Blood pressure telemonitoring is useful to achieve blood pressure control in inadequately treated patients with arterial hypertension

• Published in: Journal of human hypertension Vol. 25; no. 12; pp. 732 - 738
• Main Authors: Neumann, C L, Menne, J, Rieken, E M, Fischer, N, Weber, M H, Haller, H, Schulz, E G
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.12.2011; Nature Publishing Group
• Subjects: 692/699/75/243; 692/700/565; Adult; Aged; Algorithms; Analysis; Antihypertensive Agents - pharmacology; Antihypertensive Agents - therapeutic use; Antihypertensives; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Biphenyl Compounds - pharmacology; Biphenyl Compounds - therapeutic use; Blood and lymphatic vessels; Blood pressure; Blood Pressure - drug effects; Blood Pressure - physiology; Blood Pressure Monitoring, Ambulatory - methods; Cardiology. Vascular system; Care and treatment; Circadian Rhythm - physiology; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Diagnosis; Epidemiology; Female; Health Administration; Humans; Hypertension; Hypertension - drug therapy; Hypertension - physiopathology; Male; Measurement; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Monitoring, Ambulatory - methods; Office Visits; original-article; Patients; Physician-Patient Relations; Public Health; Risk groups; Telemedicine; Telemedicine - methods; Tetrazoles - pharmacology; Tetrazoles - therapeutic use; Time Factors; Titration; Treatment Outcome; Type 2 diabetes; Germany; telemedicine; irbesartan; antihypertensive agents; telemonitoring; home blood pressure; treatment goals; Human; Hypertension; Imidazole derivatives; Tetrazole derivatives; Peptide hormone; Cardiovascular disease; Octapeptide; Treatment; Irbesartan; Biphenyl derivatives; Antihypertensive agent; Arterial pressure; Sartan derivatives; Blood pressure; Angiotensin antagonist; Angiotensin II
• ISSN: 0950-9240; 1476-5527
• DOI: 10.1038/jhh.2010.119

Failing to reach blood pressure (BP) goals is one of the main problems in hypertension management. Especially in high-risk patients, intensive monitoring including frequently office visits or new techniques to monitor home BP is required. A total of 60 patients with uncontrolled hypertension were included and randomized into a group with telemetric BP monitoring (TBPM) ( n =30) and a control group receiving standard care ( n =30). During the 3-month study period, patients received in addition to their antihypertensive pre-treatment up to 2 × 300 mg irbesartan to achieve the required target BP. All patients were instructed to measure their BP once daily in the morning. In the TBPM group automatic alerts were generated by the central database server using pre-defined algorithms and patients were subsequently contacted by the physician. At baseline mean 24-h ambulant BP monitoring (ABPM) was 143.3±11.1/82.6±9.9 mm Hg in the TBPM group and 141.4±12.6/82.1±6.5 mm Hg in the standard care group. During treatment mean systolic BP showed a more intensive decrease in the TBPM vs control group (−17.0±11.1 mm Hg vs −9.8±13.7 mm Hg; P =0.032). Patients in the TBPM group had a more pronounced night dipping and a higher reduction of mean pulse pressure than controls (−8.1±5.9 mm Hg vs −2.8±7.4 mm Hg, P =0.004). After 3 months, TBPM-treated patients were given a higher mean daily dose of irbesartan (375±187 mg vs 222±147 mg in controls; P =<0.001). We demonstrated that with TBPM a more effective and faster titration of the antihypertensive agent is possible. The alarm criteria chosen were useful to improve BP control.