E-Health in Hypertension Management: an Insight into the Current and Future Role of Blood Pressure Telemonitoring

Abstract

Purpose of Review Out-of-office blood pressure (BP) monitoring techniques, including home and ambulatory BP monitoring, are currently recommended by hypertension guidelines worldwide to confirm the diagnosis of hypertension and to monitor the appropriateness of treatment. However, such techniques are not always effectively implemented or timely available in the routine clinical practice. In recent years, the widespread availability of e-health solutions has stimulated the development of blood pressure telemonitoring (BPT) systems, which allow remote BP tracking and tighter and more efficient monitoring of patients' health status. Recent Findings There is currently strong evidence that BPT may be of benefit for hypertension screening and diagnosis and for improving hypertension management. The advantage is more significant when BPT is coupled with multimodal interventions involving a physician, a nurse or pharmacist, and including education on lifestyle and risk factors and drug management. Several randomized controlled studies documented enhanced hypertension management and improved BP control of hypertensive patients through BPT. Potential additional effects of BPT are represented by improved compliance to treatment, intensification, and optimization of drug use, improved quality of life, reduction in risk of developing cardiovascular complications, and costsaving. Applications based on m-health and making use of wearables or smartwatches integrated with machine learning models are particularly promising for the future development of efficient BPT solutions, and they will provide remarkable support decision tools for doctors. Summary BPT and telehealth will soon disrupt hypertension management. However, which approach will be the most effective and whether it will be sustainable in the long-term still need to be elucidated. Keywords E-health . Blood pressure telemonitoring . Hypertension . Telemedicine . M-health . Machine learning This article is part of the Topical Collection on Blood Pressure Monitoring and Management

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

“…The different technological and clinical aspects will be presented and discussed. The focus will be on telemonitoring, the telemedicine solution proven to be the most effective for hypertension management [7]. The potential of telemedicine for maintaining continuity of care for hypertensive patients in the time of infectious disease outbreaks, such as COVID-19, or more in general in national emergencies or disasters, will also be discussed.…”

“…These studies show some evidence of effectiveness, particularly in the case of underserved areas and ethnic minorities. Furthermore, there is currently great interest in new hybrid solutions for remote management of hypertensive patients, based on devices (socalled "connected kiosks") placed in community centers, waiting rooms of outpatients or primary care clinics, pharmacy or grocery stores [7]. These devices provide unsupervised measurement of BP and other relevant parameters, together with collection of information on the individual's CV risk, lifestyle and physical fitness status.…”

The Application of Image Recognition and Machine Learning to Capture Readings of Traditional Blood Pressure Devices: A Platform to Promote Population Health Management to Prevent Cardiovascular Diseases

“…Besides, regarding the lack of API and service providers integration, limited analytical functions of these solutions have hampered their usage as clinical reference for healthcare professionals 22 , but merely for personal reference purpose. Hardly can HBPM and BPT interoperably exert their full potential in maximizing the clinical significance under such constraints and therefore worth of attention.…”

Blood pressure telemonitoring and remote counseling of hypertensive patients: pros and cons

“…После получения данных на центральном сервере (удаленный компьютер медицинской организации) они обрабатываются (расшифровываются) для предоставления автоматически сгенерированного отчета (в зависимости от того, применяются ли методики искусственного интеллекта, машинного обучения или нет) или (чаще) электронный отчет проверяется и подтверждается врачом или иным медицинским работником с аналитикой и рекомендациями. Последний шаг -медицинское заключение направляется пациенту любым удобным и безопасным способом [13]. Такой вариант ТМАД называется традиционным (conventional blood pressure telemonitoring).…”

“…Телемониторирование АД (ТМАД) является одним из компонентов кластера телемедицины (telehealth). Цифровые (в т. ч. мобильные) технологии, использующиеся для ТМАД -это потенциальное решение для повышения эффективности и доступности СКАД и компенсации его основных недостатков [13]. С распространением и услож нением мобильных устройств ТМАД превращается в дистанционные клиники, следуя тезису о том, что дополнительные вмешательства прогрессивно повышают эффективность домашнего контроля АД [14].…”