What question did this study set out to answer?

To evaluate the efficacy and feasibility of a fully virtual, pharmacist-led telehealth management system for blood pressure control in patients with chronic kidney disease and difficult-to-manage hypertension.

June 1, 2023Kidney360Open Access

Telehealth and Management Support for Hypertension in CKD: Time to Raise the Bar

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Uncontrolled hypertension and chronic kidney disease (n=55). Intervention: Fully virtual management system (telehealth and pharmacist management) vs. Baseline (initial visit). Primary outcome: Change in systolic blood pressure (SBP) from baseline (MD -16).

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Key result

A fully virtual management system involving telehealth and pharmacist support resulted in a mean reduction in systolic blood pressure of 16 mm Hg from baseline in patients with CKD.

Why the study?

Does a fully virtual management system with pharmacist support reduce systolic blood pressure in patients with CKD and difficult-to-manage hypertension?

Key Points

To evaluate the efficacy and feasibility of a fully virtual, pharmacist-led telehealth management system for blood pressure control in patients with chronic kidney disease and difficult-to-manage hypertension.
Evaluated 55 eligible veterans (from 116 referred) with uncontrolled hypertension and CKD managed virtually by a clinical pharmacist with nephrologist guidance.
Patients performed home blood pressure monitoring and completed telephone follow-up visits every 4–12 weeks for medication titration toward a target of <130/80 mm Hg.
Assessed changes in systolic and diastolic blood pressure from baseline in patients who completed at least three telephone visits with objective blood pressure logs.
Mean systolic blood pressure decreased by 16 ± 4 mm Hg and diastolic blood pressure decreased by 6 ± 7 mm Hg from the initial to final clinic visit.
Reductions in systolic blood pressure of ≥10 mm Hg, ≥15 mm Hg, and ≥20 mm Hg were achieved by 65%, 53%, and 44% of patients, respectively.
Significantly fewer patients had systolic blood pressure ≥150 mm Hg (P < 0.0002) and 140–149 mm Hg (P = 0.02) at their last visit compared with baseline.

Structured PICO

Does a fully virtual management system with pharmacist support reduce systolic blood pressure in patients with CKD and difficult-to-manage hypertension?

Population

55 Veterans Administration patients with uncontrolled hypertension and CKD who participated in a fully virtual management system.

Intervention

Fully virtual management system including a home BP monitor, daily home BP measurements communicated to the clinic, and telephone visits conducted by a clinical pharmacist every 4-12 weeks for BP medication adjustment, alongside usual nephrology care

Outcome

Change in SBP from baselinesurrogate

Main Result

Mean Difference: -16

Limitations

Selection and reporting bias because data are only for patients who met a certain threshold of home BP measurements.
Lack of intention-to-treat approaches.
Need for large RCTs with longer follow-up durations assessing cardiovascular, kidney, or mortality benefits.
Lack of large RCT design with longer follow-up durations
Lack of cardiovascular, kidney, or mortality endpoints
Selection and reporting bias due to inclusion of only patients who met a certain threshold of home BP measurements
Lack of intention-to-treat approach

Discussion

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Implication

A fully virtual management system utilizing home BP monitoring and pharmacist-led medication adjustments demonstrates feasibility and effectiveness in significantly reducing blood pressure among CKD patients with uncontrolled hypertension.

Cite This Study

Okpechi et al. (2023) conducted an editorial in Uncontrolled hypertension and chronic kidney disease (n=55). Fully virtual management system (telehealth and pharmacist management) vs. Baseline (initial visit) was evaluated on Change in systolic blood pressure (SBP) from baseline (MD -16). A fully virtual management system involving telehealth and pharmacist support resulted in a mean reduction in systolic blood pressure of 16 mm Hg from baseline in patients with CKD.

synapsesocial.com/papers/6a9d666c187e1fe57f29f8a1 https://doi.org/10.34067/kid.0000000000000156

Topics

Hypertension management

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Telehealth and Management Support for Hypertension in CKD: Time to Raise the Bar

Key Points

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Topics

Telehealth and Management Support for Hypertension in CKD: Time to Raise the Bar

Key Points

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider