Advantages of Remote Blood Pressure Monitoring in Patients with Arterial Hypertension Undergoing Outpatient Observation in a City Polyclinic
Aim. To evaluate the effectiveness of outpatient monitoring of patients with arterial hypertension using an automatic remote blood pressure (BP) monitoring system and compare it with the effectiveness of traditional self-monitoring of BP in a metropolitan urban clinic. Design. Prospective, interventional, randomized, open-label study. Materials and methods. We recruited 60 patients (40% men, aged 25–65 years, median age 59.5 [48.5; 69.0] years) undergoing outpatient monitoring with a diagnosis of stage 1 or 2 essential (primary) hypertension. Participants were randomized into two groups using the envelope randomization method. The main group consisted of 30 people who were given certified automatic tonometers for measuring BP with remote online data transmission to the physician's computer. The control group included 30 patients who measured their blood pressure at home using their own automatic tonometers and completed self-monitoring diaries. Pulse rate was recorded two or three times, simultaneously with blood pressure measurements. All patients underwent a comprehensive examination, including a general clinical and biochemical blood test, and a urinalysis. Adherence to therapy was assessed using the Morisky — Greene scale, and anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. The observation period was 6 months, during which two follow-up visits were conducted: on day 3 and at 180 ± 2 days, and a phone call at 90 ± 2 days. Results. When assessing the dynamics of office BP, a statistically significant decrease in systolic and diastolic BP was found in the main and in the control groups (for all indicators p < 0.001) at visit 3 compared with the values at visit 1. By visit 3, in the main group, target values of outpatient BP were achieved in 26 (86.7%) patients, while in the control group — in 23 (76.7%) (p = 0.011). In the main group, the number of patients prescribed drugs in the form of fixed-dose combinations increased from 15 (50%) to 22 (73.3%) people (p < 0.001), in the control group — from 15 (50%) to 19 (63.3%) people (p < 0.001). An intergroup comparison revealed a statistically significant difference in the frequency of taking fixed-dose combinations of AHT agents at visit 3: 22 (73.3%) patients in the main group and 19 (63.3%) patients in the control group (p = 0.005). In patients in the main group, the severity of anxiety (p = 0.016) and depression (p = 0.014) decreased significantly from visit 1 to visit 3, while in the control group — only depression (p = 0.036). According to the Morisky — Greene scale, adherence to therapy in the main group increased statistically significantly (p = 0.007). Improved adherence to treatment was noted in 29 (96.7%) patients. In an intergroup comparison at visit 3, the number of points on the Morisky — Greene scale was statistically significantly lower in the main group than in the control group: 1 [0; 1] versus 3 [2; 3] points (p = 0.001). Conclusion. Remote BP monitoring is a promising method that can significantly improve hypertension control in real-life clinical practice in patients aged 25–65 years. Keywords: telemedicine, telemonitoring, remote monitoring of blood pressure, dispensary observation, arterial hypertension