful and were only taken up by a small proportion of participants. After 12 months, a post hoc analysis showed that 112/234 (47%) patients in the usual care group reported monitoring their own blood pressure at home at least once per month during the trial; of these, 78 (70%) said that they took their readings to their general practitioner. A within trial economic analysis estimated cost per unit reduction in systolic blood pressure—the primary outcome—by using similar adjustments and multiple imputation for missing values as described in the statistical analysis section. Six and 12 months after randomisation, participants attended follow-up appointments with an independent research nurse where blood pressure and weight were recorded (weight was recorded at 12 months only). Participants then completed follow-up questionnaires online. The HOME BP digital intervention, combined with self-monitoring, has the potential to provide cost effective support for patients and professionals in lowering blood pressure. Trump spends his first weekend as ex-president playing golf at his West Palm Beach club... Scar-free stitch in the stomach could help patients shed up to FIVE stone in six months - and cut their risk... 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