Directly observed therapy prior to ambulatory blood pressure measurement (DOT-HTN) in uncontrolled hypertensive patients - Effect on blood pressure, safety and patient perception

Hjørnholm, Ulla; Larstorp, Anne Cecilie K.; Andersen, Marit Helen; Høieggen, Aud

doi:10.1080/08037051.2019.1633907

Cited by 6 publications

(6 citation statements)

References 27 publications

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“…Optimal management of HF patients includes special care programs for both hospitalized patients and outpatients who can be managed in HF clinics, in which the problem of long-term drug adherence is also addressed [1162]. Patients with very low EF (<20%) may need to be stabilized in hospital as they frequently present with tachycardia as a compensatory mechanism to maintain cardiac output.…”

Section: Hypertension In Established Cardiovascular Disordersmentioning

confidence: 99%

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

Chairperson

Co-Chair

Brunström

et al. 2023

Journal of Hypertension

861

280

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Document Reviewers: Luis Alcocer (Mexico), Christina Antza (Greece), Mustafa Arici (Turkey), Eduardo Barbosa (Brazil), Adel Berbari (Lebanon), Luís Bronze (Portugal), John Chalmers (Australia), Tine De Backer (Belgium), Alejandro de la Sierra (Spain), Kyriakos Dimitriadis (Greece), Dorota Drozdz (Poland), Béatrice Duly-Bouhanick (France), Brent M. Egan (USA), Serap Erdine (Turkey), Claudio Ferri (Italy), Slavomira Filipova (Slovak Republic), Anthony Heagerty (UK), Michael Hecht Olsen (Denmark), Dagmara Hering (Poland), Sang Hyun Ihm (South Korea), Uday Jadhav (India), Manolis Kallistratos (Greece), Kazuomi Kario (Japan), Vasilios Kotsis (Greece), Adi Leiba (Israel), Patricio López-Jaramillo (Colombia), Hans-Peter Marti (Norway), Terry McCormack (UK), Paolo Mulatero (Italy), Dike B. Ojji (Nigeria), Sungha Park (South Korea), Priit Pauklin (Estonia), Sabine Perl (Austria), Arman Postadzhian (Bulgaria), Aleksander Prejbisz (Poland), Venkata Ram (India), Ramiro Sanchez (Argentina), Markus Schlaich (Australia), Alta Schutte (Australia), Cristina Sierra (Spain), Sekib Sokolovic (Bosnia and Herzegovina), Jonas Spaak (Sweden), Dimitrios Terentes-Printzios (Greece), Bruno Trimarco (Italy), Thomas Unger (The Netherlands), Bert-Jan van den Born (The Netherlands), Anna Vachulova (Slovak Republic), Agostino Virdis (Italy), Jiguang Wang (China), Ulrich Wenzel (Germany), Paul Whelton (USA), Jiri Widimsky (Czech Republic), Jacek Wolf (Poland), Grégoire Wuerzner (Switzerland), Eugene Yang (USA), Yuqing Zhang (China).

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Section: Hypertension In Established Cardiovascular Disordersmentioning

confidence: 99%

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

Chairperson

Co-Chair

Brunström

et al. 2023

Journal of Hypertension

861

280

View full text Add to dashboard Cite

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“…1) have been described in detail (12,13). In short, of 65 patients with apparent treatment-resistant hypertension who were referred for RDN, 45 patients were excluded after a thorough investigation, either due to secondary causes or after obtaining a normalized daytime ABPM following witnessed intake of drugs as previously described by us and detailed in the Online Supplement (14). Thus, 20 patients were randomized to either RDN or drug adjustment assisted by hemodynamic assessments using the HOTMAN system (Hemo Sapiens Inc. Sedona, AZ, USA), described in detail by others (15).…”

Section: Procedures and Treatmentsmentioning

confidence: 99%

The randomised Oslo study of renal denervation vs. Antihypertensive drug adjustments: efficacy and safety through 7 years of follow-up

et al. 2020

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Purpose:The blood pressure (BP) lowering effect of renal sympathetic denervation (RDN) in treatment-resistant hypertension shows variation amongst the existing randomized studies.The long-term efficacy and safety of RDN requires further investigation. For the first time, we report BP changes and safety up to seven years after RDN, compared to drug adjustment in the randomized Oslo RDN study. Materials and methods:Patients with treatment-resistant hypertension, defined as daytime systolic ambulatory BP ≥135 mmHg after witnessed intake of ≥3 antihypertensive drugs including a diuretic, were randomized to either RDN (n=9) or drug adjustment (n=10). The initial primary endpoint was the change in office BP after six months. The RDN group had their drugs adjusted after one year using the same principles as the Drug Adjustment group.Both groups returned for long-term follow-up after three-and seven years. Results:The decrease in office BP and ambulatory BP (ABPM) after six months did not persist, but gradually increased in both groups. From six months to seven years follow-up, mean daytime systolic ABPM increased from 142±10 to 145±15 mmHg in the RDN group, and from 133±11 to 137±13 mmHg in the Drug Adjustment group, with the difference between them decreasing. In a mixed factor model, a significantly different variance was found between the groups in daytime systolic ABPM (p=0.04) and diastolic ABPM (p=0.01) as well as office diastolic BP (p<0.01), but not in office systolic BP (p=0.18). At long-term followup we unveiled no anatomical-or functional renal impairment in either group. Conclusion:Blood pressure changes up to seven years show a tendency towards a smaller difference in BPs between the RDN and drug adjustment patients. Our data support RDN as a safe procedure, but it remains non-superior to intensive drug adjustment seven years after the intervention.

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“…Despite extreme importance of adequate compliance, there is still no 'gold standard' test [22]. Our study used the widely recognised DOT technique [23]. We observed that over two thirds of patients had good adherence in the BPTM group.…”

Section: Discussionmentioning

confidence: 93%

Value-based approach to blood pressure telemonitoring and remote counseling in hypertensive patients

et al. 2020

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Purpose: Blood pressure telemonitoring and remote counselling (BPTM) improves blood pressure (BP) control in patients with hypertension (HTN). Studies assessing the efficacy of BPTM from a value-based perspective are lacking. We investigated whether BPTM fits all principles of the value-based approach (clinical and economic effectiveness, improvement in patient-reported outcome/experience measures (PROM/PREM)). Materials and methods: Two hundred and forty ambulatory patients with uncontrolled HTN were randomised in a 2: 1 manner to BPTM (n ¼ 160, mean age 47 y.o.) and usual care (UC, n ¼ 80; 49 y.o.) with baseline and 3-month follow-up clinic visits. BPTM employed a mobile application (for patients) and a desktop version (for clinician), which allowed communication and exchange of medical data. The main outcomes were changes in office and ambulatory systolic (S) BPs, rate of BP control. The incremental cost-effectiveness ratio (ICER) and incremental costutility ratio (ICUR) were evaluated in economic analysis. The MOS SF-36 score was taken as a PROM, and the PEQ score was used as a PREM. Results: Larger decreases in office and ambulatory SBPs (-16.8 and À8.9 mm Hg, respectively; p < .05) was achieved in BPTM group while the treatment intensity was equal (2.4 drugs). The ICER 11.1 EUR/-1 mm Hg 24-hour SBP/1 year was 75% effective as per willingness-to-pay threshold. BPTM improved PROM (þ2.1 in mean MOS SF-36; p ¼ .04), reduced long-term mortality (þ0.11 life years gained), leading to þ0.49 quality-adjusted life years (QALYs) gained as compared with UC. The ICUR was 4 169.4 EUR/QALY gained. Patient-reported experience was higher in the BPTM (þ10 PEQ, p ¼ .01). The UC group showed minor changes in MOS SF-36 and PEQ (þ1.3; þ6, respectively; p n.s.). Conclusions: Being cost-effective, BPTM incorporates both clinical benefits and patient-perceived value. Larger randomised studies are needed to confirm our findings.

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Directly observed therapy prior to ambulatory blood pressure measurement (DOT-HTN) in uncontrolled hypertensive patients - Effect on blood pressure, safety and patient perception

Cited by 6 publications

References 27 publications

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

The randomised Oslo study of renal denervation vs. Antihypertensive drug adjustments: efficacy and safety through 7 years of follow-up

Value-based approach to blood pressure telemonitoring and remote counseling in hypertensive patients

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