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

Abstract

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.

Fig. 1

Blood pressure and heart rate values telemonitored weekly (a–c) or measured before and after the intervention in the office (d–f). The self-measured telemonitored SBP was significantly different before and after the program, and this was true also for SBP in the office (a, d) (*p < 0.05). No difference was observed for the same patients who maintained follow-up for usual care

Fig. 2

Number of total compounds and types of antihypertensive drugs and other weekly telemonitored parameters in hypertensive patients before and after the ICT-IC home care program is shown. The graphs show that no changes were observed in the number of total drugs (A), antihypertensive drugs (B), Body weight (C), Body composition (D and E) and oxygen saturation (F).

Fig. 3

CVR before and after 1 month of intervention. Before the ICT-IC home care program (left graph), cardiovascular risk was statistically significantly higher than after the program (right graph) (*p < 0.05)