M-HEALTH IN PATIENTS WITH UNCONTROLLED HYPERTENSION

Abstract

Objective: Hypertension (HTN) has multiple combinations of stages and risk profiles affecting treatment efficacy. Handy m-Health tools are to be a valuable adjunct to conventional care. The aim was to determine the effect of m-Health intervention in patients with essential uncontrolled HTN with response to its stage and related cardiovascular (CVD) risk profile. Design and method: Study enlisted 64 patients (44 males, mean age 50 ± 16 y.o.) with essential HTN, office and home blood pressure (BP) above target for 3 previous months. A non-blind design was expected and all patients consecutively underwent teleBP monitoring and distant counseling using safe and simple m-Health app integrated into local medical information system. Follow-up for 6 months with treatment effect calculation respectively to HTN stage and CVD risk profile according to the latest practice Guidelines (Group 1: stage 1 HTN and low-to-moderate risk; Group 2: stages 2–3 HTN and high-to-very high risk). Results: Total of 60 patients has completed follow-up (42 males, 48 ± 14 y.o., 5 with Grade 3, 22 - Grade 2 and 33 - Grade 1 HTN; mean office BP 156 ± 15.4 mmHg). Of all individuals 8 were with stage 3 HTN (mostly due to HFpEF and AFib, very-high risk), 22 patients with stage 2 HTN (mostly due to hypertensive LVH, high risk) and 30 - uncomplicated stage 1 HTN (low-to-moderate risk), therefore Group 1 and 2 consisted of 30 patients each. Patients in Group 2 were older (56 ± 15.6 vs 42.2 ± 12.7 y.o., p < 0.001), with longer history of HTN (10.3 ± 5.1 vs 3.5 ± 1.4 years, p < 0.0001). The overall effect of m-Health was –22 ± 12,4 mmHg for SBP and –13,6 ± 10,8 mmHg for DBP) and 63% (n = 38) of patients were in target range at 6 months. Patients in Group 1 were more likely to have their BP controlled at the end of the study (n = 24 in Group 1 and n = 14 in Group 2, OR 4.57, [95%CI, 1.45 - 14.4]). Conclusions: m-Health intervention is associated with remarkable improvement in blood pressure at 6 months. The effect is more pronounced in younger patients with uncomplicated short-term HTN and of low-to-moderate CVD risk.