Connected Health in Hypertension Management

Abstract

e-health is defined as the use of communication and information technologies (ICT) to manage patients and their health in a more efficient way, with the aim of improving the overall quality of care. Healthcare services relying on telehealth (or telemedicine) and mobile health (m-health) are the most popular e-health tools used by healthcare professionals and consumers. These applications allow the exchange of medical data between patients and their doctors or among healthcare professionals, mainly through the Internet, and are used to provide healthcare services remotely (so-called “ connected health ”). The most popular telemedicine application in the field of hypertension is blood pressure telemonitoring (BPT), which enables transmission of BP and various clinical information from patients' homes or from the community to the doctor's surgery or the hospital. Numerous randomized controlled trials have documented a significant BP reduction combined with an intensification and optimization of the use of antihypertensive medications in patients making use of BPT plus remote counseling by a case manager, with the supervision of a doctor or a community pharmacist (telepharmacy). The major benefits of BPT are usually observed in high-risk patients. BPT can also be based on m-health wireless solutions, provided with educational support, medication trackers and reminders, and teleconsultation. In this context, BPT may favor patient's self-management, as an adjunct to the doctor's intervention, and foster patient's participation in medical decision making, with consequent improvement in BP control and increase in medication adherence. In conclusion, e-health solutions, and in particular telemedicine, are increasingly attaining a key position in the management of the hypertensive patient, with an enormous potential in terms of improvement of the quality of the delivered care, increase in the chance of a successful BP control and effective prevention of cardiovascular diseases.

Evidence and Recommendations on the Use of Telemedicine for the Management of Arterial Hypertension

“…Currently, the most common way to deliver telemedicine services is by the Internet, often using mobile devices and using a "closed-loop" healthcare model also called "Internet-of-Medical-Things" (IoMT), which is schematically outlined in FIGURE 1 and further discussed in the next sections of the paper [5].…”

“…Exact estimates of the implementation of telemedicine services among hypertensive patients worldwide are lacking. However, recent statistics suggest that around the world seven million patients are managed by telemedicine, with the most popular applications targeting patients with heart failure, hypertension and diabetes [5]. Europe and North America dominate the market of telemedicine, but emergent markets include Asia and Oceania.…”

“…Europe and North America dominate the market of telemedicine, but emergent markets include Asia and Oceania. Although televisit and teleconsultation are the most popular telemedicine solutions, home-based telemonitoring relying on m-health apps is the fastest growing application of telemedicine and it is expected to help ongoing implementation of telemedicine, particularly in the context of a global pandemic [5].…”

“…The studies performed so far, however, were based on heterogeneous interventions, technologies, and study designs, which makes it difficult to identify the right solution for a given patient. The only strong evidence available from many studies is that solutions that are based on complex interventions, including not only telemonitoring but also multidisciplinary case management, education, and feedback to the patient, are the most effective [5]. Future studies should be more focused on this multifaceted multimodal approach and test such solutions in specific groups of hypertensive patients, such as those with resistant hypertension, those at high risk of developing CV diseases, or those with multiple comorbidities.…”

“…Hypertension is a good target for telemedicine, and in particular, for telemonitoring, as it is the most common and important risk factor for CV disease worldwide [4]. However, while telemedicine has been shown to improve blood pressure (BP) control as compared to standard care, its place in daily clinical practice is not yet clear [5]. Whilst most guidelines refer to it in the context of excluding white coat or masked hypertension, there are no current specific recommendations on the place of telemedicine in general hypertension management, with the partial exception of the 2017 American College of Cardiology (ACC) / American Heart Association (AHA) guidelines which suggest that telehealth strategies can be useful adjuncts to interventions shown to reduce BP for adults with hypertension [6].…”