Assessment of the clinical efficacy of telemonitoring and distant counseling in patients with uncontrolled hypertension

Abstract

The aim of the study was to investigate the mathematical correlation of the clinical efficacy of blood pressure telemonitoring and distant counseling (BPTM) in patients in uncontrolled hypertension (HTN). Telehealth tools are widely used in HTN management. However clinical efficacy of such interventions assessed mainly in groups investigated without its populational and attributable impact. Materials and methods. The total of 240 patients were included, then randomized in 2:1 manner to BPTM group (n=160, median age 47 y.o.) and control group (n=80, median age 49 y.o). The user-friendly and secure telehealth software was provided with mobile application (patients) and desktop (doctors) platforms which allowed storage and analysis of self-BP monitoring data and remote consultations. A three-month surveillance was designed with mandatory baseline and final face-to-face visits with the assessment of office systolic BP (oSBP). Mathematical evaluation was based on target SBP rates achieved in comparator groups and included the absolute efficacies (AE), the attributable efficacy (AtE), the relative efficacy (RE) and the population attributable efficacy (PAtE). Results. BPTM group characterized by larger decrease in SBP level compared with controls (–16.8±2.9 mm Hg versus –7.9±3.9 mm Hg; р<0.001). There were 120 and 16 patients with SBP on target by the end of the study in BPTM and control group respectively (AE 75±6.7% versus 20±8.8%, p<0.001). AtE was found to be 55.0±11.3%; RE was estimated as 3.75 (95% CI 1.94–5.56) and PAtE was found to be 36.7% (95% CI 24.1–49.2). Number needed to treat to achieve target BP with BPTM was estimated as 1.8. Conclusion. Implementing BPTM into management strategy significantly increases the likelihood of BP control. The results of the study indicate a pronounced effect of BPTM on the achievement of target BP.