Difficult-to-control hypertension: identification of clinical predictors and use of ICT-based integrated care to facilitate blood pressure control.

Authors:
Rosa Finelli
Rosa Finelli
University of Salerno
Fisciano | Italy
Antonietta Valeria Pascale
Antonietta Valeria Pascale
Università degli Studi di Salerno
Italy
Pietro Mazzeo
Pietro Mazzeo
Università degli Studi di L'Aquila
Italy
Valentina Trimarco
Valentina Trimarco
Department of Clinical Medicine
Italy
Maddalena Illario
Maddalena Illario
University of Naples Federico II
Napoli | Italy
Michele Ciccarelli
Michele Ciccarelli
University of Salerno
Fisciano | Italy

J Hum Hypertens 2018 Jul 1;32(7):467-476. Epub 2018 May 1.

Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.

Difficult-to-control (DTC) hypertension represents a burden in real life that can be partially solved through identification of the characteristics of clinical patterns and tailoring antihypertensive strategies, including ICT-enabled integrated care (ICT-IC). In the quest for clinical predictors of DTC hypertension, we screened 482 hypertensive patients who were consecutively referred to the departmental hypertension clinic. Following a data quality check, patients were divided into controlled (C, 49.37%) and uncontrolled (UC, 50.63%) groups based on their systolic blood pressure (BP) at follow-up. We then performed statistical analysis on the demographic, clinical, laboratory, and ultrasound data and observed that older age, female sex, higher BP levels, and a family history of hypertension were predictors of DTC hypertension. We then developed a pilot service of ICT-IC, including weekly home visits by nurses and patient education on self-monitoring of BP, heart rate, body weight, and oxygen saturation using 3G-connected devices. Self-monitored data were transmitted to the hospital servers on the electronic chart of the patient for remote assessment by the hospital hypertension specialists. A total of 20 UC patients (M/F = 10/10; age: 72.04 ± 2.17 years) were enrolled to verify the efficacy of BP control without changes in medical treatment. After 1 month of the ICT-IC program, BP was reduced both at the office assessment (systolic BP (SBP): 162.40 ± 2.23 mm Hg, beginning of the program vs. 138.20 ± 4.26 mm Hg at 1 month, p < 0.01) and at home (SBP: 149.83 ± 3.44, beginning of the program vs. 134.16 ± 1.67 mm Hg at 1 month, p < 0.01). We concluded that DTC hypertension can be predicted based on the clinical characteristics at the first visit. For these patients, ICT-IC is a feasible therapeutic strategy to achieve BP control.

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http://dx.doi.org/10.1038/s41371-018-0063-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057905PMC
July 2018
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