scholarly journals Efficiency of remote blood pressure monitoring in outpatients with hypertension: a pilot project in a city ambulatory care clinic

2021 ◽  
Vol 25 ◽  
pp. 4149
Author(s):  
Yu. A. Sharapova ◽  
I. A. Starodubtseva ◽  
S. V. Villevalde
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Therapy ◽  
Blood Pressure Monitoring ◽  
Pilot Project ◽  
Fixed Dose ◽  
Call Rate ◽  
Monitoring Methods ◽  
Care Clinic ◽  
The Mean ◽  
Ambulatory Care Clinic

Aim. In a pilot project, to evaluate the effectiveness of remote blood pressure (BP) monitoring in outpatients followed up for hypertension (HTN).Material and methods. A total of 1,121 patients (707 women and 414 men) with hypertension were included in the pilot project (mean age, 52,0±12,0 years; BP, 151,4±9,1/96,9±10,3 mm Hg). Patients independently measured BP and entered the values into self-management paper diaries (n=886), in digital form to their personal account (n=200), or transmitted data from BP monitor using installed mobile application (n=35). Each of the three groups was assessed at baseline and after 6 months. We assessed achievement of BP targets, medication adherence using the Morisky Green scale, the prevalence of patients with fixed-dose antihypertensive therapy, and the ambulance call rate.Results. Prior to the study, 15,2% (n=171) of hypertensive patients regularly monitored their BP. After 6 months, the mean systolic BP decreased from 151,4±9,1 to 135,5±10,1 mm Hg (p<0,01), diastolic BP — from 96,9±10,3 to 85,8±6,3 mm Hg (p<0,01). The proportion of patients adhering to treatment (Morisky Green score of 4) increased from 17,9 to 55,4%, the frequency of prescribing dual antihypertensive therapy — from 25,8 to 43,3%, triple therapy — from 11,5 to 22,9%, fixed-dose combinations — from 25,4 to 51,6%. At the same time, the proportion of patients who achieved the target BP values increased from 14,5 to 43,1%, while the ambulance call rate decreased from 19,3 to 16,9%.Conclusion. The use of remote BP monitoring methods, including BP monitors with automated data transmission, increases the prescription rate of combined antihypertensive therapy and proportion of patients who achieved the target BP, as well as decreases the ambulance call rate.

scholarly journals Twenty-four-hour and office blood pressure measurement in a comprehensive assessment of the effectiveness of 12-week therapy with a triple fixed-dose combination of amlodipine/indapamide/perindopril in hypertensive patients in actual clinical practice

2021 ◽  
Vol 26 (5) ◽  
pp. 4498
Author(s):  
V. M. Gorbunov ◽  
Yu. A. Karpov ◽  
E. V. Platonova ◽  
Ya. N. Koshelyaevskaya
Keyword(s):  
Blood Pressure ◽  
Clinical Practice ◽  
Antihypertensive Therapy ◽  
Blood Pressure Measurement ◽  
Fixed Dose Combination ◽  
Fixed Dose ◽  
Actual Clinical Practice ◽  
Dose Combination ◽  
The Mean

Aim. To study the efficacy and safety of the triple fixed-dose combination (FDC) of amlodipine/indapamide/perindopril on blood pressure (BP) profile in patients with grade I-II hypertension (HTN) in actual clinical practice.Material and methods. Data from 54 patients with paired 24-hour ambulatory BP monitoring (ABPM) data were included in the TRICOLOR subanalysis (ClinicalTrials. gov study ID — NCT03722524). The mean 24-hour, daytime, and nighttime BP were calculated at baseline and after 12-week follow-up. We determined the proportion of patients with nocturnal HTN (≥120/70 mm Hg) and nocturnal hypotension (<100/60 and <90/50 mm Hg) initially and after 12 weeks of triple FDC therapy. Patients with nocturnal BP decrease included dippers (D; 10-20%), reduced dippers (RD; 0-10%) and extreme dippers (ED; >20%), as well as those without nocturnal BP decrease (>0%, non-dipper (ND)). The smoothness index (SI) was analyzed as the ratio of the mean hourly SBP fall to its mean standard deviation in paired ABPM. To assess the BP phenotypes, two methods were used with reference values of <130/80 and <140/90 mm Hg for ABPM and office BP, respectively. Controlled hypertension (CHT), uncontrolled hypertension (UHT), white coat hypertension (WHT) and masked ineffectiveness of antihypertensive therapy were distinguished.Results. Among 1247 participants of the TRICOLOR study, 54 patients with valid paired ABPM were selected (men, 46%; mean age, 57,7 [12,1] years; mean office BP, 150,4 [16,6]/93,3 [10,7] mm Hg; HTN duration, 8,3 [7,5] years). Initially, the mean 24-hour, daytime and nighttime BP was 141,1 [15,4]/85,9 [9,9], 144,2 [15,5]/88,8 [10,5] and 132,6 [18,0]/78,1 [9,9] mm Hg, respectively. After 12-week follow-up, the mean 24-hour, daytime and nighttime BP was 123,1 [10,5]/75,6 [8,5], 125,7 [10,9]/77,9 [8,7] and 115,4 [10,2]/68,6 [8,8] mm Hg, respectively (p<0,001). After 12-week follow-up, the proportion of patients with nocturnal hypertension decreased from 64,8% to 25,0% (2,6 times) (p<0,001). The proportion of NDs and EDs decreased from 16,7% and 7,4% to 5,8% and 0%, respectively (p=0,048); the proportion of patients with RD and D patterns increased from 42,6% and 33,3 to 57,7% and 36,5%, respectively (p=0,048). With triple FDC therapy, the SI during the day was higher than 0,73 in half of the cases. According to the two methods, the proportion of patients with UHT decreased from 81,6% to 4,4%, WHT from 12,2% to 0%. The prevalence of CHT increased from 4,1% to 57,8%, while masked ineffectiveness of antihypertensive therapy — from 2,0% to 37,8%.Conclusion. Twelve-week FDC therapy of amlodipine/indapamide/perindopril led to a significant fall in the mean 24-hour, daytime and nighttime BP values. Comprehensive analysis of two techniques (24-hour and office BP measurement) identified patients requiring further triple FGC titration.

scholarly journals Home Blood Pressure Control and Drug Prescription Patterns among Thai Hypertensives: A 1-Year Analysis of Telehealth Assisted Instrument in Home Blood Pressure Monitoring Nationwide Pilot Project

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Anut Sakulsupsiri ◽  
Pairoj Chattranukulchai ◽  
Sarawut Siwamogsatham ◽  
Patchaya Boonchayaanant ◽  
Witthawat Naeowong ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Channel Blocker ◽  
Blood Pressure Monitoring ◽  
Drug Prescription ◽  
Pilot Project ◽  
Home Blood Pressure ◽  
Pressure Monitoring ◽  
The Mean ◽  
One Year

Background. Several interventions have been proposed to improve hypertension control with various outcomes. The home blood pressure (HBP) measurement is widely accepted for assessing the response to medications. However, the enhancement of blood pressure (BP) control with HBP telemonitoring technology has yet to be studied in Thailand. Objective. To evaluate the attainment of HBP control and drug prescription patterns in Thai hypertensives at one year after initiating the TeleHealth Assisted Instrument in Home Blood Pressure Monitoring (THAI HBPM) nationwide pilot project. Methods. A multicenter, prospective study enrolled treated hypertensive adults without prior regular HBPM to obtain monthly self-measured HBP using the same validated, oscillometric telemonitoring devices. The HBP reading was transferred to the clinic via a cloud-based system, so the physicians can adjust the medications at each follow-up visit on a real-life basis. Controlled HBP is defined as having HBP data at one year of follow-up within the defined target range (<135/85 mmHg). Results. A total of 1,177 patients (mean age 58 ± 12.3 years, 59.4% women, 13.1% with diabetes) from 46 hospitals (81.5% primary care centers) were enrolled in the study. The mean clinic BP was 143.9 ± 18.1/84.3 ± 11.9 mmHg while the mean HBP was 134.4 ± 15.3/80.1 ± 9.4 mmHg with 609 (51.8%) patients having HBP reading <135/85 mmHg at enrollment. At one year of follow-up after implementing the HBP telemonitoring, 671 patients (57.0%) achieved HBP control. Patients with uncontrolled HBP had a higher prevalence of dyslipidemia and greater waist circumference than the controlled group. The majority of uncontrolled patients were still prescribed only one (36.0%) or two drugs (34.4%) at the end of the study. The antihypertensive drugs were not uptitrated in 136 (24%) patients with uncontrolled HBP at baseline. Calcium channel blocker was the most prescribed drug class (63.0%) followed by angiotensin-converting enzyme inhibitor (44.8%) while the thiazide-type diuretic was used in 18.9% of patients with controlled HBP and 16.4% in uncontrolled patients. Conclusion. With the implementation of HBP telemonitoring, the BP control rate based on HBP analysis was still low. This is possibly attributed to the therapeutic inertia of healthcare physicians. Calcium channel blocker was the most frequently used agent while the diuretic was underutilized. The long-term clinical benefit of overcoming therapeutic inertia alongside HBP telemonitoring needs to be validated in a future study.

scholarly journals Analysis of Pulse Arrival Time as an Indicator of Blood Pressure in a Large Surgical Biosignal Database: Recommendations for Developing Ubiquitous Blood Pressure Monitoring Methods

2019 ◽  
Vol 8 (11) ◽  
pp. 1773 ◽  
Author(s):  
Joonnyong Lee ◽  
Seungman Yang ◽  
Saram Lee ◽  
Hee Chan Kim
Keyword(s):  
Blood Pressure ◽  
Arrival Time ◽  
Blood Pressure Monitoring ◽  
International Standards ◽  
Confounding Factors ◽  
Monitoring Methods ◽  
Pressure Monitoring ◽  
Pulse Arrival Time ◽  
The Mean ◽  
Pulse Arrival

As non-invasive continuous blood pressure monitoring (NCBPM) has gained wide attraction in the recent decades, many pulse arrival time (PAT) or pulse transit time (PTT) based blood pressure (BP) estimation studies have been conducted. However, most of the studies have used small homogeneous subject pools to generate models of BP based on particular interventions for induced hemodynamic change. In this study, a large open biosignal database from a diverse group of 2309 surgical patients was analyzed to assess the efficacy of PAT, PTT, and confounding factors on the estimation of BP. After pre-processing the dataset, a total of 6,777,308 data pairs of BP and temporal features between electrocardiogram (ECG) and photoplethysmogram (PPG) were extracted and analyzed. Correlation analysis revealed that PAT or PTT extracted from the intersecting-tangent (IT) point of PPG showed the highest mean correlation to BP. The mean correlation between PAT and systolic blood pressure (SBP) was −0.37 and the mean correlation between PAT and diastolic blood pressure (DBP) was −0.30, outperforming the correlation between BP and PTT at −0.12 for SBP and −0.11 for DBP. A linear model of BP with a simple calibration method using PAT as a predictor was developed which satisfied international standards for automatic oscillometric BP monitors in the case of DBP, however, SBP could not be predicted to a satisfactory level due to higher errors. Furthermore, multivariate regression analyses showed that many confounding factors considered in previous studies had inconsistent effects on the degree of correlation between PAT and BP.

scholarly journals COGNITIVE IMPAIRMENT, THEIR DYNAMICS AND STRUCTURE IN THE ACUTE AND RECOVERY PERIODS OF STROKE, DEPENDING ON ARTERIAL HYPERTENSION SEVERITY AND DURATION

2018 ◽  
Vol 13 (3-4) ◽  
pp. 22-27
Author(s):  
T.M. Cherenko ◽  
Yu.L. Heletyuk
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Arterial Hypertension ◽  
Blood Pressure Monitoring ◽  
Cognitive Status ◽  
Neurological Deficits ◽  
Stroke Patients ◽  
Mean Values ◽  
Post Stroke ◽  
The Mean

Relevance. Cognitive impairment is common in the post-stroke period. Different characteristics of arterial hypertension (AH), namely its severity, duration and variability of blood pressure, can affect the development of cognitive impairment in stroke patients. Objective: to investigate cognitive impairment, their dynamics and structure in acute and recovering stroke periods, depending on the arterial hypertension severity and duration. Materials and methods. 150 patients with a primary ischemic stroke and history of hypertension: 74 (49,3 %) women and 76 (50,7 %) men, the mean age (67,4±0,7) years have been examined. Neurological deficits was evaluated by the NIHSS scale. The cognitive status was evaluated by the MMSE scale at the end of an acute period of 21 days and 1 year. Diagnosis of hypertension was based on the clinical and instrumental examination results and medical documents. Daily blood pressure monitoring was using on admission and every 4 hours during 6 days of acute stroke stage. Mean SBP, mean DBP, maximum SBP and DBP, standard deviation (SD) of SBP and DBP were studied. Results. By the mean score on the MMSE scale, there are differences in patients during acute post-stroke period, depending on the severity of hypertension: 27,2±0,6 points in the case of hypertension stage 1, 24,3±0,6 in the case of hypertension stage 2 and 20,7±0,8 in case of AH stage 3, (p=0.001). By this indicator, patients with different AH duration were different: 26,4±0,9 points; 25,1±0,5 points; 20,5±0,7 points, respectively. The significance of these differences by the mean values of MMSE score was obtained in patients with a duration of AH less than 5 years and more than 10 years, as well as when comparing the group of "6-10 years" and "over 10 years" (p=0,001). Significant differences in the structure of cognitive deficits severity, depending on the hypertension stage and its duration, were observed only in patients with moderate and severe stroke (p=0,006). Cognitive deterioration a year after a stroke was observed in 40 (31,5 %) patients. They have significantly higher mean values SD 1-3, SD 1-6, SBP on the first day after a stroke, and duration of hypertension. Conclusions. The relationship between the degree of intellectual decline and the duration of hypertension (r=0,592, p=0,001), severity of hypertension (r=0,459, p=0,001) was found. The severity of the neurological deficiency affects the structure of cognitive impairment at discharge in patients with different severity and duration of hypertension, and higher mean values of the variability of blood pressure from 1 to 6 days, SBP on the first day after stroke and higher duration of hypertension in the history is associated with a negative dynamics of cognitive impairment in stroke patients in a year after stroke.

Sign in / Sign up

Export Citation Format

Share Document