A telemedicine program combining home blood-pressure measurement and self-titration was feasible and well-accepted, with 80% of patients satisfied (95% CI, 73-87%).
Does self-measurement and self-titration of antihypertensive treatment using telemedicine improve patient satisfaction, compliance, and blood pressure control in patients with uncontrolled hypertension on monotherapy?
Self-measurement and self-titration of antihypertensive therapy using telemedicine is feasible, safe, and well-accepted, leading to significant reductions in blood pressure.
BACKGROUND: Because of poor patient compliance and clinical inertia, hypertension control rates remain poor. Home blood-pressure measurements (HBPM) improve compliance of patients and achievement of blood pressure (BP) targets. However, few studies have evaluated self-BP management by patients. METHODS: In a multicenter, prospective, single-group, open-label pilot study of 111 patients whose hypertension was uncontrolled despite monotherapy, we studied satisfaction with, and feasibility of, HBPM and self-titration of antihypertensive treatment using telemedicine for compliance, efficacy, and safety. After education (protocol, action plan, and use of the HBPM device), patients performed a sequence of HBPM every 2 weeks for 8 weeks. Following a stepwise approach, treatment was increased by the patient at weeks 4 and 6 if average HBPM values exceeded predefined limits. For each titration, the patient informed the Core Center by telemedicine, but BP values were transferred automatically. RESULTS: Overall, 80% of patients were satisfied (58%) or very satisfied (23%) with the program (95% confidence interval, 73% to 87%). Regarding compliance, 78% of patients fully complied with self-measurement, and just over 71% titrated their treatment adequately. Physicians were satisfied (52%) or very satisfied (22%) with the program. Between the first and final visits (at week 8), office systolic/diastolic BP (mean +/- SD) decreased significantly from 151 +/- 9/91 +/- 6 to 143 +/- 13/84 +/- 11 mmHg. During the trial, HBPM (mean +/- SD) decreased significantly from 149 +/- 13/86 +/- 12 to 138 +/- 16/81 +/- 10 mmHg. No significant safety issues were reported. CONCLUSIONS: This innovative approach to the management of hypertension, combining self-measurement and self-titration, is feasible, well-accepted by both patients and physicians, and safe.
Bobrie et al. (Sat,) conducted a other in Hypertension (n=111). Home blood-pressure measurement and self-titration using telemedicine was evaluated on Patient satisfaction with the program (95% CI 73-87). A telemedicine program combining home blood-pressure measurement and self-titration was feasible and well-accepted, with 80% of patients satisfied (95% CI, 73-87%).