Home blood pressure telemonitoring for improving blood pressure control in middle‐aged and elderly patients with hypertension

Abstract

The blood pressure (BP) control rate among treated hypertensives in China remains low at 37.5%. The relationship between home blood pressure telemonitoring (HBPT) and BP control is controversial. The authors aimed to investigate the relationship between HBPT and BP control in middle‐aged and elderly hypertensives. In total, 252 hypertension patients aged between 60 and 79 years were enrolled. The patients were given either HBPT through interactive platforms between physicians and patients (telemonitoring group, n = 126) or conventional management (routine management group, n = 126). All patients were followed‐up for 15 months. BP control was defined as home systolic blood pressure < 135 mm Hg and home diastolic blood pressure < 85 mm Hg. At baseline, there were no significant differences in the baseline BP control rate (p = .083). However, after 15 months, the BP control rate improved in both groups, and the telemonitoring group (71.3%) had a significantly higher BP control than the routine management group (49.8%) (p < .001). The change of BP control rate from baseline in the routine management group increased by 26.1%, and that of the telemonitoring group increased by 35.4%. The results of the fully adjusted binary logistic regression showed that HBPT was positively associated with BP control after adjusting for confounders (OR = 4.15, 95% CI 2.05–8.39). Similar results were observed after 3, 9, and 12 months. The association of HBPT with BP control was similar in subgroups. In conclusions, HBPT is recommended for BP control in middle‐aged and elderly hypertensives in the community setting.

Telemedicine and Digital Medicine in the Clinical Management of Hypertension and Hypertension-Related Cardiovascular Diseases: A Position Paper of the Italian Society of Arterial Hypertension (SIIA)

“…Telemonitoring also has considerable utility in the home management of frail patients with multiple chronic diseases [59,60]. In this setting, the concomitant presence of cognitive or visual impairment might complicate the use of digital tools.…”

“…However, such barriers can be overcome using devices tailored to the patient's clinical conditions and digital skills. For example, in patients unable to use e-mails or other ICT platforms, physicians can use telemonitoring systems that directly transfer home-acquired BP values to the patient's clinical records, minimizing patient involvement [60]. Similarly, video supports, voice assistants or smart speaker technologies embedded in remote BP monitoring systems can guide patients with cognitive or visual impairment on the correct use of the devices [61][62][63].…”

Telemonitoring and protocolized case management for hypertensive community dwelling older adults (TECHNOMED): a randomized controlled trial

“…65) participants [31], though older participants have been captured alongside middle-aged and younger participants with hypertension. Some of these trials enrolling predominantly older participants showed that telemonitoring and case management was effective [35][36][37], while others have shown reduced effectiveness in subgroup analyses of older participants [21][22][23]. The limited evidence and variability of outcomes demonstrate a need to examine older subjects as a distinct population, for whom additional considerations may apply when attempting to improve BP control.…”

“…Some previous studies of telemonitored HBPM and case management appear to show worse effectiveness in subgroup analyses of older adults compared to middle-aged adults [21][22][23]. BP reduction alone is also not the sole objective in older adults; in cases where hypotension or other adverse effects occur, deprescribing of anti-hypertensive agents is also important [14,24].…”

Effects of Smartphone-Based Remote Interventions on Dietary Intake, Physical Activity, Weight Control, and Related Health Benefits Among the Older Population With Overweight and Obesity in China: Randomized Controlled Trial

“…In a study, middle-aged and older patients with hypertension under standardized management by the Hypertension Research Institute of the Second Affiliated Hospital of Baotou Medical College used intelligent sphygmomanometers to monitor their blood pressure and smartphone apps to monitor and manage their blood pressure. After 12 months, the systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the patients significantly decreased ( P <.001) [ 22 ]. Sun et al [ 23 ] used the remote “Internet plus” internet-based management mode to intervene in older patients with hypertension aged ≥60 years for 6 months.…”