Achieving the target blood pressure level at home as part of personalized remote monitoring

Authors: Shvartz V.A., Sokolskaya M.A.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2024-18-4-437-446

For citation: Shvartz V.A., Sokolskaya M.A. Achieving the target blood pressure level at home as part of personalized remote monitoring. Creative Cardiology. 2024; 18 (4): 437–446 (in Russ.). DOI: 10.24022/1997-3187-2024-18-4-437-446

Received / Accepted:  08.10.2024 / 28.11.2024

Keywords: arterial hypertension remote monitoring m-Health telemedicine cardiovascular surgery

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Abstract

The purpose of this work – to assess the achievement of target blood pressure levels at home within the framework of the pilot study “Personalized remote monitoring of patients with cardiovascular pathology using modern information technologies”.

Materials and methods. The study included 50 patients, of whom 30 were men and 20 were women. The average age of the patients was 60±12 years. Patients used 3 personal digital devices at home: an ECG recorder, an automatic blood pressure monitor and a fitness bracelet for monitoring physical activity. Each device had its own smartphone application (on iOS or Android platforms), through which all measurement data was automatically sent to the server, where they were available at any time to the doctor through his personal account.

Results. The median follow-up was 29 (28; 31) months. During the first 12 months, 8 (16%) patients stopped being monitored. Baseline levels of SAD and DAD did not differ between the groups of patients who dropped out and patients who continued follow-up. The analysis of dynamics for different fractions of blood pressure levels showed statistically significant differences at different time points of the study. The median adherence across the cohort was 62 (40; 85)%. The group of patients with unsatisfactory adherence was statistically significantly more likely to have coronary heart disease, angina pectoris (myocardial infarction, coronary artery bypass grafting, percutaneous coronary interventions. Patients with cardiac arrhythmias and with surgical interventions for arrhythmias had significantly better adherence. The scores on the Morisky–Green test were higher in the group of satisfactorily committed: 2.7 (2; 4) points, versus 1.9 (1.5; 2.5) points in the group of unsatisfactorily committed.

Conclusion. Using self-measurement of blood pressure at home is an effective method in achieving target blood pressure levels. Comprehensive remote patient monitoring programs using multiple personal medical “assistants” have additional advantages because they lead to “synergy” type interaction, increasing the likelihood of using each other and increasing overall commitment. Validated questionnaires and psychological tests, screening evaluation and identification of insufficiently compliant patients in clinical practice are important.

References

  1. Kobalava Zh.D., Konradi A.O., Nedogoda S.V., Shlyakhto E.V., Arutyunov G.P., Baranova E.I. et al. Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020; 25 (3): 3786 (in Russ.). DOI: 10.15829/1560-4071-2020-3-3786
  2. Mancia G., Kreutz R., Brunström M., Burnier M., Grassi G., Januszewicz A. et al. 2023 ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J. Hypertension. 2023; 41: 12: 1874–2071. DOI: 10.1097/HJH.0000000000003480
  3. Chulkov V.S., Martynov A.I., Kokorin V.A. Hypertension in pregnancy: controversial issues of national and international guidelines. Russian Journal of Cardiology. 2020; 25 (4S): 4181 (in Russ.). DOI: 10.15829/1560-4071-2020-4181
  4. Gridnev V.I., Kiselev A.R., Posnenkova O.M., Popova Yu.V., Lazareva N.V., Belova O.A. et al. Objectives and design of russian registry of hypertension, coronary artery disease, and chronic heart failure. Russian Open Medical Journal. 2017; 6: e0201.
  5. Choudhry N.K., Kronish I.M., Vongpatanasin W., Ferdinand K.C., Pavlik V.N., Egan B.M. et al.; American Heart Association Council on Hypertension; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Medication Adherence and Blood Pressure Control: A Scientific Statement From the American Heart Association. Hypertension. 2022; 79 (1): e1–e14. DOI: 10.1161/HYP.0000000000000203
  6. Avanesyan G.A., Filatov А.G., Shalov R.Z. Atrial fibrillation and arterial hypertension. Annaly Aritmologii. 2022; 19 (4): 218–223 (in Russ.). DOI: 10.15275/annaritmol.2022.4.2
  7. Kiselev A.R., Schwarz V.A., Posnenkova O.M., Gridnev V.I., Dovgalevsky P.Ya., Oschepkova E.V., Evstifeeva S.E. Outpatient prophylaxis and treatment of arterial hypertension with application of mobile telephone systems and internet-techniques. Terapevticheskii Arkhiv. 2011; 83 (4): 46–52 (in Russ.).
  8. Lyapina I.N., Zvereva T.N., Pomeshkina S.A. Modern methods of remote monitoring and rehabilitation of patients with cardiovascular diseases. Complex Issues of Cardiovascular Diseases. 2022; 11 (1): 112–123 (in Russ.) DOI: 10.17802/2306-1278-2022-11-1-112-123
  9. Narita K., Hoshide S., Kario K. Polypill therapy for cardiovascular disease prevention and combination medication therapy for hypertension management. J. Clin. Med. 2023; 12 (23): 7226. DOI: 10.3390/jcm12237226
  10. Morozova M.A., Potanin S.S., Beniashvili A.G., Burminsky D.S., Lepilkina T.A., Rupchev G.E., Kibitov A.A. Validation of the Hospital Anxiety and Depression Scale Russian-language version in the general population. Russian Journal of Preventive Medicine. 2023; 26 (4): 7–14 (in Russ.). DOI: 10.17116/profmed2023260417
  11. Sokolskaya M.A., Shvartz V.A., Bockeria L.A. Evaluation of the use of personal wearable devices for self-registration of electrocardiography at home. Annaly Aritmologii. 2023; 20 (3): 194–206 (in Russ.). DOI: 10.15275/annaritmol.2023.3.8
  12. Sokolskaya M.A., Shvartz V.A., Bockeria L.A. Home monitoring system in patients undergoing cardiac surgery. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2021; 22 (S3): 100 (in Russ.).
  13. Sokolskaya M.A., Shvartz V.A., Bockeria L.A. A clinical case of diagnostics of sinus node dysfunction using a personal remote ECG monitoring system in a patient after surgical treatment of hypertrophic cardiomyopathy. Annaly Aritmologii. 2022; 19 (2): 110–115 (in Russ.). DOI: 10.15275/annaritmol.2022.2.7
  14. Sokolskaya M., Shvartz V.A., Bockeria O.L., Bockeria L.A. Home monitoring program for patients following cardiac surgery. Eur. Heart J. 2021; 42 (Suppl. 1): ehab724.3088. DOI: 10.1093/eurheartj/ehab724.3088
  15. Kiselev A.R., Gridnev V.I., Shvartz V.A., Posnenkova O.M., Dovgalevsky P.Y. et al. Active ambulatory care management supported by short message services and mobile phone technology in patients with arterial hypertension. J. Am. Soc. Hypertension. 2012; 6 (5): 346–355. DOI: 10.1016/j.jash.2012.08.001
  16. Götzinger F., Kunz M., Lauder L., Böhm M., Mahfoud F. Arterial hypertension – clinical trials update 2023. Hypertension Res. 2023; 46 (9): 2159–2167. DOI: 10.1038/s41440-02301359-y
  17. Li Y., Jiang Y., Tang Y. Is remote blood pressure monitoring and management a better approach for patients with hypertension? A narrative review. J. Clin. Hypertension (Greenwich, Conn.). 2023; 25 (2): 121–126. DOI: 10.1111/jch.14624
  18. Savova E.M., Zavarina A.Yu., Shvedunova V.N., Putyato N.A. Physical rehabilitation in children with congenital heart disease: current state of the problem. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2020; 21 (5): 474–487 (in Russ.). DOI: 10.24022/1810-0694-2020-21-5-474-487
  19. Bockeria L.A., Filatov A.G., Kakuchaya T.T., Dzhitava T.G., Kuular A.M., Filatova A.G. et al. The role of cardiac rehabilitation in patients with pacemakers. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2019; 20 (6): 491–497 (in Russ.). DOI: 10.24022/1810-0694-2019-20-6-491-497
  20. Dzhitava T.G., Shamsiev G.A., Abdulloev O.K., Filaretova O.V., Agafonov I.A., Kusraev G.A. et al. Determining factors of early rehabilitation of patients after open heart surgery. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2024; 66 (1): 99–112 (in Russ.). DOI: 10.24022/0236-2791-2024-66-1-99-112

About Authors

  • Vladimir A. Shvartz, Dr. Med. Sci., Leading Researcher, Professor of Chair; ORCID, e-mail: vashvartz@ya.ru
  • Mariya A. Sokolskaya, Cand. Med. Sci., Associate Professor of Chair, Researcher; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery