Cardiovascular disease is the leading cause of morbidity and mortality in the USA. Disease management programs, while successful, are intensive and expensive. Follow-up is often inadequate, incomplete, and inconsistent. To address these problems, we developed an Internet-Telemedicine system. Patients send/receive data to/from their care provider via the Internet. The system optimizes function and minimizes cost (all hardware is off the shelf and FDA approved). We are currently using this Telemedicine system in a prospective, randomized clinical trial, to reduce CVD risk in medically underserved populations. Over an 8-month time interval, we found very high rates of usage of the Telemedicine system (92%). This rate of self-monitoring greatly exceeded the self-monitoring rate in controls (48%). The patient-entered Telemedicine blood pressure values were similar to the meter recorded values and to the office values.