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McManus RJ, Little P, Stuart B, Morton K, Raftery J, Kelly J, Bradbury K, Zhang J, Zhu S, Murray E, May CR, Mair FS, Michie S, Smith P, Band R, Ogburn E, Allen J, Rice C, Nuttall J, Williams B, Yardley L. Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial. BMJ 2021; 372:m4858. [PMID: 33468518 PMCID: PMC7814507 DOI: 10.1136/bmj.m4858] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. DESIGN Unmasked randomised controlled trial with automated ascertainment of primary endpoint. SETTING 76 general practices in the United Kingdom. PARTICIPANTS 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. INTERVENTIONS Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. MAIN OUTCOME MEASURES The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. RESULTS After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of -3.4 mm Hg (95% confidence interval -6.1 to -0.8 mm Hg) and a mean difference in diastolic blood pressure of -0.5 mm Hg (-1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. CONCLUSIONS The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. TRIAL REGISTRATION ISRCTN13790648.
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Affiliation(s)
- Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Paul Little
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Katherine Morton
- School of Psychology, University of Southampton, Southampton, UK
| | - James Raftery
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Jo Kelly
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | | | - Jin Zhang
- School of Psychology, University of Southampton, Southampton, UK
| | - Shihua Zhu
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Elizabeth Murray
- eHealth Unit, Research Department of Primary Care and Population Health Sciences, University College London, London, UK
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Susan Michie
- UCL Centre for Behaviour Change, University College London, London, UK
| | - Peter Smith
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Rebecca Band
- School of Psychology, University of Southampton, Southampton, UK
| | - Emma Ogburn
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Julie Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Cathy Rice
- Patient and Public Contributor, Bristol, UK
| | - Jacqui Nuttall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Bryan Williams
- Institute of Cardiovascular Sciences, NIHR UCL Hospitals Biomedical Research Centre, University College London, London, UK
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, UK
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152
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Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, Federici M, Filippatos G, Grobbee DE, Hansen TB, Huikuri HV, Johansson I, Jüni P, Lettino M, Marx N, Mellbin LG, Östgren CJ, Rocca B, Roffi M, Sattar N, Seferović PM, Sousa-Uva M, Valensi P, Wheeler DC. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2021; 41:255-323. [PMID: 31497854 DOI: 10.1093/eurheartj/ehz486] [Citation(s) in RCA: 2387] [Impact Index Per Article: 795.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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153
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Iacopo F, Branch M, Cardinale D, Middeldorp M, Sanders P, Cohen JB, Achirica MC, Jaiswal S, Brown SA. Preventive Cardio-Oncology: Cardiovascular Disease Prevention in Cancer Patients and Survivors. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00883-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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154
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Sharma K, Desai HD. Role of Self-Measured Home Blood Pressure Monitoring (HBPM) and Effectiveness of Telemedicine During the Era of COVID-19 Pandemic. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:1071-1073. [PMID: 33718780 PMCID: PMC7943330 DOI: 10.1007/s42399-021-00852-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Kamal Sharma
- grid.414133.00000 0004 1767 9806Department of Cardiology, UN Mehta Institute of Cardiology and Research Center, BJMC, Ahmedabad, India
| | - Hardik D. Desai
- Graduate Medical Education, Gujarat Adani Institute of Medical Sciences, Affiliated to K.S.K.V University, Bhuj, 370001 Gujarat India
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155
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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: 70] [Impact Index Per Article: 23.3] [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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156
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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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157
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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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158
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Falter M, Scherrenberg M, Dendale P. Digital Health in Cardiac Rehabilitation and Secondary Prevention: A Search for the Ideal Tool. SENSORS (BASEL, SWITZERLAND) 2020; 21:E12. [PMID: 33374985 PMCID: PMC7792579 DOI: 10.3390/s21010012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/08/2020] [Accepted: 12/19/2020] [Indexed: 12/19/2022]
Abstract
Digital health is becoming more integrated in daily medical practice. In cardiology, patient care is already moving from the hospital to the patients' homes, with large trials showing positive results in the field of telemonitoring via cardiac implantable electronic devices (CIEDs), monitoring of pulmonary artery pressure via implantable devices, telemonitoring via home-based non-invasive sensors, and screening for atrial fibrillation via smartphone and smartwatch technology. Cardiac rehabilitation and secondary prevention are modalities that could greatly benefit from digital health integration, as current compliance and cardiac rehabilitation participation rates are low and optimisation is urgently required. This viewpoint offers a perspective on current use of digital health technologies in cardiac rehabilitation, heart failure and secondary prevention. Important barriers which need to be addressed for implementation in medical practice are discussed. To conclude, a future ideal digital tool and integrated healthcare system are envisioned. To overcome personal, technological, and legal barriers, technological development should happen in dialog with patients and caregivers. Aided by digital technology, a future could be realised in which we are able to offer high-quality, affordable, personalised healthcare in a patient-centred way.
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Affiliation(s)
- Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium; (M.S.); (P.D.)
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
- KU Leuven, Faculty of Medicine, 3000 Leuven, Belgium
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium; (M.S.); (P.D.)
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium; (M.S.); (P.D.)
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
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159
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Home blood pressure monitoring and e-Health: investigation of patients' experience with the Hy-Result system. Blood Press Monit 2020; 25:155-161. [PMID: 32118677 DOI: 10.1097/mbp.0000000000000436] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hy-Result is a validated system designed to help patients complying with the home blood pressure monitoring (HBPM) protocol and understanding their blood pressure (BP) readings. It is available as a standalone web application or within a wireless BP monitor app. OBJECTIVE The aim of the study was to explore patients' experience with Hy-Result. METHODS Online survey completed by 512 users of the Hy-Result web application or monitor app, and three focus groups with 24 hypertensive patients who monitor their BP at home and use the Hy-Result web application to record their data. We assessed the experience of patients with the functionalities and medical content of Hy-Result, their feelings and expectations, and the impact of Hy-Result on the physician-patient relationship. RESULTS (1) Functionalities: Over 90% of survey respondents and all focus group participants found Hy-Result easy to use. The main drawback of the web application is the need to manually enter all BP values at once. (2) Medical content: Hy-Result offers information on arterial hypertension and HBPM that most patients found useful. Users found that Hy-Result triggers appropriate reactions to BP readings, including adequately timed general practitioner visits. (3) Feelings and expectations: Over 90% of survey respondents trust Hy-Result and focus group participants understood that text messages are suggestions, not diagnoses. Hy-Result did not cause anxiety or excessive BP measurements. (4) Physician-patient relationship: Three-quarter of survey respondents agreed that Hy-Result may help when talking with their doctor about their BP values but only one-third of those have shown the report to their physician. For focus group participants, using Hy-Result should ideally be a physician prescription. They were aware that Hy-Result does not replace clinical judgment and that physicians still have a decisive role in BP management. CONCLUSION Most of the users described Hy-Result as an easy-to-use and useful tool. Patients are willing to use it on physician request.
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160
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Measurement of SBP at home by parents using hand-held Doppler device and aneroid sphygmomanometer: a single-centre experience. J Hypertens 2020; 39:904-910. [PMID: 33273193 DOI: 10.1097/hjh.0000000000002736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We taught parents to use at home a hand-held Doppler device and aneroid sphygmomanometer for SBPmeasurement (HDBPM). METHODS Retrospective study including all children referred to evaluate hypertension over a 6-year period. Each child underwent HDBPM measurements performed by parents while awake over 2 weeks with three measurements performed twice daily. RESULTS Of n = 155 children, 145 (93.5%) were successful and aged median (interquartile range) 2.48 (1.01, 5.12) years, including 85 boys. Overall, there were 25, 19, 30 and 26% aged less than 1, 1 to less than 2, 2 to less than 5 and at least 5 years old, respectively. Seventy-eight (54%) had been referred for confirming diagnosis and 67 (46%) for ongoing monitoring of treated hypertension. Following HDBPM, 70 of 78 (90%) patients in the 'Diagnosis subgroup' were observed to have normal blood pressure (BP). In the monitoring subgroup, treated hypertension that required no medication changes was recorded in 35 of 67 (52%) and medication changed in 32 of 67 (48%), [increased, decreased or changed] in 22, 6 and 5%, respectively. In 10 of 67 (15%) medication was weaned and stopped completely following HDBPM. None of the children required admission to hospital to evaluate their BP level or manage hypertension. CONCLUSION Out-of-office BP monitoring using HDBPM is acceptable to children and families of young children when parents are taught to measure BP and supported by health professionals. We report evidence of the feasibility and clinical utility of HDBPM in a challenging population of children who are either too young or unable to tolerate 24-h ambulatory BP monitoring for both the diagnosis and ongoing management of clinically relevant hypertension.
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161
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Hinton L, Hodgkinson J, Tucker KL, Rozmovits L, Chappell L, Greenfield S, McCourt C, Sandall J, McManus RJ. Exploring the potential for introducing home monitoring of blood pressure during pregnancy into maternity care: current views and experiences of staff-a qualitative study. BMJ Open 2020; 10:e037874. [PMID: 33262186 PMCID: PMC7709507 DOI: 10.1136/bmjopen-2020-037874] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/21/2020] [Accepted: 08/29/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE One in 20 women are affected by pre-eclampsia, a major cause of maternal and perinatal morbidity, death and premature birth worldwide. Diagnosis is made from monitoring blood pressure (BP) and urine and symptoms at antenatal visits after 20 weeks of pregnancy. There are no randomised data from contemporary trials to guide the efficacy of self-monitoring of BP (SMBP) in pregnancy. We explored the perspectives of maternity staff to understand the context and health system challenges to introducing and implementing SMBP in maternity care, ahead of undertaking a trial. DESIGN Exploratory study using a qualitative approach. SETTING Eight hospitals, English National Health Service. PARTICIPANTS Obstetricians, community and hospital midwives, pharmacists, trainee doctors (n=147). METHODS Semi-structured interviews with site research team members and clinicians, interviews and focus group discussions. Rapid content and thematic analysis undertaken. RESULTS The main themes to emerge around SMBP include (1) different BP changes in pregnancy, (2) reliability and accuracy of BP monitoring, (3) anticipated impact of SMBP on women, (4) anticipated impact of SMBP on the antenatal care system, (5) caution, uncertainty and evidence, (6) concerns over action/inaction and patient safety. CONCLUSIONS The potential impact of SMBP on maternity services is profound although nuanced. While introducing SMBP does not reduce the responsibility clinicians have for women's health, it may enhance the responsibilities and agency of pregnant women, and introduces a new set of relationships into maternity care. This is a new space for reconfiguration of roles, mutual expectations and the relationships between and responsibilities of healthcare providers and women. TRIAL REGISTRATION NUMBER NCT03334149.
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Affiliation(s)
- Lisa Hinton
- THIS Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - James Hodgkinson
- Primary Care Clinical Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Katherine L Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Lucy Chappell
- Women's Health Academic Centre, King's College, London, UK
| | - Sheila Greenfield
- Primary Care Clinical Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christine McCourt
- Department of Midwifery and Child Health, City University of London, London, UK
| | - Jane Sandall
- Department of Women and Children's Health, Kings College, London, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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162
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Bunova SS, Zhernakova NI, Fedorin MM, Skirdenko YP, Osipova OA. Effective antihypertensive therapy: focus on adherence management. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
High medical adherence is a prerequisite for achieving goals in the treatment of hypertension (HTN). The majority of patients with HTN showed low adherence to treatment, which requires finding ways to solve this problem. This review describes the factors influencing adherence, ways of its assessment, and analyzes methods of increasing medical adherence in hypertensive patients. Noteworthy is the lack of publications describing the effectiveness of methods for increasing long-term (>2 years) adherence in hypertensive patients. The review also describes a not fully clear individualized approach, which consists in choosing a therapy regimen based on levels of medical adherence, medical follow-up and lifestyle modification.
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Affiliation(s)
- S. S. Bunova
- National Research University Belgorod State University (BelSU))
| | | | | | | | - O. A. Osipova
- National Research University Belgorod State University (BelSU))
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163
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Healthcare practitioner views and experiences of patients self-monitoring blood pressure: a vignette study. BJGP Open 2020; 4:bjgpopen20X101101. [PMID: 33144364 PMCID: PMC7880181 DOI: 10.3399/bjgpopen20x101101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/27/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Home self-monitoring of blood pressure is widely used in primary care to assist in the diagnosis of hypertension, as well as to improve clinical outcomes and support adherence to medication. The National Institute for Health and Care Excellence (NICE) care pathways for hypertension recommend specific guidelines, although they lack detail on supporting patients to self-monitor. AIM To elicit primary care practitioners' experiences of managing patients' home blood pressure self-monitoring, across surgeries located in different socioeconomic areas. DESIGN & SETTING A qualitative focus group study was conducted with a total of 21 primary care professionals. METHOD Participants were GPs and practice nurses (PNs), purposively recruited from surgeries in areas of low and high deprivation, according to the English indices of multiple deprivation. Six vignettes were developed featuring data from interviews with people who self-monitor and these were used in five focus groups. Results were thematically analysed. RESULTS Themes derived in the thematic analysis largely reflected topics covered by the vignettes. These included: advice on purchase of a device; supporting home monitoring; mitigating patient anxiety experienced as a result of home monitoring; valuing patients' data; and effect of socioeconomic factors. CONCLUSION The work provides an account of methods used by primary care practitioners in the management of home blood pressure self-monitoring, where guidance may be lacking and primary care practitioners act on their own judgement. Findings complement recent policy documentation, which recognises the need to adopt new ways of working to empower patients (for example, additional support from healthcare assistants), but lacks detail on how this should be done.
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164
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Lin HJ, Wang TD, Yu-Chih Chen M, Hsu CY, Wang KL, Huang CC, Hsieh MJ, Chiu YW, Chiang LT, Chuang WP, Hsu PF, Wu CH, Hung CS, Chen KC, Wu CC, Wang YC, Chou PC, Yap HY, Cheng HM. 2020 Consensus Statement of the Taiwan Hypertension Society and the Taiwan Society of Cardiology on Home Blood Pressure Monitoring for the Management of Arterial Hypertension. ACTA CARDIOLOGICA SINICA 2020; 36:537-561. [PMID: 33235411 PMCID: PMC7677637 DOI: 10.6515/acs.202011_36(6).20201106a] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/06/2020] [Indexed: 12/30/2022]
Abstract
To facilitate the applications of home blood pressure (HBP) monitoring in clinical settings, the Taiwan Hypertension Society and the Taiwan Society of Cardiology jointly put forward the Consensus Statement on HBP monitoring according to up-to-date scientific evidence by convening a series of expert meetings and compiling opinions from the members of these two societies. In this Consensus Statement as well as recent international guidelines for management of arterial hypertension, HBP monitoring has been implemented in diagnostic confirmation of hypertension, identification of hypertension phenotypes, guidance of anti-hypertensive treatment, and detection of hypotensive events. HBP should be obtained by repetitive measurements based on the " 722 " principle, which is referred to duplicate blood pressure readings taken per occasion, twice daily, over seven consecutive days. The " 722" principle of HBP monitoring should be applied in clinical settings, including confirmation of hypertension diagnosis, 2 weeks after adjustment of antihypertensive medications, and at least every 3 months in well-controlled hypertensive patients. A good reproducibility of HBP monitoring could be achieved by individuals carefully following the instructions before and during HBP measurement, by using validated BP devices with an upper arm cuff. Corresponding to office BP thresholds of 140/90 and 130/80 mmHg, the thresholds (or targets) of HBP are 135/85 and 130/80 mmHg, respectively. HBP-based hypertension management strategies including bedtime dosing (for uncontrolled morning hypertension), shifting to drugs with longer-acting antihypertensive effect (for uncontrolled evening hypertension), and adding another antihypertensive drug (for uncontrolled morning and evening hypertension) should be considered. Only with the support from medical caregivers, paramedical team, or tele- monitoring, HBP monitoring could reliably improve the control of hypertension.
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Affiliation(s)
- Hung-Ju Lin
- Cardiovascular Center and Divisions of Cardiology, Department of Internal Medicine, National Taiwan University Hospital
| | - Tzung-Dau Wang
- Cardiovascular Center and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Michael Yu-Chih Chen
- Division of Cardiology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien
| | - Chien-Yi Hsu
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine
- Taipei Heart Institute, Taipei Medical University
| | | | - Chin-Chou Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Cardiovascular Research Center
- Institute of Pharmacology, National Yang-Ming University, Taipei
| | - Ming-Jer Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine
| | - Yu-Wei Chiu
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital
| | - Liang-Ting Chiang
- Division of Cardiology, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Wen-Po Chuang
- Division of Cardiology, Far Eastern Memorial Hospital, New Taipei City
| | - Pai-Feng Hsu
- Healthcare and Management Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
| | - Chun-Hsien Wu
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Chi-Sheng Hung
- Cardiovascular Center and Divisions of Cardiology, Department of Internal Medicine, National Taiwan University Hospital
| | - Kuan-Chun Chen
- Heart Center, Cheng Hsin General Hospital
- National Defense Medical Center
- Institute of Emergency and Critical Care Medicine, National Yang Ming University, Taipei
| | - Chih-Cheng Wu
- Cardiovascular Center, National Taiwan University Hospital Hsin-Chu Branch
- Institute of Biomedical Engineering, National Tsing-Hwa University, Hsinchu
- Institute of Cellular and System Medicine, National Health Research Institute, Miaoli, Taiwan
| | - Yu-Chen Wang
- Division of Cardiology, Department of Internal Medicine, Asia University Hospital
- Department of Biotechnology, Asia University
- Division of Cardiology, Department of Internal Medicine, China Medical University College of Medicine and Hospital, Taichung
| | - Po-Ching Chou
- Cardiovascular Center of Cathay General Hospital, Taipei
| | - Hui-Yi Yap
- Department of cardiology, Chi Mei Medical Center, Liouying
| | - Hao-Min Cheng
- Faculty of Medicine, National Yang-Ming University School of Medicine
- Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital
- Institute of Public Health and Community Medicine Research Center
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
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165
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Michalakeas C, Katsi V, Soulaidopoulos S, Dilaveris P, Vrachatis D, Lekakis I, Vlachopoulos C, Tsioufis K, Tousoulis D. Mobile phones and applications in the management of patients with arterial hypertension. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2020; 10:419-431. [PMID: 33224593 PMCID: PMC7675159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/06/2020] [Indexed: 06/11/2023]
Abstract
The use of mobile health (mHealth) in the field of medicine is constantly evolving and advancing. Arterial hypertension, a major modifiable cardiovascular risk factor with a high prevalence in the general population, frequently remains underdiagnosed and thus untreated. Furthermore, the majority of hypertensive patients fail to achieve blood pressure target levels. The purpose of this review is to identify and evaluate current use of mHealth strategies, with focus on mobile phones, smartphones and applications, in the management of patients with arterial hypertension. Current mobile technology has the capacity to inform and motivate the general public for timely diagnosis of hypertension, to facilitate communication between physicians and patients, to aid in the monitoring of blood pressure levels and the optimization of treatment and to promote, in general, a healthy lifestyle and assist in the management of other cardiovascular risk factors. There is potential for positive impact of mHealth technology in the management of arterial hypertension, as well as probable detrimental effects that warrant caution. The research in this field is ongoing and future well-conducted studies are needed in order to establish the use of mobile technology in arterial hypertension management.
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Affiliation(s)
- Christos Michalakeas
- Second Department of Cardiology, Attikon Hospital, Athens Medical School, National and Kapodistrian University of AthensAthens, Greece
| | - Vasiliki Katsi
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of AthensGreece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of AthensGreece
| | - Polychronis Dilaveris
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of AthensGreece
| | - Dimitrios Vrachatis
- Department of Cardiology, General Hospital of Athens “G. Gennimatas”Athens, Greece
| | - Ioannis Lekakis
- Second Department of Cardiology, Attikon Hospital, Athens Medical School, National and Kapodistrian University of AthensAthens, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of AthensGreece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of AthensGreece
| | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of AthensGreece
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Abstract
PURPOSE OF REVIEW Herein, we provide a review of the recent literature on the epidemiological and pathophysiological relationship between hypertension (HTN) and diabetes mellitus, along with prognostic implications and current treatment concepts. RECENT FINDINGS Diabetes mellitus affects ∼10% of US adults. The prevalence of HTN in adults with diabetes mellitus was 76.3% or 66.0% based on the definitions used by guidelines. There exist differences among major society guidelines regarding the definition of HTN and target blood pressure (BP) levels. Recent basic and clinical research studies have shed light on pathophysiologic and genetic links between HTN and diabetes mellitus. Randomized controlled trials over the past 5 years have confirmed the favorable BP and cardiovascular risk reduction by antidiabetic agents. SUMMARY HTN and diabetes mellitus are 'silent killers' with rising global prevalence. The development of HTN and diabetes mellitus tracks each other over time. The coexistence of both clinical entities synergistically contributes to micro- and macro-vasculopathy along with cardiovascular and all-cause mortality. Various shared mechanisms underlie the pathophysiological relationship between HTN and diabetes mellitus. Moreover, BP reduction with lifestyle interventions and antihypertensive agents is a primary target for reducing cardiovascular risk among patients with HTN and diabetes mellitus.
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167
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Vallée A, Gabet A, Grave C, Lelong H, Blacher J, Olié V. Home blood pressure monitoring in France: Device possession rate and associated determinants, the Esteban study. J Clin Hypertens (Greenwich) 2020; 22:2204-2213. [PMID: 32966691 DOI: 10.1111/jch.14055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/24/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022]
Abstract
Home blood pressure monitoring (HBPM) is increasingly being promoted in hypertension guidelines to improve hypertension management. Possessing a HBPM device could improve blood pressure (BP) control and prognostic impact. The aims of this study were to estimate the possession rate of HBPM devices in the French population and in hypertensive adults, and to investigate the determinants of possessing such devices at home. Cross-sectional analyses were performed using data from the Esteban survey, which comprised a representative sample of the French population. Among the 2,054 study participants, 673 had hypertension. Of these, 385 were aware they had it. Weighted logistic regressions were performed to investigate the factors (socioeconomic, clinical, drug treatment, and healthcare visits) associated with possessing a HBPM device. 20.9% of the study sample, 42.1% of those with hypertension, and 54% of those aware of their hypertension, possessed a HBPM device. Female gender (OR = 2.03, 95%CI [1.46; 2.60]), smoking (OR = 2.33, 95%CI [1.51; 3.15]), antihypertensive drugs (OR = 1.75, 95%CI [1.06; 2.44]), general practitioner (GP) visits (OR = 3.28, 95%CI [1.84; 4.68]), and diabetes (OR = 0.41 95% CI [0.14; 0.68]) were associated with possessing a HBPM device among those aware of their hypertension. Over 20% of the study population possessed a HBPM device at home. This proportion rose to one in two in those aware or their hypertension. Among the latter, possessing a device was positively associated with female gender, GP visits, and antihypertensive drug use. Increasing possession of HBPM devices in the hypertensive population could foster better management of the condition.
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Affiliation(s)
- Alexandre Vallée
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, AP-HP, University of Paris, Paris, France
| | - Amélie Gabet
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
| | - Clémence Grave
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
| | - Hélène Lelong
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, AP-HP, University of Paris, Paris, France
| | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, AP-HP, University of Paris, Paris, France
| | - Valérie Olié
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
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168
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Cappuccio FP. The Role of Nocturnal Blood Pressure and Sleep Quality in Hypertension Management. Eur Cardiol 2020; 15:e60. [PMID: 32944089 PMCID: PMC7479543 DOI: 10.15420/ecr.2020.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022] Open
Abstract
The accurate measurement, prediction and treatment of high blood pressure (BP) are essential to the management of hypertension and the prevention of its associated cardiovascular (CV) risks. However, even if BP is optimally controlled during the day, nocturnal high blood pressure may still increase the risk of CV events. The pattern of circadian rhythm of BP can be evaluated by ambulatory BP monitoring (ABPM). Night-time ABPM is more closely associated with fatal and nonfatal CV events than daytime ambulatory BP. However, the use of ABPM is limited by low availability and the fact that it can cause sleep disturbance, therefore may not provide realistic nocturnal measurements. Home blood pressure monitoring (HBPM) offers an inexpensive alternative to ABPM, is preferred by patients and provides a more realistic assessment of BP during an individual’s daily life. However, until recently, HBPM did not offer the possibility to measure nocturnal (sleep time) BP. The development and validation of new BP devices, such as the NightView (OMRON Healthcare, HEM9601T-E3) HBPM device, could overcome these limitations, offering the possibility of daytime and night-time BP measurements with minimal sleep disturbance.
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Affiliation(s)
- Francesco P Cappuccio
- ESH Centre of Excellence in Hypertension and Cardio-metabolic Research, University of Warwick Medical School Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust Coventry, UK
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169
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Omboni S, McManus RJ, Bosworth HB, Chappell LC, Green BB, Kario K, Logan AG, Magid DJ, Mckinstry B, Margolis KL, Parati G, Wakefield BJ. Evidence and Recommendations on the Use of Telemedicine for the Management of Arterial Hypertension: An International Expert Position Paper. Hypertension 2020; 76:1368-1383. [PMID: 32921195 DOI: 10.1161/hypertensionaha.120.15873] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Telemedicine allows the remote exchange of medical data between patients and healthcare professionals. It is used to increase patients' access to care and provide effective healthcare services at a distance. During the recent coronavirus disease 2019 (COVID-19) pandemic, telemedicine has thrived and emerged worldwide as an indispensable resource to improve the management of isolated patients due to lockdown or shielding, including those with hypertension. The best proposed healthcare model for telemedicine in hypertension management should include remote monitoring and transmission of vital signs (notably blood pressure) and medication adherence plus education on lifestyle and risk factors, with video consultation as an option. The use of mixed automated feedback services with supervision of a multidisciplinary clinical team (physician, nurse, or pharmacist) is the ideal approach. The indications include screening for suspected hypertension, management of older adults, medically underserved people, high-risk hypertensive patients, patients with multiple diseases, and those isolated due to pandemics or national emergencies.
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Affiliation(s)
- Stefano Omboni
- From the Clinical Research Unit, Italian Institute of Telemedicine, Varese (S.O.).,Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Russian Federation (S.O.)
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom (R.J.M.)
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, NC (H.B.B.).,Department of Psychiatry and Behavioral Sciences (H.B.B.), Duke University, Durham, NC.,Division of General Internal Medicine (H.B.B.), Duke University, Durham, NC.,Department of Population Health Sciences (H.B.B.), Duke University, Durham, NC
| | - Lucy C Chappell
- Women's Health Academic Centre, King's College London, United Kingdom (L.C.C.)
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle (B.B.G.)
| | - Kazuomi Kario
- Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | - Alexander G Logan
- Department of Medicine, Mount Sinai Hospital, University Health Network and University of Toronto, ON, Canada (A.G.L.)
| | - David J Magid
- Colorado Permanente Medical Group, Denver and School of Public Health, University of Colorado, Aurora (D.J.M.)
| | - Brian Mckinstry
- Emeritus Professor of Primary Care eHealth, Usher Institute, The University of Edinburgh, United Kingdom (B.M.)
| | | | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.).,Istituto Auxologico Italiano, IRCCS San Luca, Milano, Italy (G.P.)
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170
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Mao Y, Lin W, Wen J, Chen G. Impact and efficacy of mobile health intervention in the management of diabetes and hypertension: a systematic review and meta-analysis. BMJ Open Diabetes Res Care 2020; 8:8/1/e001225. [PMID: 32988849 PMCID: PMC7523197 DOI: 10.1136/bmjdrc-2020-001225] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/22/2020] [Accepted: 07/02/2020] [Indexed: 01/02/2023] Open
Abstract
With the continuous development of science and technology, mobile health (mHealth) intervention has been proposed as a treatment strategy for managing chronic diseases. In some developed countries, mHealth intervention has been proven to remarkably improve both the quality of care for patients with chronic illnesses and the clinical outcomes of these patients. However, the effectiveness of mHealth in developing countries remains unclear. Based on this fact, we conducted this systematic review and meta-analysis to evaluate the impact of mHealth on countries with different levels of economic development. To this end, we searched Pubmed, ResearchGate, Embase and Cochrane databases for articles published from January 2008 to June 2019. All of the studies included were randomized controlled trials. A meta-analysis was performed using the Stata software. A total of 51 articles (including 13 054 participants) were eligible for our systematic review and meta-analysis. We discovered that mHealth intervention did not only play a major role in improving clinical outcomes compared with conventional care, but also had a positive impact on countries with different levels of economic development. More importantly, our study also found that clinical outcomes could be ameliorated even further by combining mHealth with human intelligence rather than using mHealth intervention exclusively. According to our analytical results, mHealth intervention could be used as a treatment strategy to optimize the management of diabetes and hypertension in countries with different levels of economic development.
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Affiliation(s)
- Yaqian Mao
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Wei Lin
- Endocrinology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Junping Wen
- Endocrinology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Gang Chen
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Endocrinology, Fujian Provincial Hospital, Fuzhou, Fujian, China
- Fujian Provincial Key Laboratory of Medical Analysis, Fujian Academy of Medical, Fuzhou, Fujian, China
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171
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Wyss F, Coca A, Lopez-Jaramillo P, Ponte-Negretti C. Position statement of the Interamerican Society of Cardiology (IASC) on the current guidelines for the prevention, diagnosis and treatment of arterial hypertension 2017-2020. Int J Cardiol Hypertens 2020; 6:100041. [PMID: 33447767 PMCID: PMC7803017 DOI: 10.1016/j.ijchy.2020.100041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES As an Inter-American Society we are convinced of the need to standardize the steps in which we diagnose, evaluate, treat and control hypertension, establishing guidelines and rules that should be adopted in all countries of Latin America, aimed at standardizing management and control of CV risk in order to achieve a substantial decrease in CV events. METHODS In the last four years important international guidelines for the diagnosis, management, treatment and control of arterial hypertension have been published. In America, mostly in mid- and low-income countries, hypertension is a major problem of public health, being the most important cardiovascular risk factor due to its great population impact. Therefore, it is crucial to dedicate all the possible efforts to increase substantially the number of hypertensive patients diagnosed in a given area, and to improve the percentage of controlled patients. This is a major necessity in order to reduce the morbidity and mortality for CVD in the Latin American region, although no guidelines takes the Latin American populations into account, and much less standardizes their diagnosis and management. CONCLUSIONS The Inter-American Society of Cardiology suggest the use of the blood pressure classification of the Latin American Society of Hypertension (LASH) and recommends the use of the SCORE System to stratify the global CV risk because this system has the capability to adapt the global risk by means of a correcting factor based on the ethnicity of the different native populations in America.
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Affiliation(s)
| | - Antonio Coca
- Internal Medicine, Universidad de Barcelona, Espana
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172
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Kario K, Nomura A, Harada N, Tanigawa T, So R, Nakagawa K, Suzuki S, Okura A, Hida E, Satake K. A multicenter clinical trial to assess the efficacy of the digital therapeutics for essential hypertension: Rationale and design of the HERB-DH1 trial. J Clin Hypertens (Greenwich) 2020; 22:1713-1722. [PMID: 32815648 PMCID: PMC7589405 DOI: 10.1111/jch.13993] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 12/12/2022]
Abstract
Digital therapeutics is a new approach to treat hypertension via using software programs such as smartphone apps and/or device algorithms. We develop a HERB system-new interactive smartphone app (HERB Mobile) with web-based patient management console (HERB Console)-to lower blood pressure (BP) based on an algorithm that helps users to promote lifestyle modifications in conjunction with medically validated non-pharmacological interventions. The app can assess the personalities, behavior characteristics, and hypertension determinants of each patient with hypertension to provide adequate guidance. To demonstrate the efficacy of the system, we designed a randomized, controlled, multicenter, open-label trial "HERB-DH1 (HERB digital hypertension 1)" to assess the efficacy of HERB system in patients with essential hypertension. The authors allocate patients to the intervention group (HERB system + standard lifestyle modification) or to the control group (standard lifestyle modification alone). In the intervention group, we provide the HERB Mobile for patients and the HERB Console for their primary physicians for 24 weeks. Both groups are instructed for standard lifestyle modifications based on the current recommendations in the Japanese Society of Hypertension 2019 guideline. The primary outcome is the mean change from baseline to 12 weeks in 24-hour systolic BP measured by ambulatory BP monitoring. We started this study in December of 2019, and the trial results will be expected in early 2021. We believe that this trial enables us to verify the efficacy of the HERB system in patients with essential hypertension.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Akihiro Nomura
- CureApp InstituteKaruizawaJapan
- Innovative Clinical Research CenterKanazawa UniversityJapan
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical SciencesKanazawaJapan
| | - Noriko Harada
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | | | | | | | | | - Ayako Okura
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Eisuke Hida
- Department of Biostatistics and Data ScienceOsaka University Graduate School of MedicineOsakaJapan
| | - Kohta Satake
- CureApp InstituteKaruizawaJapan
- CureApp, IncTokyoJapan
- Department of Respiratory MedicineJapanese Red Cross Medical CenterTokyoJapan
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173
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The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res 2020; 42:1235-1481. [PMID: 31375757 DOI: 10.1038/s41440-019-0284-9] [Citation(s) in RCA: 1059] [Impact Index Per Article: 264.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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174
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Accuracy of blood-pressure monitors owned by patients with hypertension (ACCU-RATE study): a cross-sectional, observational study in central England. Br J Gen Pract 2020; 70:e548-e554. [PMID: 32482629 PMCID: PMC7274541 DOI: 10.3399/bjgp20x710381] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background Home blood-pressure (BP) monitoring is recommended in guidelines and is increasingly popular with patients and health professionals, but the accuracy of patients’ own monitors in real-world use is not known. Aim To assess the accuracy of home BP monitors used by people with hypertension, and to investigate factors affecting accuracy. Design and setting Cross-sectional, observational study in urban and suburban settings in central England. Method Patients (n = 6891) on the hypertension register at seven practices in the West Midlands, England, were surveyed to ascertain whether they owned a BP monitor and wanted it tested. Monitor accuracy was compared with a calibrated reference device at 50 mmHg intervals between 0–280/300 mmHg (static pressure test); a difference from the reference monitor of +/−3 mmHg at any interval was considered a failure. Cuff performance was also assessed. Results were analysed by frequency of use, length of time in service, make and model, monitor validation status, purchase price, and any previous testing. Results In total, 251 (76%, 95% confidence interval [95% CI] = 71 to 80%) of 331 tested devices passed all tests (monitors and cuffs), and 86% (CI] = 82 to 90%) passed the static pressure test; deficiencies were, primarily, because of monitors overestimating BP. A total of 40% of testable monitors were not validated. The pass rate on the static pressure test was greater in validated monitors (96%, 95% CI = 94 to 98%) versus unvalidated monitors (64%, 95% CI = 58 to 69%), those retailing for >£10 (90%, 95% CI = 86 to 94%), those retailing for ≤£10 (66%, 95% CI = 51 to 80%), those in use for ≤4 years (95%, 95% CI = 91 to 98%), and those in use for >4 years (74%, 95% CI = 67 to 82%). All in all, 12% of cuffs failed. Conclusion Patients’ own BP monitor failure rate was similar to that demonstrated in studies performed in professional settings, although cuff failure was more frequent. Clinicians can be confident of the accuracy of patients’ own BP monitors if the devices are validated and ≤4 years old.
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175
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Bryant KB, Sheppard JP, Ruiz-Negrón N, Kronish IM, Fontil V, King JB, Pletcher MJ, Bibbins-Domingo K, Moran AE, McManus RJ, Bellows BK. Impact of Self-Monitoring of Blood Pressure on Processes of Hypertension Care and Long-Term Blood Pressure Control. J Am Heart Assoc 2020; 9:e016174. [PMID: 32696695 PMCID: PMC7792261 DOI: 10.1161/jaha.120.016174] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Self-monitoring of blood pressure (SMBP) improves blood pressure (BP) outcomes at 12-months, but information is lacking on how SMBP affects hypertension care processes and longer-term BP outcomes. Methods and Results We pooled individual participant data from 4 randomized clinical trials of SMBP in the United Kingdom (combined n=2590) with varying intensities of support. Multivariable random effects regression was used to estimate the probability of antihypertensive intensification at 12 months for usual care versus SMBP. Using these data, we simulated 5-year BP control rates using a validated mathematical model. Trial participants were mostly older adults (mean age 66.6 years, SD 9.5), male (53.9%), and predominantly white (95.6%); mean baseline BP was 151.8/85.0 mm Hg. Compared with usual care, the likelihood of antihypertensive intensification increased with both SMBP with feedback to patient or provider alone (odds ratio 1.8, 95% CI 1.2-2.6) and with telemonitoring or self-management (3.3, 2.5-4.2). Over 5 years, we estimated 33.4% BP control (<140/90 mm Hg) with usual care (95% uncertainty interval 27.7%-39.4%). One year of SMBP with feedback to patient or provider alone achieved 33.9% (28.3%-40.3%) BP control and SMBP with telemonitoring or self-management 39.0% (33.1%-45.2%) over 5 years. If SMBP interventions and associated BP control processes were extended to 5 years, BP control increased to 52.4% (45.4%-59.8 %) and 72.1% (66.5%-77.6%), respectively. Conclusions One year of SMBP plus telemonitoring or self-management increases the likelihood of antihypertensive intensification and could improve BP control rates at 5 years; continuing SMBP for 5 years could further improve BP control.
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Affiliation(s)
| | - James P Sheppard
- Nuffield Department of Primary Care Health Sciences University of Oxford United Kingdom
| | | | | | - Valy Fontil
- University of California at San Francisco CA
| | | | | | | | | | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences University of Oxford United Kingdom
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Al-Rousan T, Pesantes MA, Dadabhai S, Kandula NR, Huffman MD, Miranda JJ, Vidal-Perez R, Dzudie A, Anderson CAM. Patients' perceptions of self-management of high blood pressure in three low- and middle-income countries: findings from the BPMONITOR study. Glob Health Epidemiol Genom 2020; 5:e4. [PMID: 32742666 PMCID: PMC7372177 DOI: 10.1017/gheg.2020.5] [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] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 04/29/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022] Open
Abstract
Hypertension is the leading risk factor for global disease burden. Self-management of high blood pressure (BP) through self-monitoring and self-titration of medications, has proved to be one successful and cost-effective tool to achieve better BP control in many high-income countries but not much is known about its potential in low- and middle-income countries (LMICs). We used semi-structured questionnaires and focus groups in three LMICs; Peru, Cameroon and Malawi to examine perceptions and attitudes of patients diagnosed with essential hypertension towards living with hypertension, BP measurement and treatment, patient-physician relationship and opinions about self-management of high blood pressure. Results in all three countries were comparable. Patients showed varied levels of health literacy related to hypertension. BP measurement habits were mostly affected by resources available and caregiver support. Treatment and adherence to it were primarily affected by cost. Most patients were welcoming of the idea of self-management but skeptical about the ability to do self-monitoring accurately and the safety involving self-titration of medications.
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Affiliation(s)
- Tala Al-Rousan
- Department of Medicine, University of California San Diego School of Medicine Division of Global Public Health, La Jolla, USA
| | - M. Amalia Pesantes
- Department of Medicine, Universidad Peruana Cayetano Heredia, CRONICAS Centre of Excellence in Chronic Diseases, Peru
| | - Sufia Dadabhai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Namratha R. Kandula
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Mark D. Huffman
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - J. Jaime Miranda
- Department of Medicine, Universidad Peruana Cayetano Heredia, CRONICAS Centre of Excellence in Chronic Diseases, Peru
| | - Rafael Vidal-Perez
- Department of Cardiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Anastase Dzudie
- Clinical Research Education, Networking and Consultancy (CRENC), Yaounde, Cameroon
| | - Cheryl A. M. Anderson
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, USA
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Abstract
Obstructive sleep apnea (OSA) telehealth management may improve initial and chronic care access, time to diagnosis and treatment, between-visit care, e-communications and e-education, workflows, costs, and therapy outcomes. OSA telehealth options may be used to replace or supplement none, some, or all steps in the evaluation, testing, treatments, and management of OSA. All telehealth steps must adhere to OSA guidelines. OSA telehealth may be adapted for continuous positive airway pressure (CPAP) and non-CPAP treatments. E-data collection enhances uses for individual and group analytics, phenotyping, testing and treatment selections, high-risk identification and targeted support, and comparative and multispecialty therapy studies.
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Oliver-McNeil S, Bowers M, LaRue SJ, Vader J, DeVore AD, Granger BB. Benefits of Optimizing Heart Failure Medication Dosage. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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179
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Hammersley V, Parker R, Paterson M, Hanley J, Pinnock H, Padfield P, Stoddart A, Park HG, Sheikh A, McKinstry B. Telemonitoring at scale for hypertension in primary care: An implementation study. PLoS Med 2020; 17:e1003124. [PMID: 32555625 PMCID: PMC7299318 DOI: 10.1371/journal.pmed.1003124] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 05/22/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While evidence from randomised controlled trials shows that telemonitoring for hypertension is associated with improved blood pressure (BP) control, healthcare systems have been slow to implement it, partly because of inadequate integration with existing clinical practices and electronic records. Neither is it clear if trial findings will be replicated in routine clinical practice at scale. We aimed to explore the feasibility and impact of implementing an integrated telemonitoring system for hypertension into routine primary care. METHODS AND FINDINGS This was a quasi-experimental implementation study with embedded qualitative process evaluation set in primary care in Lothian, Scotland. We described the overall uptake of telemonitoring and uptake in a subgroup of representative practices, used routinely acquired data for a records-based controlled before-and-after study, and collected qualitative data from staff and patient interviews and practice observation. The main outcome measures were intervention uptake, change in BP, change in clinician appointment use, and participants' views on features that facilitated or impeded uptake of the intervention. Seventy-five primary care practices enrolled 3,200 patients with established hypertension. In an evaluation subgroup of 8 practices (905 patients of whom 427 [47%] were female and with median age of 64 years [IQR 56-70, range 22-89] and median Scottish Index of Multiple Deprivation 2012 decile of 8 [IQR 6-10]), mean systolic BP fell by 6.55 mm Hg (SD 15.17), and mean diastolic BP by 4.23 mm Hg (SD 8.68). Compared with the previous year, participating patients made 19% fewer face-to-face appointments, compared with 11% fewer in patients with hypertension who were not telemonitoring. Total consultation time for participants fell by 15.4 minutes (SD 68.4), compared with 5.5 minutes (SD 84.4) in non-telemonitored patients. The convenience of remote collection of BP readings and integration of these readings into routine clinical care was crucial to the success of the implementation. Limitations include the fact that practices and patient participants were self-selected, and younger and more affluent than non-participating patients, and the possibility that regression to the mean may have contributed to the reduction in BP. Routinely acquired data are limited in terms of completeness and accuracy. CONCLUSIONS Telemonitoring for hypertension can be implemented into routine primary care at scale with little impact on clinician workload and results in reductions in BP similar to those in large UK trials. Integrating the telemonitoring readings into routine data handling was crucial to the success of this initiative.
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Affiliation(s)
- Vicky Hammersley
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Richard Parker
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Mary Paterson
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Janet Hanley
- School of Health and Social Care. Edinburgh Napier University, Edinburgh, United Kingdom
| | - Hilary Pinnock
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Paul Padfield
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew Stoddart
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Brian McKinstry
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Margolis KL, Crain AL, Bergdall AR, Beran M, Anderson JP, Solberg LI, O'Connor PJ, Sperl-Hillen JM, Pawloski PA, Ziegenfuss JY, Rehrauer D, Norton C, Haugen P, Green BB, McKinney Z, Kodet A, Appana D, Sharma R, Trower NK, Williams R, Crabtree BF. Design of a pragmatic cluster-randomized trial comparing telehealth care and best practice clinic-based care for uncontrolled high blood pressure. Contemp Clin Trials 2020; 92:105939. [PMID: 31981712 DOI: 10.1016/j.cct.2020.105939] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Uncontrolled hypertension is the largest single contributor to all-cause and cardiovascular mortality in the U.S. POPULATION Nurse- and pharmacist-led team-based care and telehealth care interventions have been shown to result in large and lasting improvements in blood pressure (BP); however, it is unclear how successfully these can be implemented at scale in real-world settings. It is also uncertain how telehealth interventions impact patient experience compared to traditional clinic-based care. AIMS/OBJECTIVES To compare the effects of two evidence-based blood pressure care strategies in the primary care setting: (1) best-practice clinic-based care and (2) telehealth care with home BP telemonitoring and management by a clinical pharmacist. To evaluate implementation using mixed-methods supported by the RE-AIM framework and Consolidated Framework for Implementation Research. METHODS The design is a cluster-randomized comparative effectiveness pragmatic trial in 21 primary care clinics (9 clinic-based care, 12 telehealth care). Adult patients (age 18-85) with hypertension are enrolled via automated electronic health record (EHR) tools during primary care encounters if BP is elevated to ≥150/95 mmHg at two consecutive visits. The primary outcome is change in systolic BP over 12 months as extracted from the EHR. Secondary outcomes are change in key patient-reported outcomes over 6 months as measured by surveys. Qualitative data are collected at various time points to investigate implementation barriers and help explain intervention effects. CONCLUSION This pragmatic trial aims to inform health systems about the benefits, strengths, and limitations of implementing home BP telemonitoring with pharmacist management for uncontrolled hypertension in real-world primary care settings.
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Affiliation(s)
- Karen L Margolis
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America.
| | - A Lauren Crain
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Anna R Bergdall
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - MarySue Beran
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Jeffrey P Anderson
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Leif I Solberg
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Patrick J O'Connor
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - JoAnn M Sperl-Hillen
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Pamala A Pawloski
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Jeanette Y Ziegenfuss
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Dan Rehrauer
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Christine Norton
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Patricia Haugen
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Av, Seattle, WA 98101, United States of America
| | - Zeke McKinney
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Amy Kodet
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Deepika Appana
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Rashmi Sharma
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Nicole K Trower
- HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - RaeAnn Williams
- HealthPartners, Mailstop 31100A, PO Box 1524, Minneapolis, MN 55440-1524, United States of America
| | - Benjamin F Crabtree
- Rutgers Robert Wood Johnson Medical School, Department of Family Medicine and Community Health, New Brunswick, NJ 08901, United States of America
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Liang X, Zhong H, Xiao L. The effect of community hypertension management on blood pressure control and its determinants in southwest China. Int Health 2020; 12:203-212. [PMID: 32176766 PMCID: PMC7320421 DOI: 10.1093/inthealth/ihaa002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/21/2019] [Accepted: 01/07/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hypertension is a leading cause of cardiovascular disease (CVD). The purpose of this study was to examine the effectiveness of community healthcare in controlling blood pressure (BP) and mitigating related risk factors after 5 y of follow-up. METHODS Hierarchical clustering sampling was employed to choose a representative sample of 10 rural and 10 urban community populations (N=4235). The 5y prospective cohort study was completed by the medical group in the community clinical centre. RESULTS The study included 4235 patients, median age 69 y (range 61-76), with hypertension in 2009; 2533 (59.81%) were female. The rate of BP control increased from 28.33% in 2009 to 64.05% in 2014. The BP control rate was higher in patients with CVD and kidney disease and lower in those with obesity than in those without. Comparing 2009 and 2014 values, the intervention resulted in median systolic BP and diastolic BP reductions of 7.0 mmHg and 6.5 mmHg, respectively. Age, medication treatment, antihypertensive agents, BP at baseline and follow-up, complications of diabetes, CVD, obesity and kidney disease, the aspartate aminotransferase:aminotransferase ratio and smoking were identified as risk factors for BP control. CONCLUSIONS Community management of hypertension by general practitioners achieved significant BP control over 5 y of intervention.
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Affiliation(s)
- Xiaohua Liang
- Clinical Epidemiology and Biostatistics Department, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children’s Hospital, Chongqing Medical University, 136 2nd Zhongshan Avenue, Yuzhong District, Chongqing, People’s Republic of China
- Corresponding author: Tel: +86 23 63638270; Fax: +86 23 63638270; E-mail: ,
| | - Haiying Zhong
- Clinical Epidemiology and Biostatistics Department, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children’s Hospital, Chongqing Medical University, 136 2nd Zhongshan Avenue, Yuzhong District, Chongqing, People’s Republic of China
| | - Lun Xiao
- Centers for Disease Control and Prevention of Jiulongpo District, Chongqing, People's Republic of China
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183
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Guía ESC 2019 sobre diabetes, prediabetes y enfermedad cardiovascular, en colaboración con la European Association for the Study of Diabetes (EASD). Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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184
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Picone DS, Deshpande RA, Schultz MG, Fonseca R, Campbell NRC, Delles C, Hecht Olsen M, Schutte AE, Stergiou G, Padwal R, Zhang XH, Sharman JE. Nonvalidated Home Blood Pressure Devices Dominate the Online Marketplace in Australia: Major Implications for Cardiovascular Risk Management. Hypertension 2020; 75:1593-1599. [PMID: 32275193 DOI: 10.1161/hypertensionaha.120.14719] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Self-home blood pressure (BP) monitoring is recommended to guide clinical decisions on hypertension and is used worldwide for cardiovascular risk management. People usually make their own decisions when purchasing BP devices, which can be made online. If patients purchase nonvalidated devices (those not proven accurate according to internationally accepted standards), hypertension management may be based on inaccurate readings resulting in under- or over-diagnosis or treatment. This study aimed to evaluate the number, type, percentage validated, and cost of home BP devices available online. A search of online businesses selling devices for home BP monitoring was conducted. Multinational companies make worldwide deliveries, so searches were restricted to BP devices available for one nation (Australia) as an example of device availability through the global online marketplace. Validation status of BP devices was determined according to established protocols. Fifty nine online businesses, selling 972 unique BP devices were identified. These included 278 upper-arm cuff devices (18.3% validated), 162 wrist-cuff devices (8.0% validated), and 532 wrist-band wearables (0% validated). Most BP devices (92.4%) were stocked by international e-commerce businesses (eg, eBay, Amazon), but only 5.5% were validated. Validated cuff BP devices were more expensive than nonvalidated devices: median (interquartile range) of 101.1 (75.0-151.5) versus 67.4 (30.4-112.8) Australian Dollars. Nonvalidated BP devices dominate the online marketplace and are sold at lower cost than validated ones, which is a major barrier to accurate home BP monitoring and cardiovascular risk management. Before purchasing a BP device, people should check it has been validated at https://www.stridebp.org.
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Affiliation(s)
- Dean S Picone
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., R.A.D., M.G.S., R.F., J.E.S.)
| | - Rewati A Deshpande
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., R.A.D., M.G.S., R.F., J.E.S.)
| | - Martin G Schultz
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., R.A.D., M.G.S., R.F., J.E.S.)
| | - Ricardo Fonseca
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., R.A.D., M.G.S., R.F., J.E.S.)
| | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (N.R.C.C.)
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (C.D.)
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbaek Hospital, Denmark (M.H.-O.).,Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, University of Southern Denmark (M.H.-O.)
| | - Aletta E Schutte
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (A.E.S.).,Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.)
| | - George Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.)
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Canada (R.P.)
| | | | - James E Sharman
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., R.A.D., M.G.S., R.F., J.E.S.)
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185
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Hypertension Subtypes among Thai Hypertensives: An Analysis of Telehealth-Assisted Instrument in Home Blood Pressure Monitoring Nationwide Pilot Project. Int J Hypertens 2020; 2020:3261408. [PMID: 32328300 PMCID: PMC7171656 DOI: 10.1155/2020/3261408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/06/2020] [Accepted: 02/19/2020] [Indexed: 11/17/2022] Open
Abstract
Background White-coat hypertension (HT), masked HT, HT with white-coat effect, and masked uncontrolled HT are well-recognized problems of over- and undertreatment of high blood pressure in real-life practice. However, little is known about the true prevalence in Thailand. Objectives To examine the prevalence and characteristics of each HT subtype defined by mean home blood pressure (HBP) and clinic blood pressure (CBP) using telemonitoring technology in Thai hypertensives. Methods A multicenter, observational study included adult hypertensives who had been diagnosed for at least 3 months based on CBP without the adoption of HBP monitoring. All patients were instructed to manually measure their HBP twice a day for the duration of at least one week using the same validated automated, oscillometric telemonitoring devices (Uright model TD-3128, TaiDoc Corporation, Taiwan). The HBP, CBP, and baseline demographic data were recorded on the web-based system. HT subtypes were classified according to the treatment status, CBP (≥or <140/90 mmHg), and mean HBP (≥or <135/85 mmHg) into the following eight subtypes: in nonmedicated hypertensives, there are four subtypes that are normotension, white-coat HT, masked HT, and sustained HT; in treated hypertensives, there are four subtypes that are well-controlled HT, HT with white-coat effect, masked uncontrolled HT, and sustained HT. Results Of the 1,184 patients (mean age 58 ± 12.7 years, 59% women) from 46 hospitals, 1,040 (87.8%) were taking antihypertensive agents. The majority of them were enrolled from primary care hospitals (81%). In the nonmedicated group, the prevalence of white-coat and masked HT was 25.7% and 7.0%, respectively. Among the treated patients, the HT with white-coat effect was found in 23.3% while 46.7% had uncontrolled HBP (a combination of the masked uncontrolled HT (9.6%) and sustained HT (37.1%)). In the medicated older subgroup (n = 487), uncontrolled HBP was more prevalent in male than in female (53.6% vs. 42.4%, p=0.013). Conclusions This is the first nationwide study in Thailand to examine the prevalence of HT subtypes. Almost one-fourth had white-coat HT or HT with white-coat effect. Approximately half of the treated patients especially in the older males had uncontrolled HBP requiring more intensive interventions. These results emphasize the role of HBP monitoring for appropriate HT diagnosis and management. The cost-effectiveness of utilizing THAI HBPM in routine practice needs to be examined in the future study.
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186
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Feng W, Wang Y, Liang X. Determinants of Blood Pressure Control in Hypertensive Community Management in China. Popul Health Manag 2020; 23:202-203. [PMID: 31453727 DOI: 10.1089/pop.2019.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Wei Feng
- Medical General Ward Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yuwei Wang
- Department of Laboratory Medicine, Chongqing Traditional Chinese Medicine Hospital, Chongqing, People's Republic of China
| | - Xiaohua Liang
- Clinical Epidemiology and Biostatistics Department, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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187
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Li R, Liang N, Bu F, Hesketh T. The Effectiveness of Self-Management of Hypertension in Adults Using Mobile Health: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2020; 8:e17776. [PMID: 32217503 PMCID: PMC7148553 DOI: 10.2196/17776] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/11/2020] [Accepted: 02/26/2020] [Indexed: 02/06/2023] Open
Abstract
Background Effective treatment of hypertension requires careful self-management. With the ongoing development of mobile technologies and the scarcity of health care resources, mobile health (mHealth)–based self-management has become a useful treatment for hypertension, and its effectiveness has been assessed in many trials. However, there is a paucity of comprehensive summaries of the studies using both qualitative and quantitative methods. Objective This systematic review aimed to measure the effectiveness of mHealth in improving the self-management of hypertension for adults. The outcome measures were blood pressure (BP), BP control, medication adherence, self-management behavior, and costs. Methods A systematic search was conducted using 5 electronic databases. The snowballing method was used to scan the reference lists of relevant studies. Only peer-reviewed randomized controlled trials (RCTs) published between January 2010 and September 2019 were included. Data extraction and quality assessment were performed by 3 researchers independently, adhering to the validation guideline and checklist. Both a meta-analysis and a narrative synthesis were carried out. Results A total of 24 studies with 8933 participants were included. Of these, 23 studies reported the clinical outcome of BP, 12 of these provided systolic blood pressure (SBP) and diastolic blood pressure (DBP) data, and 16 articles focused on change in self-management behavior and medication adherence. All 24 studies were included in the narrative synthesis. According to the meta-analysis, a greater reduction in both SBP and DBP was observed in the mHealth intervention groups compared with control groups, −3.78 mm Hg (P<.001; 95% CI −4.67 to −2.89) and −1.57 mm Hg (P<.001; 95% CI −2.28 to −0.86), respectively. Subgroup analyses showed consistent reductions in SBP and DBP across different frequencies of reminders, interactive patterns, intervention functions, and study duration subgroups. A total of 16 studies reported better medication adherence and behavioral change in the intervention groups, while 8 showed no significant change. Six studies included an economic evaluation, which drew inconsistent conclusions. However, potentially long-term financial benefits were mentioned in all economic evaluations. All studies were assessed to be at high risk of bias. Conclusions This review found that mHealth self-management interventions were effective in BP control. The outcomes of this review showed improvements in self-management behavior and medication adherence. The most successful mHealth intervention combined the feature of tailored messages, interactive communication, and multifaceted functions. Further research with longer duration and cultural adaptation is necessary. With increasing disease burden from hypertension globally, mHealth offers a potentially effective method for self-management and control of BP. mHealth can be easily integrated into existing health care systems. Trial Registration PROSPERO CRD42019152062; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=152062
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Affiliation(s)
- Ran Li
- Center of Global Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ning Liang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fanlong Bu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Therese Hesketh
- Center of Global Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China.,Institute of Global Health, University College London, London, United Kingdom
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188
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Contribution of telemedicine and information technology to hypertension control. Hypertens Res 2020; 43:621-628. [PMID: 32203451 DOI: 10.1038/s41440-020-0422-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/17/2020] [Accepted: 01/18/2020] [Indexed: 11/08/2022]
Abstract
Due to fast-paced technological advancements, digital health and telemedicine represent a promising and complex reality, with the potential to change the current management of hypertension and improve its outcomes. New types of health-related strategies are available, ranging from telemonitoring of blood pressure (BP) values to counseling for patients and decisional tools for physicians, thanks to the development of new technology. Even though the strength of available evidence is currently low due to the high heterogeneity of studies and of the proposed interventions, available data suggest a beneficial effect of digital health strategies on BP control and, more generally, on cardiovascular risk reduction. In addition, well-designed randomized controlled trials are needed to further investigate the real impact of these new strategies on clinical outcomes. Furthermore, due to consistent commercial interests in this field, there is a strong need for strict regulations to ensure a safe and secure implementation of this new reality in clinical care.
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189
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Self-blood pressure measurement as compared to office blood pressure measurement in a large Indian population; the India Heart Study. J Hypertens 2020; 38:1262-1270. [DOI: 10.1097/hjh.0000000000002410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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190
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Kim BJ, Park JM, Park TH, Kim J, Lee J, Lee KJ, Lee J, Chae JE, Thabane L, Lee J, Bae HJ. Remote blood pressure monitoring and behavioral intensification for stroke: A randomized controlled feasibility trial. PLoS One 2020; 15:e0229483. [PMID: 32160205 PMCID: PMC7065804 DOI: 10.1371/journal.pone.0229483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/06/2020] [Indexed: 12/20/2022] Open
Abstract
Measuring blood pressure (BP) at home and remote monitoring can improve the patient’s adherence to BP control and vascular outcomes. This study evaluated the feasibility of a trial regarding the effects of an intensive mobile BP management strategy versus usual care in acute ischemic stroke patients. A feasibility-testing, randomized, open-labeled controlled trial was conducted. Remote BP measurement, data transmission, storage, and centralized monitoring system were organized through a Bluetooth-equipped sphygmomanometer paired to the participants’ smartphones. Participants were randomized equally into intensive management (behavioral intensification to measure BP at home by texting, direct telephone call, or breakthrough visit) and control (usual care) groups. The primary feasibility outcomes were: 1) recruitment time for the pre-specified number of participants, 2) retention of participants, 3) frequency of breakthrough visit calls, 4) response to breakthrough visit call, and 5) proportions satisfying BP measurement criteria. Sixty participants were randomly assigned to the intensive management (n = 31) and control (n = 29) groups, of which 57 participants were included in the primary analysis with comparable baseline characteristics. Recruitment time from the first to the last participant was 350 days, and 95% of randomized participants completed the final visit (intensive, 94%; control, 98%). Eight breakthrough visit calls were made to 7 participants (23%), with complete and immediate responses within 3 ± 4 days. The median of half-day blocks fulfilling the BP measurement criteria per patient were 91% in the intensive group and 83% in the control group (difference, 12.2; 95% confidence interval, 2.2–22.2). No adverse events related to the trial procedures were reported. The intensive monitoring, including remote BP measurement, data transfer, and centralized monitoring system, engaged with behavioral intensification was feasible if the patients complied with the intervention. However, the device utilized would need further improvement prior to a large trial.
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Affiliation(s)
- Beom Joon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jong-Moo Park
- Nowon Eulji Medical Center, Department of Neurology, Eulji University, Seoul, Republic of Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea
| | - Joungsim Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - JongShill Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Keon-Joo Lee
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - JiSung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea
| | - Jae Eun Chae
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, St. Joseph’s Healthcare—Hamilton, Hamilton, Ontario, Canada
| | - Juneyoung Lee
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hee-Joon Bae
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- * E-mail:
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Muijsers HEC, van der Heijden OWH, de Boer K, van Bijsterveldt C, Buijs C, Pagels J, Tönnies P, Heiden S, Roeleveld N, Maas AHEM. Blood pressure after PREeclampsia/HELLP by SELF monitoring (BP-PRESELF): rationale and design of a multicenter randomized controlled trial. BMC WOMENS HEALTH 2020; 20:41. [PMID: 32131802 PMCID: PMC7055029 DOI: 10.1186/s12905-020-00910-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/20/2020] [Indexed: 12/16/2022]
Abstract
Background Hypertensive disorders of pregnancy (HDP), such as preeclampsia (PE) or the Hemolysis Elevated Liver enzymes and Low Platelets (HELLP) syndrome are associated with elevated cardiovascular disease (CVD) risks, but standardized prevention guidelines after such pregnancies are lacking. Hypertension is the first emerging risk factor after PE/HELLP pregnancies and is a major risk factor for CVD. Hypertension before the age of 55 years may lead to various manifestations of end-organ damage at relatively young age. Therefore, timely treatment of elevated blood pressure is mandatory, but many of these high-risk women have long-term undetected and untreated hypertension before adequate treatment is initiated. Aim The aim of our study is to assess whether home blood pressure monitoring (HBPM) in women with a previous PE/HELLP pregnancy is a valuable tool for the early detection of hypertension. Methods Women with a history of both early and late PE/HELLP syndrome aged 40–60 years are invited to participate. Patients with a history of CVD, known hypertension and/or use of antihypertensive medication are excluded. Women are randomized between HPBM or ‘usual care’. The primary outcome is feasibility and usability of HBPM after 1 year of follow-up. Secondary outcomes will be the effectiveness of HPBM to detect hypertension, the efficacy of BP treatment, quality of life, health-related symptoms, work ability, and life-style behaviour. The results of this study will provide better strategies for timely detection and prevention of hypertension in women after PE/HELLP. Trial registration ClinicalTrials.gov, NCT03228082. Registered June 15, 2017.
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Affiliation(s)
- Hella E C Muijsers
- Department of Cardiology, Radboud university medical center, Geert-Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands.
| | - Olivier W H van der Heijden
- Department of Obstetrics and Gynecology, Radboud university medical center, Geert-Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Karin de Boer
- Department of Obstetrics and Gynecology, Rijnstate, Wagnerlaan 55, 6815, AD, Arnhem, The Netherlands
| | - Chantal van Bijsterveldt
- Department of Obstetrics and Gynecology, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6532, SZ, Nijmegen, The Netherlands
| | - Ciska Buijs
- Department of Obstetrics and Gynecology, Maasziekenhuis Pantein, Dokter Kopstraat 1, 5835 BV, Beugen, The Netherlands
| | - Jens Pagels
- Department of Obstetrics and Gynecology, St. Josef Hospital Moers, Asberger Strasse 4, 47441, Moers, Germany
| | - Peter Tönnies
- Department of Obstetrics and Gynecology, Bethanien Hospital Moers, Bethanienstrasse 21, 47441, Moers, Germany
| | - Susanne Heiden
- Department of Obstetrics and Gynecology, St. Antonius Hospital Kleve, Albersallee 5-7, 47533, Kleve, Germany
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, Geert-Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud university medical center, Geert-Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
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192
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Persell SD, Peprah YA, Lipiszko D, Lee JY, Li JJ, Ciolino JD, Karmali KN, Sato H. Effect of Home Blood Pressure Monitoring via a Smartphone Hypertension Coaching Application or Tracking Application on Adults With Uncontrolled Hypertension: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e200255. [PMID: 32119093 PMCID: PMC7052730 DOI: 10.1001/jamanetworkopen.2020.0255] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Mobile applications (apps) may help improve hypertension self-management. OBJECTIVE To investigate the effect of an artificial intelligence smartphone coaching app to promote home monitoring and hypertension-related behaviors on systolic blood pressure level compared with a blood pressure tracking app. DESIGN, SETTING, AND PARTICIPANTS This was a 2-group, open, randomized clinical trial. Participants with uncontrolled hypertension were recruited in 2016 and 2017 and were followed up for 6 months. Data analysis was performed from April 2019 to December 2019. INTERVENTIONS Intervention group participants received a smartphone coaching app to promote home monitoring and behavioral changes associated with hypertension self-management plus a home blood pressure monitor. Control participants received a blood pressure tracking app plus a home blood pressure monitor. MAIN OUTCOMES AND MEASURES The primary study outcome was systolic blood pressure at 6 months. Secondary outcomes included self-reported antihypertensive medication adherence, home monitoring and self-management practices, measures of self-efficacy associated with blood pressure, weight, and self-reported health behaviors. RESULTS There were 333 participants randomized, and 297 completed the follow-up assessment. Among the participants who completed the study, the mean (SD) age was 58.9 (12.8) years, 182 (61.3%) were women, and 103 (34.7%) were black. Baseline mean (SD) systolic blood pressure was 140.6 (12.2) mm Hg among intervention participants and 141.8 (13.4) mm Hg among control participants. After 6 months, the corresponding mean (SD) systolic blood pressures were 132.3 (15.0) mm Hg and 135.0 (13.9) mm Hg, with a between-group adjusted difference of -2.0 mm Hg (95% CI, -4.9 mm Hg to 0.8 mm Hg; P = .16). At 6 months, self-confidence in controlling blood pressure was greater in the intervention group (0.36 point on a 5-point scale; 95% CI, 0.18 point to 0.54 point; P < .001). There were no significant differences between the 2 groups in other secondary outcomes. The adjusted difference in self-reported physical activity was 26.7 minutes per week (95% CI, -5.4 minutes per week to 58.8 minutes per week; P = .10). Subgroup analysis raised the possibility that intervention effects differed by age. CONCLUSIONS AND RELEVANCE Among individuals with uncontrolled hypertension, those randomized to a smartphone coaching app plus home monitor had similar systolic blood pressure compared with those who received a blood pressure tracking app plus home monitor. Given the direction of the difference in systolic blood pressure between groups and the possibility for differences in treatment effects across subgroups, future studies are warranted. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03288142.
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Affiliation(s)
- Stephen D. Persell
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Center for Primary Care Innovation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yaw A. Peprah
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dawid Lipiszko
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ji Young Lee
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jim J. Li
- Omron Healthcare Co Ltd, Kyoto, Japan
| | - Jody D. Ciolino
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kunal N. Karmali
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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193
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Zheng L, Wang Y, Liu S, Zheng R, Pei D, Sun Y, Sun Z. Financial incentives for hypertension control: rationale and study design. Trials 2020; 21:134. [PMID: 32014046 PMCID: PMC6998348 DOI: 10.1186/s13063-020-4051-7] [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: 07/14/2019] [Accepted: 01/06/2020] [Indexed: 11/22/2022] Open
Abstract
Background Even though the effectiveness of lifestyle modifications and antihypertensive pharmaceutical treatment for the prevention of hypertension and its complications have been demonstrated in randomized controlled trials, the benefits of adhering to these treatments have not been popularized among the general public. Studies suggest that incentive approaches based on behavioral economic concepts can improve patients’ adherence to treatment. Therefore, we aimed to test whether financial incentives will reduce the blood pressure (BP) of hypertensive patients in China. Methods/Design This is a multicenter, randomized controlled trial with two parallel arms. A total of 400 participants from six cities in the Liaoning and Shanxi provinces of China are block-randomized into intervention and control group with a 1:1 ratio. Patients in the control group will receive interactive management of mobile devices, including patient education and communication. Patients in the intervention group will receive financial incentives in addition to interactive management of mobile devices, conditional on them achieving their antihypertensive goals or hypertension control. Masking the arm allocation will be precluded by the behavioral nature of the intervention and investigators of BP measurement and statistics are masked to clinic assignment. The primary outcome is net change in systolic BP (SBP) from baseline to month 12 between the intervention and control groups. The secondary outcomes are net change in diastolic BP (DBP), BP control, change in medication adherence and lifestyle, and cost-effectiveness. Discussion This trial will determine whether financial incentives will improve hypertension control and generate necessary data for controlling hypertension and concomitant cardiovascular diseases among hypertensive patients in China. Trial registration ISRCTN13467677. Registered on 16 May 2019.
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Affiliation(s)
- Liqiang Zheng
- Department of Cardiology, Department of Library and Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China.
| | - Yali Wang
- Department of Cardiology, Department of Library and Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Sitong Liu
- Department of Cardiology, Department of Library and Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Rui Zheng
- Department of Respiratory, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Dongmei Pei
- Department of General Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Yingxian Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China.
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194
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A pilot study of hypertension management using a telemedicine treatment approach. Blood Press Monit 2020; 25:18-21. [DOI: 10.1097/mbp.0000000000000413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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195
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Yun YH, Kang E, Cho YM, Park SM, Kim YJ, Lee HY, Kim KH, Lee K, Koo HY, Kim S, Rhee Y, Lee J, Min JH, Sim JA. Efficacy of an Electronic Health Management Program for Patients With Cardiovascular Risk: Randomized Controlled Trial. J Med Internet Res 2020; 22:e15057. [PMID: 32012053 PMCID: PMC7003122 DOI: 10.2196/15057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/16/2019] [Accepted: 10/26/2019] [Indexed: 01/15/2023] Open
Abstract
Background In addition to medication, health behavior management is crucial in patients with multiple risks of cardiovascular mortality. Objective This study aimed to examine the efficacy of a 3-month Smart Management Strategy for Health–based electronic program (Smart Healthing). Methods A 2-arm randomized controlled trial was conducted to assess the efficacy of Smart Healthing in 106 patients with at least one indicator of poor disease control and who had hypertension, diabetes, or hypercholesterolemia. The intervention group (n=53) took part in the electronic program, which was available in the form of a mobile app and a Web-based PC application. The program covered 4 areas: self-assessment, self-planning, self-learning, and self-monitoring by automatic feedback. The control group (n=53) received basic educational material concerning disease control. The primary outcome was the percentage of participants who achieved their clinical indicator goal after 12 weeks into the program: glycated hemoglobin (HbA1c) <7.0%, systolic blood pressure (SBP) <140 mmHg, or low-density lipoprotein cholesterol <130 mg/dL. Results The intervention group showed a significantly higher success rate (in comparison with the control group) for achieving each of 3 clinical indicators at the targeted goal levels (P<.05). Only the patients with hypertension showed a significant improvement in SBP from the baseline as compared with the control group (72.7% vs 35.7%; P<.05). There was a significant reduction in HbA1c in the intervention group compared with the control group (difference=0.54%; P≤.05). In the intervention group, 20% of patients with diabetes exhibited a ≥1% decrease in HbA1c (vs 0% among controls; P≤.05). Conclusions A short-term self-management strategy-based electronic program intervention may improve clinical outcomes among patients with cardiovascular risks. Trial Registration ClinicalTrials.gov NCT03294044; https://clinicaltrials.gov/ct2/show/NCT03294044
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Affiliation(s)
- Young Ho Yun
- Seoul National University College of Medicine, Department of Family Medicine, Seoul, Republic of Korea
| | - EunKyo Kang
- Seoul National University College of Medicine, Department of Family Medicine, Seoul, Republic of Korea
| | - Young Min Cho
- Seoul National University College of Medicine, Department of Internal Medicine, Seoul, Republic of Korea
| | - Sang Min Park
- Seoul National University College of Medicine, Department of Family Medicine, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Seoul National University College of Medicine, Department of Internal Medicine, Seoul, Republic of Korea
| | - Hae-Young Lee
- Seoul National University College of Medicine, Department of Internal Medicine, Seoul, Republic of Korea
| | - Kyae Hyung Kim
- Seoul National University College of Medicine, Department of Family Medicine, Seoul, Republic of Korea
| | - Kiheon Lee
- Bundang Seoul National University Hospital, Department of Family Medicine, Seongnam, Republic of Korea
| | - Hye Yeon Koo
- Bundang Seoul National University Hospital, Department of Family Medicine, Seongnam, Republic of Korea
| | - Soojeong Kim
- Seoul National University College of Medicine, Department of Family Medicine, Seoul, Republic of Korea
| | - YeEun Rhee
- Seoul National University College of Medicine, Department of Family Medicine, Seoul, Republic of Korea
| | - Jihye Lee
- Seoul National University College of Medicine, Department of Family Medicine, Seoul, Republic of Korea
| | - Jeong Hee Min
- Seoul National University College of Medicine, Department of Family Medicine, Seoul, Republic of Korea
| | - Jin-Ah Sim
- Seoul National University College of Medicine, Cancer Research Institute, Seoul, Republic of Korea
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196
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Zhu H, Zheng H, Liu X, Mai W, Huang Y. Clinical applications for out-of-office blood pressure monitoring. Ther Adv Chronic Dis 2020; 11:2040622320901660. [PMID: 32010437 PMCID: PMC6974752 DOI: 10.1177/2040622320901660] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/18/2019] [Indexed: 12/26/2022] Open
Abstract
Hypertension is one of the most common chronic diseases as well as the leading risk factor for cardiovascular disease (CVD). Efficient screening and accurate blood pressure (BP) monitoring are the basic methods of detection and management. However, with developments in electronic technology, BP measurement and monitoring are no longer limited to the physician's office. Epidemiological and clinical studies have documented strong evidence for the efficacy of out-of-office BP monitoring in multiple fields for managing hypertension and CVD. This review discusses applications for out-of-office BP monitoring, including home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), based on recent epidemiological data and clinical studies regarding the following factors: the detection of abnormal BP phenotypes, namely, white coat hypertension and masked hypertension; stronger ability to determine the prognosis for target organ damage and mortality; better BP control; screening for hypotension; and unique approaches to identifying circadian BP patterns and BP variability.
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Affiliation(s)
- Hailan Zhu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Haoxiao Zheng
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Xinyue Liu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Weiyi Mai
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazi Road 1, Lunjiao Town, Shunde District, Foshan, Guangdong 523808, China
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197
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Kalafat E, Benlioglu C, Thilaganathan B, Khalil A. Home blood pressure monitoring in the antenatal and postpartum period: A systematic review meta-analysis. Pregnancy Hypertens 2020; 19:44-51. [PMID: 31901652 DOI: 10.1016/j.preghy.2019.12.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/05/2019] [Indexed: 11/26/2022]
Abstract
Recent evidence suggests that home blood pressure monitoring (HBPM) is an effective way of managing women with hypertensive disorders of pregnancy (HDP) without increasing adverse outcomes. The aim of this systematic review and meta-analysis was to investigate the safety and efficacy of HBPM during pregnancy. Medline, EMBASE and the Cochrane library databases were searched electronically in November 2018. Studies were included from which data could be extracted on the pregnancy outcomes and included pregnancies with HDP or at increased risk of developing HDP. Data from nine studies were included in the meta-analysis. The use of HBPM during the antenatal period was associated with reduced risk of induction of labor (OR: 0.55, 95% CI: 0.36-0.82, 444 women, I2 = 0%), prenatal hospital admissions (OR: 0.31, 95% CI: 0.19-0.49, 416 women, I2 = 0%) and diagnosis of preeclampsia (OR: 0.50, 95% CI: 0.31-0.81, 725 women, I2 = 37%). The number of antenatal visits was significantly less in the HBPM group (standard mean difference: -0.49, 95% CI: -0.82 to -0.16, 738 women, I2 = 75%). There were no significant differences between HBPM and conventional care regarding composite maternal, fetal or neonatal outcomes when used during the antenatal period. There were no significant differences between the groups who had HBPM compared to those who had conventional care regarding postpartum readmissions and obtaining a blood pressure measurement within 10 days of delivery after discharge. The significant clinical heterogeneity and low quality of evidence are the main limitations, and therefore, more high quality studies are needed.
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Affiliation(s)
- Erkan Kalafat
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0RE, UK; Department of Statistics, Middle East Technical University, Ankara, Turkey
| | - Can Benlioglu
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0RE, UK; Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, TURKEY
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0RE, UK; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London SW17 0RE, UK
| | - Asma Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0RE, UK; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London SW17 0RE, UK.
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198
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Patil SJ, Wareg NK, Hodges KL, Smith JB, Kaiser MS, LeFevre ML. Home Blood Pressure Monitoring in Cases of Clinical Uncertainty to Differentiate Appropriate Inaction From Therapeutic Inertia. Ann Fam Med 2020; 18:50-58. [PMID: 31937533 PMCID: PMC7227476 DOI: 10.1370/afm.2491] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/11/2019] [Accepted: 07/17/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Conventional clinic blood pressure (BP) measurements are routinely used for hypertension management and physician performance measures. We aimed to check home BP measurements after elevated conventional clinic BP measurements for which physicians did not intensify treatment, to differentiate therapeutic inertia from appropriate inaction. METHODS We conducted a pre and post study of home BP monitoring for patients with uncontrolled hypertension as determined by conventional clinic BP measurements for which physicians did not intensify hypertension management. Physicians were notified of average home BP 2-4 weeks after the initial clinic visit. Outcome measures were the proportion of patients with controlled hypertension using average home BP measurements, changes in hypertension management by physicians, changes in physicians' hypertension metrics, and factors associated with home-clinic BP differences. RESULTS Of 90 recruited patients who had elevated conventional clinic BP recordings, 65.6% had average home BP measurements that were <140/90 mm Hg. Physicians changed treatment plans for 61% of patients with average home BP readings of ≥140/90 mm Hg, whereas decisions to not change treatment for the remaining patients were based on contextual factors. Substituting average home BP for conventional clinic BP for 4% of patients from 2 physicians' hypertension registries improved the physicians' hypertension control rates by 3% to 5%. Greater body mass index and increased number of BP medications were associated with home BP measurement ≥140/90 mm Hg. Clinic BP levels did not estimate normal home BP levels. CONCLUSIONS Documented home BP in cases of clinical uncertainty helped differentiate therapeutic inertia from appropriate inaction and improved physicians' hypertension metrics.
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Affiliation(s)
- Sonal J Patil
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Nuha K Wareg
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Kelvin L Hodges
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Jamie B Smith
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Mark S Kaiser
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Michael L LeFevre
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
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199
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Ionov МV, Zvartau NЕ, Emelyanov IV, Konradi AО. Telemonitoring and remote counseling in hypertensive patients. Looking for new ways to do old jobs. ACTA ACUST UNITED AC 2019. [DOI: 10.18705/1607-419x-2019-25-4-337-356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
XXI century emphasized humanity to embrace the digital era after a reality of Third and Fourth Industrial Revolutions, nowadays dictating new terms of social networking. It is expected that information and communication technologies integrated with value-based medicine will significantly impact healthcare delivery to tremendous number of patients with socially important noncommunicable diseases. Cardiovascular illnesses comprise the greatest part of such pathologies. Hypertension (HTN) being the most prevalent cardiovascular disease is also the key modifiable cardiovascular risk factor yet seems to be an attractive target for both value-based concept and telehealth interventions. Present review addresses up-to-date science on telehealth, sets out the main well-known, but yet unsolved challenges in management of HTN along with the new approaches involving telemedicine programs, digital health outlooks. The main barriers of telehealth implementation are also considered along with the possible solutions.
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Affiliation(s)
- М. V. Ionov
- Almazov National Medical Research Centre;
ITMO University
| | - N. Е. Zvartau
- Almazov National Medical Research Centre;
ITMO University
| | | | - A. О. Konradi
- Almazov National Medical Research Centre;
ITMO University
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200
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Rodrigues CIS. Self-Monitoring with or Without Telemonitoring: Is a New Time for Diagnosis and Management Hypertension? Arq Bras Cardiol 2019; 113:976-978. [PMID: 31800723 PMCID: PMC7020953 DOI: 10.36660/abc.20190701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Cibele Isaac Saad Rodrigues
- Faculdade de Ciências Médicas e da Saúde - Departamento de Medicina - Área de Nefrologia, Sorocaba, SP - Brazil.,Pontifícia Universidade Católica de São Paulo (PUC-SP), São Paulo, SP - Brazil
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