What does this research mean for the field?

An integrated ICT-based system (POST) significantly improves office blood pressure control at 6 months compared to routine management in patients with uncontrolled hypertension. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

August 1, 2016

An ICT and mobile health integrated approach to optimize patients' education on hypertension and its management by physicians: The Patients Optimal Strategy of Treatment(POST) pilot study

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Uncontrolled hypertension (n=690). Intervention: Integrated ICT-based Patients Optimal Strategy for Treatment (POST) system vs. Routine management based on repeated office visits. Primary outcome: Office BP control (<149/90 mmHg).

Key Result

An integrated ICT-based system (POST) improved office blood pressure control at 6 months compared to routine management (72.3% vs 40.0%).

Study Design

Type

RCT (n=690)

Randomization

alternatively assigned

Multicenter

Yes

Structured PICO

Does an integrated ICT-based system (POST) improve blood pressure control in treated hypertensive patients with uncontrolled office BP?

Population

690 treated hypertensive patients with uncontrolled office blood pressure, followed for 6 months.

Intervention

Integrated ICT-based Patients Optimal Strategy for Treatment (POST) system including Home BP monitoring teletransmission, a dedicated web-based platform for patients' management by physicians (Misuriamo platform), and a smartphone mobile application (Eurohypertension APP, E-APP)

Comparator

Routine management based on repeated office visits

Outcome

Office BP control (<149/90 mmHg) at 6 monthssurrogate

An integrated ICT and mobile health approach significantly improves blood pressure control in patients with previously uncontrolled hypertension compared to routine office-based management.

Main Result

Absolute Event Rate: 72.3% vs 40%

Abstract

INTRODUCTION: Uncontrolled hypertension is largely attributed to unsatisfactory doctor's engagement in its optimal management and to poor patients' compliance to therapeutic interventions. ICT and mobile Health solutions might improve these conditions, being widely available and providing highly effective communication strategies. OBJECTIVE: To evaluate whether ICT and mobile Health tools are able to improve hypertension control by improving doctors' engagement and by increasing patients' education and involvement, and their compliance to lifestyle modification and prescribed drug therapy. METHODS: In a pilot study, we have included 690 treated hypertensive patients with uncontrolled office blood pressure (BP), consecutively recruited by 9 general practitioners over 3 months. Patients were alternatively assigned to routine management based on repeated office visits or to an integrated ICT-based Patients Optimal Strategy for Treatment (POST) system including Home BP monitoring teletransmission, a dedicated web-based platform for patients' management by physicians (Misuriamo platform), and a smartphone mobile application (Eurohypertension APP, E-APP), over a follow-up of 6 months. BP values, demographic and clinical data were collected at baseline and at all follow-up visits (at least two). BP control and cardiovascular risk level have been evaluated at the beginning and at the end of the study. RESULTS: 89 patients did not complete the follow-up, thus data analysis was carried out in 601 of them (303 patients in the POST group and 298 in the control group). Office BP control (<;149/90 mmHg) was 40.0% in control group, and 72.3% in POST group at 6 month follow-up. At the same time Home BP control (<;135/85 mmHg average of 6 days) in POST group was 87.5%. CONCLUSION: this pilot study suggests that ICT based tools might be effective in improving hypertension management, implementing positive patients' involvement with better adherence to treatment prescriptions and providing the physicians with dynamic control of patients' home BP measurements, resulting in lesser clinical inertia.

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