PATIENT‑ORIENTED ASSESSMENT OF BLOOD PRESSURE TELEMONITORING AND REMOTE COUNSELING IN HYPERTENSIVE PATIENTS: A PILOT PROJECT

Abstract

Objective. To evaluate patient-oriented endpoints and antihypertensive effectiveness of blood pressure (BP) monitoring and distant counseling (TMDC) among outpatients with uncontrolled hypertension (HTN). Design and methods . Programs of TMDC with different duration of follow-up (1, 3, 6, 12 months) were developed (with obligatory initial and final clinic visits). The demand in TMDC was assessed by a preliminary survey among cardiologists (n = 73) and hypertensive patients (n = 540) referred to Almazov National Medical Research Centre. Patients with uncontrolled HTN who signed informed consent were enrolled in the study being assigned to TMDC or to the age, sex and BP level-matched control group; the latter ones were given standard recommendations (outpatient visits once every 3 months). None of the patients had any serious comorbidities requiring frequent face-to-face visits. On a baseline clinic visit TMDC patients were given detailed technical instructions on BP selfmonitoring and request for counseling through web-site and mobile application. Office BP levels were evaluated twice, at baseline and at the final clinic visit. In the TMDC group BP level, the frequency and reasons for the consultations were assessed. For evaluation of patient-reported outcomes questionnaires of the Hospital Anxiety and Depression Scale («HADS») and «SF-36» were provided at the first and final visits. Results. According to initial survey, 12 (16 %) of 73 cardiologists and 184 (34 %) among 540 patients at Almazov National Medical Research Centre gave a positive opinion regarding TMDC. Most patients (n = 129; 70 %) chose a three-month TMDC plan. Of these, 110 patients (74 men, mean age 51,2 ± 17,0 years) completed follow-up period; control group consisted of 80 sex-, age- and BP-matched patients. TMDC group demonstrated a more pronounced decrease in office systolic (SBP) and diastolic (DBP) BP levels as compared to the control group: Δ –22 ± 12,4 versus Δ –8,6 ± 22,4 mmHg for SBP (p = 0,005) and Δ –13,6 ± 10,8 versus Δ –7 ± 11,3 mm Hg for DBP (p = 0,02). At final visit target office BP level (< 140/90 mmHg) was achieved in 82 patients (75 %) and 16 patients (20 %) in the TMDC and control groups, respectively (χ 2 = 20,8; p < 0,01). For the entire follow-up period, everyone in TMDC group required at least 1 remote doctor’s advice and in 36 cases (33 %) antihypertensive therapy correction was necessary. Aside, TMDC group showed reduction in anxiety and depression according to HADS (–1,2 and –1,8 score, respectively, p < 0,05) and improvement in physical HRQoL (+ 9 ± 3,3 points SF-36, p = 0,04). Conclusion . Results demonstrated that a simple and safe telehealth tool for patients with uncontrolled HTN is easily applicable in routine daily clinical practice, provides additional antihypertensive effect and improves patientreported outcomes. However, it needs additional support measures for higher acceptance in routine practice.