Physician-guided telemedical care achieves sustained blood pressure control in uncontrolled hypertension: a randomized-controlled pilot study.

Background Blood pressure (BP) control remains insufficient in routine practice despite effective pharmacological therapy. Lack of structured follow-up and insufficient treatment intensification are major barriers. Telemonitoring may enable proactive management and overcome these limitations. Purpose To determine whether structured physician-guided telemedical care improves BP control and sustains treatment effects compared with telemonitoring alone in patients with uncontrolled hypertension. Methods In this single-centre, randomized controlled pilot trial, 60 patients with uncontrolled hypertension were randomized (1:1) to home BP telemonitoring alone or telemonitoring plus structured biweekly telephone consultations with a study physician enabling treatment optimisation. Patients performed twice-daily home BP measurements with automated data transmission. Clinical visits occurred at 6 and 12 months with crossover after 6 months. The primary outcome was time in target range (TTR) at 6 months. Secondary endpoints included TTR at 12 months, and medication adherence. Results Mean age of 61±13 years, 61% were male. Baseline BP was 161±17/97±12 mmHg and comparable between groups. At 6 months, physician-led telemonitoring resulted in markedly greater systolic (-15.0±9.8 vs. -4.0±8.7 mmHg) and diastolic BP reduction (-9.8±6.7 vs. -1.8±5.6 mmHg; both p<0.001). Systolic TTR was significantly higher (52.2±24.2 vs. 36.0±29.2%, p=0.028), accompanied by superior measurement adherence (82.2±15.4 vs. 70.5±25.9%, p=0.033). After crossover, the former control group experienced a significant additional systolic BP reduction during months 6-12 (-9.3±10.9 mmHg, p<0.001), and achieved BP levels comparable to the initial intervention group at 12 months (131±10 vs. 129±10 mmHg, p=0.428). Importantly, BP reductions achieved during the initial intervention phase were maintained after discontinuation of scheduled telephone support. Conclusion Structured physician-led telemonitoring substantially improves BP control with a sustained effect beyond active intervention phase. These findings support structured telemonitoring strategies to overcome therapeutic inertia in uncontrolled hypertension and warrant validation in larger, multicentre outcome trials.