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. 2025 Jul 22:S1109-9666(25)00175-7.
doi: 10.1016/j.hjc.2025.07.003. Online ahead of print.

Electronic health care records, automated blood pressure measurements, and reminders to healthcare professionals for improving blood pressure control in treated patients with hypertension in clinical practice: PHIDIAS randomized study

Anastasios Kollias  1 , Konstantinos Karakousis  2 , Vassileios Kotsis  3 , Melpomeni Ntalapascha  4 , Periklis Ntavlouros  5 , Evangelos Pisimisis  6 , Christos Savopoulos  7 , Panagiotis Semertzidis  8 , Konstantinos Tsioufis  9 , George S Stergiou  10 ; PHIDIAS Study Group
Collaborators, Affiliations
Free article

Electronic health care records, automated blood pressure measurements, and reminders to healthcare professionals for improving blood pressure control in treated patients with hypertension in clinical practice: PHIDIAS randomized study

Anastasios Kollias et al. Hellenic J Cardiol. .
Free article

Abstract

Objective: To investigate the impact of using electronic case report forms (eCRFs), automated blood pressure (BP) measurements, and reminders to healthcare professionals for improving BP control in treated patients with hypertension in clinical practice.

Methods: Primary care and hospital outpatient clinics were randomized to assess consecutive treated patients with hypertension at baseline and after 8-12 weeks using a standard eCRF (control) or an upgraded version with automated reminders to healthcare professionals for their patients with uncontrolled hypertension (active). At each visit, triplicate office BP measurements (Microlife BPA3 PC) were automatically uploaded to a cloud platform. Physicians were encouraged to follow the European Society of Hypertension guidelines.

Results: The analysis included 1344 patients (55% men, mean age 65.2 ± 11.8 [SD] years, 38%, 39%, 20% on 1, 2, 3 antihypertensive drugs, respectively, 49/51% in active/control arm). The control arm had a slightly higher baseline BP by 2.2 ± 1/0.3 ± 0.6 mmHg (systolic/diastolic, p < 0.05/NS) and lower control rate (33%) than the active arm (38%, p < 0.05). Treatment was intensified in 50/48% of patients with uncontrolled BP in the control/active arm (p = NS). The systolic BP decline tended to be larger in the active arm (by 2.1 mmHg, p = 0.06), with more frequent use of fixed-dose combinations (60/50%, p = 0.02). Hypertension control was considerably improved at follow-up in both arms, especially in the active versus control group (56/47%, p < 0.01). However, almost half of the participants remained uncontrolled in both arms.

Conclusion: The eCRFs, automated BP measurements, and reminders to healthcare professionals can help in improving hypertension control. However, physician inertia remains a common and persistent issue requiring more complex interventions.

Keywords: Automated blood pressure measurement; Electronic case report forms; Hypertension control; Inertia.

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Conflict of interest statement

Conflict of interest AK has received consulting fees by Astra-Zeneca, Boehringer In, Elpen, Menarini Hellas SA, Pfizer, Rafarm, Servier, Uni-Pharma, Vianex, Viatris, Winmedica. VK has received honoraria and other support from Astra-Zeneca, Boehringer-Ing, Elpen, Innovis, Menarini, Servier, Vianex, Viatris. CS received honoraria for advisory boards and lectures from Astra-Zeneca, Boehringer In, Elpen, Menarini, Pfizer, Winmedica. PS received research grants by Menarini and honoraria for advisory boards from Astra-Zeneca, Elpen, Novartis, Pfizer, Servier. KT received research grants by Medtronic, Recor, Recordatti and honoraria for advisory boards and lectures from Amgen, Astra-Zeneca, Bayer, Boehringer In, Chiesi, Medtronic, Menarini, Novartis, Pharmanel, Pfizer, Sanofi, Servier, Viatris. GSS received lecture fees, consulting fees and research grants by Astra-Zeneca, Menarini, Microlife, Sanofi-Aventis, Servier, Viatris. Other authors declared no competing interests.

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