Effectiveness Of Home Blood Pressure Telemonitoring In Hypertensive Patients

We compared HBPT method with the traditional BP management method in the application in the Chinese hypertensive patients.Because of the limited comditions of the study for single-central,small sample sizes,different intervention methods and short follow-up times.So we collected foreign literatures about HBPT,and used Meta analysis software to comprehensive analysis the studies results.We hoped to provide scientific and reasonable guidance and basis for the use of HBPT in the clinical.This research was divided into two parts:Chapter Ⅰ Effectiveness of internet of things-based home blood pressure telemonitoring in the hypertensive patientsObjective To analysis the blood pressure telemonitoring based on chronic disease management system on BP control,medication adherence,life-quality and carry-over effect in the hypertensive patients.Methods:A total of 300 hypertensive patients were recruited from communities in Guangzhou,and were randomized into control(n =71)and intervention(n =71)group.The patients in the control group were treated with traditional care,and the patients in the intervention group were intervened with telemonitoring method that based on chronic disease management system for 12 months.Medication adherence and life-quality was respectively evaluated by Morisky scale and SF-12 scale before and after intervention.And in the 6 months wash-out period we aim to evaluate legacy effect of the telemonitorning.Results:At the end of 12 months blood pressure telemonitoring,blood pressure in the intervention group was significantly lower than the control group(P<0.05);And the control rates in intervention group were significantly higher than control group(P<0.05);Medication adherence was significantly higher for intervention group than control group(P<0.05);There were no difference between two group for life-quality.In the 6 months wash-out period,the outcomes of BP changes and medication adherence also showed a significantly improvement in the intervention group as well(all P<0.05).Conclusions:Compared with controls,BP telemonitoring method that based on chronic disease management system can more effectively increase BP control and improve medication adherence.Chapter Ⅱ Effectiveness of Home Blood Pressure Telemonitoring:A Systematic Review and Meta-analysis of Randomized Controlled StudiesObjective To summarize evidence about the effectiveness of home blood pressure telemonitoring(HBPT)and identify the key components of intervention.Methods:We comprehensively searched PubMed,EMBASE and the Cochrane Library for relevant studies.The authors were contacted for additional information.Two authors independently extracted the data and assessed the risk of bias.Results:46 randomized controlled trials(RCTs)including a total of 13 875 cases were identified.Compared to usual care,HBPT improved office systolic blood pressure(BP)and diastolic BP by 3.99 mmHg(95%CI:5.06 to 2.93;p<0.001)and 1.99 mmHg(95%CI:-2.60 to-1.39;p<0.001),respectively.A larger proportion of patients achieved BP normalization in the intervention group(RR:1.16;95%CI:1.08 to 1.25;p<0.001).For HBPT plus additional support(including counseling,education,behavioral management,medication management with decision,adherence contracts,etc.)versus HBPT alone(or plus less intense additional support),the mean changes in systolic and diastolic BP were 2.44 mmHg(95%Cl,4.88 to 0.00 mmHg;p=0.05)and 1.12 mmHg(95%CI,-2.34 to 0.1 mmHg;p=0.07),respectively.For those surrogate outcomes,low strength evidence failed to show difference.In the subgroup analysis,high strength evidence supports a lower BP with HBPT that lasted 6 or 12 months,used a computer,and accompanied with counseling from study personnel.Conclusions:HBPT can improve BP control in the hypertensive patients.It may be more efficacious when using a modern and portable device and providing a proactive additional support during the process of the intervention.