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Carey NP, Curtis F, Eisenbeisz ML, Akbari S, Sambharia M, Jalal DI, Wilkinson TJ. Does home blood pressure monitoring improve blood pressure-related outcomes in people living with chronic kidney disease? A systematic review. J Clin Hypertens (Greenwich) 2024; 26:314-329. [PMID: 38523586 PMCID: PMC11007799 DOI: 10.1111/jch.14795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 03/26/2024]
Abstract
High blood pressure is an important risk factor for cardiovascular disease and disease progression in chronic kidney disease (CKD). Evidence on the effects of home blood pressure monitoring (HBPM) is limited. This review aimed to determine the effect of HBPM on systolic (SBP) and diastolic blood pressure (DBP) in patients with CKD. We searched medical literature databases for eligible studies presenting pre- and post-data for interventions utilizing HBPM. Study quality was assessed using the NHLBI tools for quality assessment. Heterogeneity prohibited a meta-analysis so estimates of effects were calculated along a sign test to examine the probability of observing the given pattern of positive effect direction. Eighteen studies were included (n = 1187 participants, mean age 56.7 [± 7.7] years). In 15 studies, HBPM was conducted within the context of additional high-level tailored support. Overall, the quality of n = 7/18 studies was rated as "good"; n = 6/18 were "fair," and n = 5/18 were rated as "poor." Interventions utilizing HBPM had a significant effect on SBP, with 14/16 studies favoring the intervention (88% [95% CI: 62%-98%], P = .002). Favorable effects were also seen on DBP (73% [95% CI: 45%-92%], P = .059). HBPM had a favorable effect on blood pressure goal attainment (86% [95% CI: 42%-100%], P = .062). HBPM in patients with CKD as part of a multicomponent intervention may lead to clinically significant reductions in blood pressure; however, research is needed to support the validity of this claim due to the high heterogeneity across the studies included.
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Affiliation(s)
- Nathan P. Carey
- Leicester Diabetes CentreUniversity of LeicesterLeicesterUK
- NIHR Applied Research Collaboration East MidlandsLeicesterUK
| | - Ffion Curtis
- Leicester Diabetes CentreUniversity of LeicesterLeicesterUK
- Liverpool Reviews and Implementation Group (LRiG), Institute of Population HealthUniversity of LiverpoolLiverpoolUK
| | - McKenna L. Eisenbeisz
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
- Center for Access & Delivery Research and Evaluation (CADRE)Iowa City VA HCSIowa CityIowaUSA
| | - Sadaf Akbari
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
- Center for Access & Delivery Research and Evaluation (CADRE)Iowa City VA HCSIowa CityIowaUSA
| | - Meenakshi Sambharia
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
- Center for Access & Delivery Research and Evaluation (CADRE)Iowa City VA HCSIowa CityIowaUSA
| | - Diana I. Jalal
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
- Center for Access & Delivery Research and Evaluation (CADRE)Iowa City VA HCSIowa CityIowaUSA
| | - Thomas J. Wilkinson
- Leicester Diabetes CentreUniversity of LeicesterLeicesterUK
- NIHR Applied Research Collaboration East MidlandsLeicesterUK
- NIHR Leicester Biomedical Research CentreLeicesterUK
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Andersson U, Nilsson PM, Kjellgren K, Ekholm M, Midlöv P. Associations between daily home blood pressure measurements and self-reports of lifestyle and symptoms in primary care: the PERHIT study. Scand J Prim Health Care 2024:1-9. [PMID: 38529930 DOI: 10.1080/02813432.2024.2332745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE To explore in a primary care setting the associations between patients' daily self-measured blood pressure (BP) during eight weeks and concurrent self-reported values of wellbeing, lifestyle, symptoms, and medication intake. We also explore these associations for men and women separately. DESIGN AND SETTING The study is a secondary post-hoc analysis of the randomised controlled trial PERson-centeredness in Hypertension management using Information Technology (PERHIT). The trial was conducted in primary health care in four regions in Southern Sweden. PATIENTS Participants (n = 454) in the intervention group in the PERHIT-trial used an interactive web-based system for self-management of hypertension for eight consecutive weeks. Each evening, participants reported in the system their wellbeing, lifestyle, symptoms, and medication adherence as well as their self-measured BP and heart rate. MAIN OUTCOME MEASURES Association between self-reported BP and 10 self-report lifestyle-related variables. RESULTS Self-reported less stress and higher wellbeing were similarly associated with BP, with 1.0 mmHg lower systolic BP and 0.6/0.4 mmHg lower diastolic BP (p < 0.001). Adherence to medication had the greatest impact on BP levels (5.2/2.6 mmHg, p < 0.001). Restlessness and headache were also significantly associated with BP, but to a lesser extent. Physical activity was only significantly associated with BP levels for men, but not for women. CONCLUSION In hypertension management, it may be important to identify patients with high-stress levels and low wellbeing. The association between medication intake and BP was obvious, thus stressing the importance of medication adherence for patients with hypertension.
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Affiliation(s)
- Ulrika Andersson
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Karin Kjellgren
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mikael Ekholm
- Wetterhälsan Primary Health Care Centre, Jönköping, Region Jönköping County, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Myers O, Markossian T, Probst B, Hiura G, Habicht K, Egan B, Kramer H. Age and sex disparities in blood pressure control and therapeutic inertia: Impact of a quality improvement program. Am J Prev Cardiol 2024; 17:100632. [PMID: 38313770 PMCID: PMC10835122 DOI: 10.1016/j.ajpc.2023.100632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/14/2023] [Accepted: 12/29/2023] [Indexed: 02/06/2024] Open
Abstract
Objective Hypertension quality improvement programs reduce uncontrolled blood pressure (BP) but impact may differ by sex and age. Methods This study examined uncontrolled BP, defined as a BP ≥ 140/90 mmHg, and therapeutic inertia, defined as absence of medication initiation or escalation during visits with uncontrolled BP, by sex and by age group (19-40, 41-65, 66-75, and 76+ years) during a 12 month follow-up period among 21, 861 patients with hypertension and ≥ two visits in primary care clinics enrolled in the American Medical Association (AMA) Measure Accurately, Act Rapidly, and Partner with Patients (MAP) BP hypertension quality improvement program. Results The mean age was 64.8 years (standard deviation [SD 12.8]) and ranged from 19 to 87 years; 53.6% were female. In age groups 19-40, 41-65, 66-75, 76-87 years, uncontrolled BP at the first clinic visit was present in 51.5%, 42.5%, 37.5% and 36.6% of males, respectively, and in 40.0%, 38.0%, 36.0% and 39.6% of females, respectively. Based on vital signs at the first vs. last clinic visit, the proportion of patients with uncontrolled BP in age groups 19-40, 41-65, 66-75 years declined by 19.4%, 13.5%, 10.1% and 8.7% in males, respectively, and 14.4%, 12.5%, 9.3%, and 8.4%, among females, respectively. Therapeutic inertia ranged from 66.5% and 75.9% of clinic visits among males and females age 19-40 years, to 85.6% and 84.9% of clinic visits among males and females age 76-87 years, respectively. The proportion of clinic visits with therapeutic inertia was lower among males vs. females across all age groups until age 76-87 years. Conclusion A quality improvement program improves BP control but declines in uncontrolled BP are larger and therapeutic inertia is lower for younger vs. older age groups and for males vs. females. More interventions are needed to reduce sex and age disparities in hypertension management.
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Affiliation(s)
- Olivia Myers
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, United States
| | - Talar Markossian
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, United States
| | - Beatrice Probst
- Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL, United States
| | - Grant Hiura
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, United States
| | | | - Brent Egan
- Improving Health Outcomes, American Medical Association, Greenville, SC, United States
| | - Holly Kramer
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, United States
- Department of Medicine, Loyola University Chicago and Loyola University Medical Center, Maywood, IL, United States
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Baklouti M, Mejdoub Y, Tombohindy MG, Ketata N, Jdidi J, Triki F, Yaich S, Abid L. Impact of Therapeutic Education on the Management of High Blood Pressure: A Quasi-experimental Survey From Southern Tunisia. Crit Pathw Cardiol 2024; 23:30-35. [PMID: 37831463 DOI: 10.1097/hpc.0000000000000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
INTRODUCTION The prevalence of arterial hypertension (HTA) was continuously increased with a low percentage of pressure control blood pressure among treated patients. Therapeutic education (TE) was one of the inventive methods in the management of high blood pressure (HBP) worldwide. The objective was to assess the impact of TE on the control and management of HBP. METHODS This was a quasi-experimental study consisting of an intervention, a pretest, and a post-test evaluation. This study was conducted in the external consultation service of cardiology CHU HEDI CHAKER of Sfax during over a period of 4 months (November 2021-March 2022). RESULTS In total, 35 of the patients (50%) were women with a sex ratio of 1. The mean age was 63.33 ± 8.91 years. We noted a statistically significant decrease on both systolic and diastolic blood pressure blood pressure values after TE among educated patients (135.3 ± 9.77 vs. 141.9 ± 10.9; P = 0.010) and (75 [70-80] vs. 80 [75-80]; P = 0.002), respectively. We found a significantly good knowledge about HBP definition (Odds ratio [OR] = 3.4; P = 0.022), HBP symptoms (OR = 9.1; P < 0.001), and HBP complications (OR = 12.3; P < 0.001) among educated patients. A significant association was noted between educated patients and low daily salt consumption after TE (OR = 2.7; P = 0.048). Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation Educated patients had significantly more adequate auto-control devise use (OR = 1.01; P = 0.028). Moreover, the respect of therapeutic compliance was statistically more important among educated patients (OR = 3.7; P = 0.028). CONCLUSIONS Our results showed that the TE training session is an operative intervention to improve HBP management. Thus, integrating TE therapy in daily care should be continuous and should be exhaustive to all cardiovascular and all chronic diseases.
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Affiliation(s)
- Mouna Baklouti
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Yosra Mejdoub
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | | | - Nouha Ketata
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Jihen Jdidi
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Faten Triki
- Cardiology Department Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Sourour Yaich
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Leila Abid
- Cardiology Department Hedi Chaker University Hospital, University of Sfax, Tunisia
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Acharya S, Neupane G, Seals A, Kc M, Giustini D, Sharma S, Taylor YJ, Palakshappa D, Williamson JD, Moore JB, Bosworth HB, Pokharel Y. Self-Measured Blood Pressure-Guided Pharmacotherapy: A Systematic Review and Meta-Analysis of United States-Based Telemedicine Trials. Hypertension 2024; 81:648-657. [PMID: 38189139 DOI: 10.1161/hypertensionaha.123.22109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/25/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND The optimal approach to implementing telemedicine hypertension management in the United States is unknown. METHODS We examined telemedicine hypertension management versus the effect of usual clinic-based care on blood pressure (BP) and patient/clinician-related heterogeneity in a systematic review/meta-analysis. We searched United States-based randomized trials from Medline, Embase, CENTRAL, CINAHL, PsycINFO, Compendex, Web of Science Core Collection, Scopus, and 2 trial registries. We used trial-level differences in BP and its control rate at ≥6 months using random-effects models. We examined heterogeneity in univariable metaregression and in prespecified subgroups (clinicians leading pharmacotherapy [physician/nonphysician], self-management support [pharmacist/nurse], White versus non-White patient predominant trials [>50% patients/trial], diabetes predominant trials [≥25% patients/trial], and White patient predominant but not diabetes predominant trials versus both non-White and diabetes patient predominant trials]. RESULTS Thirteen, 11, and 7 trials were eligible for systolic and diastolic BP difference and BP control, respectively. Differences in systolic and diastolic BP and BP control rate were -7.3 mm Hg (95% CI, -9.4 to -5.2), -2.7 mm Hg (-4.0 to -1.5), and 10.1% (0.4%-19.9%), respectively, favoring telemedicine. Greater BP reduction occurred in trials where nonphysicians led pharmacotherapy, pharmacists provided self-management support, White patient predominant trials, and White patient predominant but not diabetes predominant trials, with no difference by diabetes predominant trials. CONCLUSIONS Telemedicine hypertension management is more effective than clinic-based care in the United States, particularly when nonphysicians lead pharmacotherapy and pharmacists provide self-management support. Non-White patient predominant trials achieved less BP reduction. Equity-conscious, locally informed adaptation of telemedicine interventions is needed before wider implementation.
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Affiliation(s)
- Sameer Acharya
- Department of Internal Medicine, Cayuga Medical Center, Ithaca, NY (S.A.)
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC (A.S., D.P., J.D.W., Y.P.)
| | - Gagan Neupane
- Department of Internal Medicine, Florida Atlantic University, Boca Raton (G.N.)
| | | | - Madhav Kc
- School of Medicine, Yale University, New Haven, CT (M.K.)
| | - Dean Giustini
- The University of British Columbia, Vancouver, Canada (D.G.)
| | - Sharan Sharma
- SCL Health Heart and Vascular: Sisters of Charity of Leavenworth Health Heart and Vascular Institute, Brighton, CO (S.S.)
| | - Yhenneko J Taylor
- Center for Health System Sciences, Atrium Health, Charlotte, NC (Y.J.T., Y.P.)
| | - Deepak Palakshappa
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC (A.S., D.P., J.D.W., Y.P.)
| | - Jeff D Williamson
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC (A.S., D.P., J.D.W., Y.P.)
| | - Justin B Moore
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC (J.B.M.)
| | - Hayden B Bosworth
- Department of Population Health Sciences, Duke University, Durham, NC (H.B.B.)
| | - Yashashwi Pokharel
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC (A.S., D.P., J.D.W., Y.P.)
- Center for Health System Sciences, Atrium Health, Charlotte, NC (Y.J.T., Y.P.)
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Kitt J, Krasner S, Barr L, Frost A, Tucker K, Bateman PA, Suriano K, Kenworthy Y, Lapidaire W, Lacharie M, Mills R, Roman C, Mackillop L, Cairns A, Aye C, Ferreira V, Piechnik S, Lukaschuk E, Thilaganathan B, Chappell LC, Lewandowski AJ, McManus RJ, Leeson P. Cardiac Remodeling After Hypertensive Pregnancy Following Physician-Optimized Blood Pressure Self-Management: The POP-HT Randomized Clinical Trial Imaging Substudy. Circulation 2024; 149:529-541. [PMID: 37950907 DOI: 10.1161/circulationaha.123.067597] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 11/09/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Hypertensive pregnancy disorders are associated with adverse cardiac remodeling, which can fail to reverse in the postpartum period in some women. The Physician-Optimized Postpartum Hypertension Treatment trial demonstrated that improved blood pressure control while the cardiovascular system recovers postpartum associates with persistently reduced blood pressure. We now report the effect on cardiac remodeling. METHODS In this prospective, randomized, open-label, blinded end point trial, in a single UK hospital, 220 women were randomly assigned 1:1 to self-monitoring with research physician-optimized antihypertensive titration or usual postnatal care from a primary care physician and midwife. Participants were 18 years of age or older, with preeclampsia or gestational hypertension, requiring antihypertensives on hospital discharge postnatally. Prespecified secondary cardiac imaging outcomes were recorded by echocardiography around delivery, and again at blood pressure primary outcome assessment, around 9 months postpartum, when cardiovascular magnetic resonance was also performed. RESULTS A total of 187 women (101 intervention; 86 usual care) underwent echocardiography at baseline and follow-up, at a mean 258±14.6 days postpartum, of which 174 (93 intervention; 81 usual care) also had cardiovascular magnetic resonance at follow-up. Relative wall thickness by echocardiography was 0.06 (95% CI, 0.07-0.05; P<0.001) lower in the intervention group between baseline and follow-up, and cardiovascular magnetic resonance at follow-up demonstrated a lower left ventricular mass (-6.37 g/m2; 95% CI, -7.99 to -4.74; P<0.001), end-diastolic volume (-3.87 mL/m2; 95% CI, -6.77 to -0.98; P=0.009), and end-systolic volume (-3.25 mL/m2; 95% CI, 4.87 to -1.63; P<0.001) and higher left and right ventricular ejection fraction by 2.6% (95% CI, 1.3-3.9; P<0.001) and 2.8% (95% CI, 1.4-4.1; P<0.001), respectively. Echocardiography-assessed left ventricular diastolic function demonstrated a mean difference in average E/E' of 0.52 (95% CI, -0.97 to -0.07; P=0.024) and a reduction in left atrial volumes of -4.33 mL/m2 (95% CI, -5.52 to -3.21; P<0.001) between baseline and follow-up when adjusted for baseline differences in measures. CONCLUSIONS Short-term postnatal optimization of blood pressure control after hypertensive pregnancy, through self-monitoring and physician-guided antihypertensive titration, associates with long-term changes in cardiovascular structure and function, in a pattern associated with more favorable cardiovascular outcomes. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04273854.
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Affiliation(s)
- Jamie Kitt
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
- Nuffield Department of Primary Care Health Sciences (J.K., K.T., P.A.B., R.J.M.), University of Oxford, United Kingdom
| | - Samuel Krasner
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Logan Barr
- Queen's University School of Medicine, Kingston, Canada (L.B.)
| | - Annabelle Frost
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
- Nuffield Department of Women's and Reproductive Health (A.F., L.M., A.C., C.A.), University of Oxford, United Kingdom
| | - Katherine Tucker
- Nuffield Department of Primary Care Health Sciences (J.K., K.T., P.A.B., R.J.M.), University of Oxford, United Kingdom
| | - Paul A Bateman
- Nuffield Department of Primary Care Health Sciences (J.K., K.T., P.A.B., R.J.M.), University of Oxford, United Kingdom
| | - Katie Suriano
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Yvonne Kenworthy
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Winok Lapidaire
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Miriam Lacharie
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (M.L., R.M., S.P.), University of Oxford, United Kingdom
| | - Rebecca Mills
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (M.L., R.M., S.P.), University of Oxford, United Kingdom
| | - Cristian Roman
- Institute of Biomedical Engineering, Department of Engineering Science (C.R.), University of Oxford, United Kingdom
| | - Lucy Mackillop
- Nuffield Department of Women's and Reproductive Health (A.F., L.M., A.C., C.A.), University of Oxford, United Kingdom
| | - Alexandra Cairns
- Nuffield Department of Women's and Reproductive Health (A.F., L.M., A.C., C.A.), University of Oxford, United Kingdom
| | - Christina Aye
- Nuffield Department of Women's and Reproductive Health (A.F., L.M., A.C., C.A.), University of Oxford, United Kingdom
- Fetal Medicine Unit, Oxford University Hospitals National Health Service Foundation Trust, United Kingdom (C.A.)
| | - Vanessa Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (V.F., E.L.), University of Oxford, United Kingdom
| | - Stefan Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (M.L., R.M., S.P.), University of Oxford, United Kingdom
| | - Elena Lukaschuk
- Oxford Centre for Clinical Magnetic Resonance Research (V.F., E.L.), University of Oxford, United Kingdom
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom (B.T.)
- Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom (B.T.)
| | - Lucy C Chappell
- King's College London and Guy's and St Thomas' National Health Service Foundation Trust, United Kingdom (L.C.C.)
| | - Adam J Lewandowski
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences (J.K., K.T., P.A.B., R.J.M.), University of Oxford, United Kingdom
| | - Paul Leeson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
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Acharya S, Neupane G, Seals A, Madhav KC, Giustini D, Sharma S, Taylor YJ, Palakshappa D, Williamson JD, Moore JB, Bosworth HB, Pokharel Y. Heterogeneity of the Effect of Telemedicine Hypertension Management Approach on Blood Pressure: A Systematic Review and Meta-analysis of US-based Clinical Trials. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.14.23295587. [PMID: 37745417 PMCID: PMC10516092 DOI: 10.1101/2023.09.14.23295587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background Telemedicine management of hypertension (TM-HTN) uses home blood pressure (BP) to guide pharmacotherapy and telemedicine-based self-management support (SMS). Optimal approach to implementing TM-HTN in the US is unknown. Methods We conducted a systematic review and a meta-analysis to examine the effect of TM-HTN vs. usual clinic-based care on BP and assessed heterogeneity by patient- and clinician-related factors. We searched US-based randomized clinical trials among adults from Medline, Embase, CENTRAL, CINAHL, PsycInfo, and Compendex, Web of Science Core Collection, Scopus, and two trial registries to 7/7/2023. Two authors extracted, and a third author confirmed data. We used trial-level differences in systolic BP (SBP), diastolic BP (DBP) and BP control rate at ≥6 months using random-effects models. We examined heterogeneity of effect in univariable meta-regression and in pre-specified subgroups [clinicians leading pharmacotherapy (physician vs. non-physician), SMS (pharmacist vs. nurse), White vs. non-White patient predominant trials (>50% patients/trial), diabetes predominant trials (≥25% patients/trial) and in trials that have majority of both non-White patients and patients with diabetes vs. White patient predominant but not diabetes predominant trials. Results Thirteen, 11 and 7 trials were eligible for SBP, DBP and BP control, respectively. Differences in SBP, DBP and BP control rate were -7.3 mmHg (95% CI: - 9.4, -5.2), -2.7 mmHg (-4.0, -1.5) and 10.1% (0.4%, 19.9%), respectively, favoring TM-HTN. More BP reduction occurred in trials with non-physician vs. physician led pharmacotherapy (9.3/4.0 mmHg vs. 4.9/1.1 mmHg, P<0.01 for both SBP/DBP), pharmacist vs. nurses provided SMS (9.3/4.1 mmHg vs. 5.6/1.0 mmHg, P=0.01 for SBP, P<0.01 for DBP), and White vs. non-White patient predominant trials (9.3/4.0 mmHg vs. 4.4/1.1 mmHg, P<0.01 for both SBP/DBP), with no difference by diabetes predominant trials. Lower BP reduction occurred in both diabetes and non-White patient predominant trials vs. White patient predominant but not diabetes predominant trials (4.5/0.9 mmHg vs. 9.5/4.2 mmHg, P<0.01 for both SBP/DBP). Conclusions TM-HTN is more effective than clinic-based care in the US, particularly when non-physician led pharmacotherapy and pharmacist provided SMS. Non-White patient predominant trials seemed to achieve lesser BP reduction. Equity conscious, locally informed adaptation of TM-HTN is needed before wider implementation. Clinical Perspective What Is New?: In this systematic review and meta-analysis of US-based clinical trials, we found that telemedicine management of hypertension (TM-HTN) was more effective in reducing and controlling blood pressure (BP) compared with clinic based hypertension (HTN) care.The BP reduction was more evident when pharmacotherapy was led by non-physician compared with physicians and HTN self-management support was provided by clinical pharmacists compared with nurses,Non-White patient predominant trials achieved lesser BP reductions than White patient predominant trials.What Are the Clinical Implications?: Before wider implementation of TM-HTN intervention in the US, locally informed adaptation, such as optimizing the team-based HTN care approach, can provide more effective BP control.Without equity focused tailoring, TM-HTN intervention implemented as such can exacerbate inequities in BP control among non-White patients in the US.
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Zheng Y, Zhang Y, Huang H, Tison GH, Burke LE, Blecker S, Dickson VV, Olgin J, Marcus GM, Pletcher MJ. Interindividual Variability in Self-Monitoring of Blood Pressure Using Consumer-Purchased Wireless Devices. Nurs Res 2023; 72:310-318. [PMID: 37350699 PMCID: PMC10299813 DOI: 10.1097/nnr.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Engagement with self-monitoring of blood pressure (BP) declines, on average, over time but may vary substantially by individual. OBJECTIVES We aimed to describe different 1-year patterns (groups) of self-monitoring of BP behaviors, identify predictors of those groups, and examine the association of self-monitoring of BP groups with BP levels over time. METHODS We analyzed device-recorded BP measurements collected by the Health eHeart Study-an ongoing prospective eCohort study-from participants with a wireless consumer-purchased device that transmitted date- and time-stamped BP data to the study through a full 12 months of observation starting from the first day they used the device. Participants received no instruction on device use. We applied clustering analysis to identify 1-year self-monitoring, of BP patterns. RESULTS Participants had a mean age of 52 years and were male and White. Using clustering algorithms, we found that a model with three groups fit the data well: persistent daily use (9.1% of participants), persistent weekly use (21.2%), and sporadic use only (69.7%). Persistent daily use was more common among older participants who had higher Week 1 self-monitoring of BP frequency and was associated with lower BP levels than the persistent weekly use or sporadic use groups throughout the year. CONCLUSION We identified three distinct self-monitoring of BP groups, with nearly 10% sustaining a daily use pattern associated with lower BP levels.
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Affiliation(s)
| | - Yanfu Zhang
- University of Pittsburgh Swanson School of Engineering
| | - Heng Huang
- University of Pittsburgh Swanson School of Engineering
| | | | | | - Saul Blecker
- NYU Grossman School of Medicine, Department of Population Health, New York, NY 100101
| | | | - Jeffrey Olgin
- University of California, San Francisco School of Medicine
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9
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Fujiwara T, Sheppard JP, Hoshide S, Kario K, McManus RJ. Medical Telemonitoring for the Management of Hypertension in Older Patients in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2227. [PMID: 36767594 PMCID: PMC9916269 DOI: 10.3390/ijerph20032227] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/13/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Hypertension is the most frequent modifiable risk factor associated with cardiovascular disease (CVD) morbidity and mortality. Even in older people, strict blood pressure (BP) control has been recommended to reduce CVD event risks. However, caution should be exercised since older hypertensive patients have increased physical vulnerability due to frailty and multimorbidity, and older patients eligible for clinical trials may not represent the general population. Medical telemonitoring systems, which enable us to monitor a patient's medical condition remotely through digital communication, have become much more prevalent since the coronavirus pandemic. Among various physiological parameters, BP monitoring is well-suited to the use of such systems, which enable healthcare providers to deliver accurate and safe BP management, even in the presence of frailty and/or living in geographically remote areas. Furthermore, medical telemonitoring systems could help reduce nonadherence to antihypertensive medications and clinical inertia, and also enable multi-professional team-based management of hypertension. However, the implementation of medical telemonitoring systems in clinical practice is not easy, and substantial barriers, including the development of user-friendly devices, integration with existing clinical systems, data security, and cost of implementation and maintenance, need to be overcome. In this review, we focus on the potential of medical telemonitoring for the management of hypertension in older people in Japan.
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Affiliation(s)
- Takeshi Fujiwara
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke 329-0498, Japan
| | - James P. Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke 329-0498, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke 329-0498, Japan
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
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10
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Rhee MY, Munakata M, Nah DY, Kim JS, Kim HY. Home blood pressure measurement for hypertension management in the real world: Do not just measure, but share with your physician. Front Cardiovasc Med 2023; 10:1103216. [PMID: 36742078 PMCID: PMC9889357 DOI: 10.3389/fcvm.2023.1103216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
Introduction Studies of the effectiveness of home blood pressure (BP) measurement on the treatment of hypertension in the real world are sparse, and the results are controversial. There is an efficacy-effectiveness gap in the treatment of hypertension using home BP measurements. We aimed to investigate the effect of reporting home BP to physicians on ambulatory BP control as a factor contributing to the efficacy-effectiveness gap in treating patients with hypertension. Methods We recruited patients ≥20 years of age taking antihypertensive drugs. Office and 24-h ambulatory BP were measured. A questionnaire to the measurement of home BP was conducted. Participants were divided into an HBPM(-) group, home BP was not measured (n = 467); HBPM(+)-R(-) group, home BP was measured but not reported (n = 81); and HBPM(+)-R(+) group, home BP was measured and reported (n = 125). Results The HBPM(+)-R(+) group had significantly lower office systolic BP (SBP, p = 0.035), 24-h SBP (p = 0.009), and daytime SBP (p = 0.016) than the HBPM(-) group, and lower nighttime SBP (p = 0.005) and diastolic BP (DBP, p = 0.008) than the HBPM(+)-R(-) group. In the multivariate analysis, the differences in 24-h SBP, daytime SBP, and nighttime DBP remained significant. There was a significant difference between groups in the target achievement rate of 24-h SBP (p = 0.046), nighttime SBP (p = 0.021), and nighttime DBP (p = 0.023). The nighttime SBP and DBP target achievement rates in the HBPM(+)-R(+) group were higher than those in the HBPM(+)-R(-) group (p = 0.006 and 0.010, respectively). Among patients measuring home BP, the adjusted odds ratio for 24-h and nighttime BP target achievement in the HBPM(+)-R(+) group were 2.233 and 3.658, respectively. Conclusion Home BP measurements should be reported to the treating physician to effectively manage hypertension. Clinical trial registration https://clinicaltrials.gov, identifier NCT03868384.
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Affiliation(s)
- Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea,College of Medicine, Dongguk University, Gyeongju-si, Gyeongsangbuk-do, Republic of Korea,*Correspondence: Moo-Yong Rhee,
| | - Masanori Munakata
- Division of Hypertension and Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan
| | - Deuk-Young Nah
- College of Medicine, Dongguk University, Gyeongju-si, Gyeongsangbuk-do, Republic of Korea,Cardiovascular Center, Dongguk University Gyeongju Hospital, Gyeongju-si, Gyeongsangbuk-do, Republic of Korea
| | - Je Sang Kim
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea,College of Medicine, Dongguk University, Gyeongju-si, Gyeongsangbuk-do, Republic of Korea
| | - Hae-Young Kim
- Department of Health Policy and Management, College of Health Science and Department of Health Care Sciences, Graduate School and BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
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Wall HK, Streeter TE, Wright JS. An Opportunity to Better Address Hypertension in Women: Self-Measured Blood Pressure Monitoring. J Womens Health (Larchmt) 2022; 31:1380-1386. [PMID: 36154466 PMCID: PMC10028595 DOI: 10.1089/jwh.2022.0371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
More than 56 million women in the United States have hypertension, including almost one in five women of reproductive age. The prevalence of hypertensive disorders of pregnancy is on the rise, putting more women at risk for adverse pregnancy-related outcomes and atherosclerotic cardiovascular disease later in life. Hypertension can be better detected and controlled in women throughout their life course by supporting self-measured blood pressure monitoring. In this study, we present some potential strategies for strengthening our nation's ability to address hypertension in women focusing on pregnancy-related considerations for self-measured blood pressure monitoring.
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Affiliation(s)
- Hilary K Wall
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Taylor E Streeter
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet S Wright
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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12
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Krutter S, Schuessler N, Kutschar P, Šabić E, Dellinger J, Klausner T, Nestler N, Beasley M, Henderson B, Pitzer S, Mitterlehner B, Langegger D, Winkler A, Kloesch M, Eßl-Maurer R, van der Zee-Neuen A, Osterbrink J. Piloting of the virtual telecare technology 'Addison Care' to promote self-management in persons with chronic diseases in a community setting: protocol for a mixed-methods user experience, user engagement and usability pilot study. BMJ Open 2022; 12:e062159. [PMID: 36123104 PMCID: PMC9486344 DOI: 10.1136/bmjopen-2022-062159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Chronic diseases in older adults are one of the major epidemiological challenges of current times and leading cause of disability, poor quality of life, high healthcare costs and death. Self-management of chronic diseases is essential to improve health behaviours and health outcomes. Technology-assisted interventions have shown to improve self-management of chronic diseases. Virtual avatars can be a key factor for the acceptance of these technologies. Addison Care is a home-based telecare solution equipped with a virtual avatar named Addison, connecting older persons with their caregivers via an easy-to-use technology. A central advantage is that Addison Care provides access to self-management support for an up-to-now highly under-represented population-older persons with chronic disease(s), which enables them to profit from e-health in everyday life. METHODS AND ANALYSIS A pragmatic, non-randomised, one-arm pilot study applying an embedded mixed-methods approach will be conducted to examine user experience, usability and user engagement of the virtual avatar Addison. Participants will be at least 65 years and will be recruited between September 2022 and November 2022 from hospitals during the discharge process to home care. Standardised instruments, such as the User Experience Questionnaire, System Usability Scale, Instrumental Activities of Daily Living scale, Short-Form-8-Questionnaire, UCLA Loneliness Scale, Geriatric Depression Scale, Stendal Adherence with Medication Score and Self-Efficacy for Managing Chronic Diseases Scale, as well as survey-based assessments, semistructured interviews and think-aloud protocols, will be used. The study seeks to enrol 20 patients that meet the criteria. ETHICS AND DISSEMINATION The study protocol has been approved by the ethic committee of the German Society for Nursing Science (21-037). The results are intended to be published in peer-reviewed journals and disseminated through conference papers. TRIAL REGISTRATION NUMBER DRKS00025992.
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Affiliation(s)
- Simon Krutter
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Nadine Schuessler
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Patrick Kutschar
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Edin Šabić
- Department of Psychology, New Mexico State University, Las Cruces, New Mexico, USA
- Electronic Caregiver Inc, Las Cruces, New Mexico, USA
| | - Johanna Dellinger
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tabea Klausner
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Nadja Nestler
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | | | - Stefan Pitzer
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Barbara Mitterlehner
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Doris Langegger
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Anna Winkler
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Kloesch
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Roland Eßl-Maurer
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Antje van der Zee-Neuen
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Jürgen Osterbrink
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
- Brooks College of Health, University of North Florida, Jacksonville, Florida, USA
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13
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Treadwell JR, Rouse B, Reston J, Fontanarosa J, Patel N, Mull NK. Consumer Devices for Patient-Generated Health Data Using Blood Pressure Monitors for Managing Hypertension: Systematic Review. JMIR Mhealth Uhealth 2022; 10:e33261. [PMID: 35499862 PMCID: PMC9112087 DOI: 10.2196/33261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/07/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background In the era of digital health information technology, there has been a proliferation of devices that collect patient-generated health data (PGHD), including consumer blood pressure (BP) monitors. Despite their widespread use, it remains unclear whether such devices can improve health outcomes. Objective We performed a systematic review of the literature on consumer BP monitors that collect PGHD for managing hypertension to summarize their clinical impact on health and surrogate outcomes. We focused particularly on studies designed to measure the specific effect of using a BP monitor independent of cointerventions. We have also summarized the process and consumer experience outcomes. Methods An information specialist searched PubMed, MEDLINE, and Embase for controlled studies on consumer BP monitors published up to May 12, 2020. We assessed the risk of bias using an adapted 9-item appraisal tool and performed a narrative synthesis of the results. Results We identified 41 different types of BP monitors used in 49 studies included for review. Device engineers judged that 38 (92%) of those devices were similar to the currently available consumer BP monitors. The median sample size was 222 (IQR 101-416) participants, and the median length of follow-up was 6 (IQR 3-12) months. Of the included studies, 18 (36%) were designed to isolate the clinical effects of BP monitors; 6 of the 18 (33%) studies evaluated health outcomes (eg, mortality, hospitalizations, and quality of life), and data on those outcomes were unclear. The lack of clarity was due to low event rates, short follow-up duration, and risk of bias. All 18 studies that isolated the effect of BP monitors measured both systolic and diastolic BP and generally demonstrated a decrease of 2 to 4 mm Hg in systolic BP and 1 to 3 mm Hg in diastolic BP compared with non–BP monitor groups. Adherence to using consumer BP monitors ranged from 38% to 89%, and ease of use and satisfaction ratings were generally high. Adverse events were infrequent, but there were a few technical problems with devices (eg, incorrect device alerts). Conclusions Overall, BP monitors offer small benefits in terms of BP reduction; however, the health impact of these devices continues to remain unclear. Future studies are needed to examine the effectiveness of BP monitors that transmit data to health care providers. Additional data from implementation studies may help determine which components are critical for sustained BP improvement, which in turn may improve prescription decisions by clinicians and coverage decisions by policy makers.
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Affiliation(s)
| | | | | | | | - Neha Patel
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Nikhil K Mull
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, PA, United States
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14
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Ambulatory diastolic blood pressure: a marker of comorbidity in elderly fit hypertensive individuals? J Geriatr Cardiol 2022; 19:254-264. [PMID: 35572223 PMCID: PMC9068589 DOI: 10.11909/j.issn.1671-5411.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Masked diastolic hypotension is a new blood pressure (BP) pattern detected by ambulatory blood pressure monitoring (ABPM) in elderly hypertensives. The aim of this study was to relate ABPM and comorbidity in a cohort of fit elderly subjects attending an outpatient hypertension clinic. METHODS Comorbidity was assessed by Charlson comorbidity index (CCI) and CHA2DS2VASc score. All subjects evaluated with ABPM were aged ≥ 65 years. CCI and CHA2DS2VASc score were calculated. Diastolic hypotension was defined as mean ambulatory diastolic BP < 65 mmHg and logistic regression analysis was carried out in order to detect and independent relationship between comorbidity burden and night-time diastolic BP < 65 mmHg. RESULTS We studied 174 hypertensive elderly patients aged 72.1 ± 5.2 years, men were 93 (53.4%). Mean CCI was 0.91 ± 1.14 and mean CHA2DS2VASc score of 2.68 ± 1.22. Subjects with night-time mean diastolic values < 65 mmHg were higher in females [54.7% vs. 45.3%, P = 0.048; odds ratio (OR) = 1.914, 95% CI: 1.047-3.500]. Logistic regression analysis showed that only CHA2DS2VASc score was independently associated with night-time mean diastolic values < 65 mmHg (OR = 1.518, 95% CI: 1.161-1.985; P = 0.002), but CCI was not. CONCLUSIONS ABPM and comorbidity evaluation appear associated in elderly fit subjects with masked hypotension. Comorbid women appear to have higher risk for low ambulatory BP.
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15
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Li Y, Maimaitiaili R, Zhang Y, Feng T, Xu Y, Yang H, Zhang J, Shi J, Wang M, Zhao F, Gao J, Hu J, Jiang C, Zhao Y. Simplified regimen for the management of hypertension with telemedicine and blood pressure self-monitoring (SIMPLE): study protocol for a randomised controlled trial. BMJ Open 2022; 12:e049162. [PMID: 35354637 PMCID: PMC8968541 DOI: 10.1136/bmjopen-2021-049162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Telemedicine and blood pressure (BP) self-monitoring conduces to management of hypertension. Recent hypertension guidelines highly recommended single pill combination (SPC) for the initial treatment of essential hypertension. Based on this fact, an SPC-based telemedicine titration regimen with BP self-monitoring could be a better way in managing hypertension. This trial aims to elucidate whether telemedicine combined with BP self-monitoring is superior to self-monitoring alone during hypertension management. METHODS AND ANALYSIS This study will be a multicentred, open-labelled, randomised controlled trial. A minimum sample of 358 hypertensive patients with uncontrolled BP from four centres will be included. The intervention group will include BP self-monitoring and tele-monitoring plus a free SPC-based telemedicine titration therapy for 6 months, they will be recommended to take BP measurements at least once every 7 days, in the meantime, researchers will call to give a consultation on lifestyle or titration advice once a fortnight. The control group will be required to self-monitor BP at the same time interval as intervention group, without any therapy change. Primary outcome of the trial will be the difference in systolic blood pressure at 6-month follow-up between intervention and control group, adjusted for baseline variables. Secondary outcomes such as BP control rate, major adverse cardiovascular events, medication adherence, quality of life will be investigated. ETHICS AND DISSEMINATION Ethics approval was granted by Ethical Committee of Shanghai Tenth People's Hospital (SHSY-IEC-4.1/20-194/01). The results will be disseminated in peer-reviewed literature, and to policy-makers and healthcare partners. TRIAL REGISTRATION NUMBER ChiCTR2000037217.
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Affiliation(s)
- Yao Li
- Tongji University School of Medicine, Shanghai, China
| | | | - Yi Zhang
- Department of Cardiology, Tongji University Tenth People's Hospital, Shanghai, China
| | - Tienan Feng
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Tongji University Tenth People's Hospital, Shanghai, China
| | - Haotian Yang
- Department of Cardiology, Tongji University Tenth People's Hospital, Shanghai, China
| | - Ji Zhang
- Department of Medical Services, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jia Shi
- Department of Cardiology, Putuo Hospital, Shanghai, China
| | - Mingliang Wang
- Department of Cardiology, Shanghai Putuo District People's Hospital, Shanghai, China
| | - Fang Zhao
- Department of Cardiology, Shanghai Putuo District People's Hospital, Shanghai, China
| | - Junqing Gao
- Department of Cardiology, Putuo Hospital, Shanghai, China
| | - Jun Hu
- Department of Cardiology, Shanghai Xuhui Central Hospital, Shanghai, China
| | | | - Yifan Zhao
- Department of Cardiology, Tongji University Tenth People's Hospital, Shanghai, China
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16
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Drapkina OM, Korsunsky DV, Komkov DS, Kalinina AM. Prospects for developing and implementing remote blood pressure monitoring in patients under dispensary follow-up. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Recently, the use of telemedicine technologies (TMT) in the healthcare has gained great importance. TMT is one of the ways to increase the healthcare availability, including in patients with high blood pressure (BP). Office BP measurement and 24-hour BP monitoring are not accurate enough to study natural or induced BP changes over long periods of time. For the selection of antihypertensive drugs and the diagnosis of hypertension (HTN) in patients with an emotionally unstable personality type, as well as in the differential diagnosis of normotension, preHTN, BP selfmonitoring comes first. The use of BP self-monitoring for the diagnosis, selection of therapy, assessment of adherence and effectiveness of treatment of HTN is more effective with remote, socalled telemetric, dynamic BP monitoring. The article presents world experience in the effective use of dynamic remote BP monitoring using TMT.
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Affiliation(s)
- O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
| | - D. V. Korsunsky
- National Medical Research Center for Therapy and Preventive Medicine
| | | | - A. M. Kalinina
- National Medical Research Center for Therapy and Preventive Medicine
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17
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Yatabe J, Yatabe MS, Okada R, Ichihara A. Efficacy of Telemedicine in Hypertension Care Through Home Blood Pressure Monitoring and Videoconferencing: Randomized Controlled Trial. JMIR Cardio 2021; 5:e27347. [PMID: 34321194 PMCID: PMC8441608 DOI: 10.2196/27347] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 12/04/2022] Open
Abstract
Background The burden of time is often the primary reason why patients discontinue their treatment. Telemedicine may help patients adhere to treatment by offering convenience. Objective This study examined the efficacy and safety of telemedicine for the management of hypertension in Japan. Methods Patients with uncomplicated hypertension were recruited through web advertising between November 2015 and February 2017. They were then screened, stratified by office systolic blood pressure (SBP), and randomized into two groups: usual care (UC) and telemedicine. The telemedicine group used a 3G network–attached home blood pressure (BP) monitoring device, consulted hypertension specialists from an academic hospital through web-based video visits, and received prescription medication by mail for 1 year. The UC group used the same BP monitoring device but was managed using self-recorded BP readings, which included their diary entries and office BP taken in a community practice setting. Results Initial screening was completed by 99 patients, 54% of whom had untreated hypertension. Baseline BP was similar between the groups, but the weekly average SBP at the end of the 1-year study period was significantly lower in the telemedicine group (125, SD 9 mmHg vs 131, SD 12 mmHg, respectively; P=.02). SBP in the telemedicine group was 3.4 mmHg lower in the morning and 5.8 mmHg lower in the evening. The rate of SBP control (135 mmHg) was better in the telemedicine group (85.3% vs 70.0%; P=.01), and significant adverse events were not observed. Conclusions We present evidence suggesting that antihypertensive therapy via home BP telemonitoring and web-based video visits achieve better BP control than conventional care and is a safe treatment alternative that warrants further investigation. Trial Registration UMIN-CTR UMIN000025372; https://tinyurl.com/47ejkn4b
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Affiliation(s)
- Junichi Yatabe
- General Incorporated Association TelemedEASE, Shinjuku-ku, Tokyo, Japan
| | | | - Rika Okada
- TM Clinic Nishishinjuku, Shinjuku-ku, Tokyo, Japan
| | - Atsuhiro Ichihara
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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18
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Benziger CP, Huffman MD, Sweis RN, Stone NJ. The Telehealth Ten: A Guide for a Patient-Assisted Virtual Physical Examination. Am J Med 2021; 134:48-51. [PMID: 32687813 PMCID: PMC7368154 DOI: 10.1016/j.amjmed.2020.06.015] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 01/22/2023]
Affiliation(s)
| | - Mark D Huffman
- Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Ranya N Sweis
- Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Neil J Stone
- Northwestern University Feinberg School of Medicine, Chicago, Ill
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19
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Hare AJ, Chokshi N, Adusumalli S. Novel Digital Technologies for Blood Pressure Monitoring and Hypertension Management. CURRENT CARDIOVASCULAR RISK REPORTS 2021; 15:11. [PMID: 34127936 PMCID: PMC8188759 DOI: 10.1007/s12170-021-00672-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Hypertension is common, impacting an estimated 108 million US adults, and deadly, responsible for the deaths of one in six adults annually. Optimal management includes frequent blood pressure monitoring and antihypertensive medication titration, but in the traditional office-based care delivery model, patients have their blood pressure measured only intermittently and in a way that is subject to misdiagnosis with white coat or masked hypertension. There is a growing opportunity to leverage our expanding repository of digital technology to reimagine hypertension care delivery. This paper reviews existing and emerging digital tools available for hypertension management, as well as behavioral economic insights that could supercharge their impact. RECENT FINDINGS Digitally connected blood pressure monitors offer an alternative to office-based blood pressure monitoring. A number of cuffless blood pressure monitors are in development but require further validation before they can be deployed for widespread clinical use. Patient-facing hubs and applications offer a means to transmit blood pressure data to clinicians. Though artificial intelligence could allow for curation of this data, its clinical use for hypertension remains limited to assessing risk factors at this time. Finally, text-based and telemedicine platforms are increasingly being employed to translate hypertension data into clinical outcomes with promising results. SUMMARY The digital management of hypertension shows potential as an avenue for increasing patient engagement and improving clinical efficiency and outcomes. It is important for clinicians to understand the benefits, limitations, and future directions of digital health to optimize management of hypertension.
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Affiliation(s)
- Allison J Hare
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Office of the Chief Medical Information Officer, Penn Medicine, Philadelphia, PA USA
- Center for Digital Cardiology, Penn Medicine, Philadelphia, PA USA
| | - Neel Chokshi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Center for Digital Cardiology, Penn Medicine, Philadelphia, PA USA
- Division of Cardiovascular Medicine, Department of Medicine, Penn Medicine, Philadelphia, PA USA
| | - Srinath Adusumalli
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Office of the Chief Medical Information Officer, Penn Medicine, Philadelphia, PA USA
- Center for Digital Cardiology, Penn Medicine, Philadelphia, PA USA
- Division of Cardiovascular Medicine, Department of Medicine, Penn Medicine, Philadelphia, PA USA
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20
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Yatabe J, Yatabe MS, Ichihara A. The current state and future of internet technology-based hypertension management in Japan. Hypertens Res 2020; 44:276-285. [PMID: 33361825 PMCID: PMC7756130 DOI: 10.1038/s41440-020-00591-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 12/23/2022]
Abstract
Internet-based information and communication technology is altering our lives. Although medicine is traditionally conservative, it can benefit in many ways from adopting new technology and styles of care. Hypertension is a prime condition for the practical application of digital health management because it is prevalent and undercontrolled, and its primary index, home blood pressure, can be effectively telemonitored. Compared to other conditions that require laboratory measures or the use of drugs with frequent side effects, hypertension can be managed without actual office visits with sufficiently low risk. In this review of hypertension in Japan, we discuss the current and somewhat fragmented state of internet technology and the components and processes necessary for smooth, integrated, and multidisciplinary care in the future. Although further clinical trials are required to show the safety and efficacy of information and communication technology-based care for hypertension, the deployment of telemonitoring and telemedicine in daily practice should be expedited to solve the hypertension paradox. Challenges remain relating to cost, data integration, the redesigning of team-based care, and the improvement of user experience, but information and communication technology-based hypertension management is sure to become pivotal in improving public health.
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Affiliation(s)
- Junichi Yatabe
- General Incorporated Association TelemedEASE, Tokyo, Japan.
| | - Midori Sasaki Yatabe
- General Incorporated Association TelemedEASE, Tokyo, Japan.,Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsuhiro Ichihara
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan
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21
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Xu H, Long H. The Effect of Smartphone App-Based Interventions for Patients With Hypertension: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2020; 8:e21759. [PMID: 33074161 PMCID: PMC7605981 DOI: 10.2196/21759] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/07/2020] [Accepted: 09/12/2020] [Indexed: 12/22/2022] Open
Abstract
Background Hypertension is a major cause of cardiovascular disease, which is the leading cause of premature death. People with hypertension who do not comply with recommended treatment strategies have a higher risk of heart attacks and strokes, leading to hospitalization and consequently greater health care costs. The smartphone, which is now ubiquitous, offers a convenient tool to aid in the treatment of hypertension through the use of apps targeting lifestyle management, and such app-based interventions have shown promising results. In particular, recent evidence has shown the feasibility, acceptability, and success of digital interventions in changing the behavior of people with chronic conditions. Objective The aim of this study was to systematically compile available evidence to determine the overall effect of smartphone apps on blood pressure control, medication adherence, and lifestyle changes for people with hypertension. Methods This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. Databases were searched to identify randomized controlled trials related to the influence of an app-based intervention in people with hypertension. Data extracted from the included studies were subjected to a meta-analysis to compare the effects of the smartphone app intervention to a control. Results Eight studies with a total of 1657 participants fulfilled the inclusion criteria. Pooled analysis of 6 studies assessing systolic blood pressure showed a significant overall effect in favor of the smartphone intervention (weighted mean difference –2.28, 95% CI –3.90-0.66). Pooled analysis of studies assessing medication adherence demonstrated a significant effect (P<.001) in favor of the intervention group (standard mean difference 0.38, 95% CI 0.26-0.50) with low heterogeneity (I2=0%). No difference between groups was demonstrated with respect to physical activity. Conclusions A smartphone intervention leads to a reduction in blood pressure and an increase in medication adherence for people with hypertension. Future research should focus on the effect of behavior coaching apps on medication adherence, lifestyle change, and blood pressure reduction.
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Affiliation(s)
- Hongxuan Xu
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Huanyu Long
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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22
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Wei F, Xue R, Thijs L, Liang W, Owusu‐Agyeman M, He X, Staessen JA, Dong Y, Liu C. Associations of Left Ventricular Structure and Function With Blood Pressure in Heart Failure With Preserved Ejection Fraction: Analysis of the TOPCAT Trial. J Am Heart Assoc 2020; 9:e016009. [PMID: 32750310 PMCID: PMC7792255 DOI: 10.1161/jaha.119.016009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Data on the association of systolic and diastolic blood pressure with the structure and function of failing hearts with preserved ejection fraction (EF) are sparse. Methods and Results This analysis included 935 patients with heart failure (49.4% women; mean age, 69.9 years) with preserved EF (≥45%) enrolled in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) Trial before initiation of randomized therapy. Left ventricular (LV) structure (dimensions, wall thickness, and mass index), diastolic function (left atrial volume index, transmitral blood flow, and mitral annular velocities), and systolic function (EF and longitudinal strain) were assessed echocardiographically. In multivariable‐adjusted analyses, association sizes expressed per 1‐SD (14.8–mm Hg) increment in systolic blood pressure were 0.020 cm (P=0.003) and 0.018 cm (P=0.004) for LV septal and posterior wall thickness, respectively, and 2.42 mg/m2 (P=0.018) for LV mass index. The corresponding associations with diastolic blood pressure were nonsignificant (P≥0.067). In similarly adjusted analyses, the association sizes expressed per 1‐SD (10.7–mm Hg) increment in diastolic blood pressure were −0.15 for E/A (P<0.001), −0.76 for E/e′ (P=0.006), and −0.62% for EF (P=0.024). These findings were consistent, if models including systolic blood pressure were additionally adjusted for diastolic blood pressure and vice versa, albeit that the relation of EF with diastolic blood pressure weakened (−0.54%; P=0.10). Conclusions In diastolic heart failure, LV wall thickness and LV mass index increased with higher systolic blood pressure, but not with higher diastolic blood pressure, whereas functional measures reflecting diastolic LV function decreased with higher diastolic blood pressure, independent of systolic blood pressure. These observations highlight the importance of controlling both systolic and diastolic blood pressure as modifiable risk factors to reduce the risk of LV remodeling and diastolic LV dysfunction.
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Affiliation(s)
- Fang‐Fei Wei
- Department of Cardiologythe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouGuangdong,China
- NHC Key Laboratory of Assisted CirculationSun Yat‐Sen UniversityGuangzhouChina
| | - Ruicong Xue
- Department of Cardiologythe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouGuangdong,China
- NHC Key Laboratory of Assisted CirculationSun Yat‐Sen UniversityGuangzhouChina
| | - Lutgarde Thijs
- Studies Coordinating CentreResearch Unit Hypertension and Cardiovascular EpidemiologyDepartment of Cardiovascular SciencesUniversity of LeuvenBelgium
| | - Weihao Liang
- Department of Cardiologythe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouGuangdong,China
- NHC Key Laboratory of Assisted CirculationSun Yat‐Sen UniversityGuangzhouChina
| | - Marvin Owusu‐Agyeman
- Department of Cardiologythe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouGuangdong,China
- NHC Key Laboratory of Assisted CirculationSun Yat‐Sen UniversityGuangzhouChina
| | - Xin He
- Department of Cardiologythe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouGuangdong,China
- NHC Key Laboratory of Assisted CirculationSun Yat‐Sen UniversityGuangzhouChina
| | - Jan A. Staessen
- Studies Coordinating CentreResearch Unit Hypertension and Cardiovascular EpidemiologyDepartment of Cardiovascular SciencesUniversity of LeuvenBelgium
- NPA Alliance for the Promotion of Preventive MedicineMechelenBelgium
| | - Yugang Dong
- Department of Cardiologythe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouGuangdong,China
- NHC Key Laboratory of Assisted CirculationSun Yat‐Sen UniversityGuangzhouChina
- National‐Guangdong Joint EngineeringLaboratory for Diagnosis and Treatment of Vascular DiseaseGuangzhouChina
| | - Chen Liu
- Department of Cardiologythe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouGuangdong,China
- NHC Key Laboratory of Assisted CirculationSun Yat‐Sen UniversityGuangzhouChina
- National‐Guangdong Joint EngineeringLaboratory for Diagnosis and Treatment of Vascular DiseaseGuangzhouChina
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23
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E-Health in Hypertension Management: an Insight into the Current and Future Role of Blood Pressure Telemonitoring. Curr Hypertens Rep 2020; 22:42. [PMID: 32506273 DOI: 10.1007/s11906-020-01056-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Out-of-office blood pressure (BP) monitoring techniques, including home and ambulatory BP monitoring, are currently recommended by hypertension guidelines worldwide to confirm the diagnosis of hypertension and to monitor the appropriateness of treatment. However, such techniques are not always effectively implemented or timely available in the routine clinical practice. In recent years, the widespread availability of e-health solutions has stimulated the development of blood pressure telemonitoring (BPT) systems, which allow remote BP tracking and tighter and more efficient monitoring of patients' health status. RECENT FINDINGS There is currently strong evidence that BPT may be of benefit for hypertension screening and diagnosis and for improving hypertension management. The advantage is more significant when BPT is coupled with multimodal interventions involving a physician, a nurse or pharmacist, and including education on lifestyle and risk factors and drug management. Several randomized controlled studies documented enhanced hypertension management and improved BP control of hypertensive patients through BPT. Potential additional effects of BPT are represented by improved compliance to treatment, intensification, and optimization of drug use, improved quality of life, reduction in risk of developing cardiovascular complications, and cost-saving. Applications based on m-health and making use of wearables or smartwatches integrated with machine learning models are particularly promising for the future development of efficient BPT solutions, and they will provide remarkable support decision tools for doctors. BPT and telehealth will soon disrupt hypertension management. However, which approach will be the most effective and whether it will be sustainable in the long-term still need to be elucidated.
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