Оценка эффективности использования дистанционного мониторинга артериального давления при диспансерном наблюдении пациентов с артериальной гипертензией

Introduction. Arterial hypertension (AH) is one of the important high-risk factors for the development of heart diseases, but its diagnosis and treatment does not require high technologies and substantial costs. However, the asymptomatic course of AH combined with a low level of medical literacy contributes to low adherence to treatment.Aim. To study the indirect impact of remote blood pressure monitoring (RBPM), the introduction of educational materials (EMs) in comparison with self-monitoring of blood pressure (SMBP) on adherence of patients with AH to outpatient treatment.Materials and methods. 60 subjects with an established fact of partial or complete refusal to use antihypertensive therapy were enrolled in the study and randomized into four equal and comparable groups: 1 – SMBP, 2 – RBPM, 3 – SMBP + EMs, 4 – RBPM + EMs. The impact of using RBPM was assessed by comparing blood pressure values in groups 1 and 2; the impact of EM – by comparing the results of questionnaire surveys in groups 1 and 2 and groups 3 and 4.Results and discussion. Additional training of patients with AH contributed to a twofold increase in adherence in using SCAD and RBPM. The average systolic blood pressure in groups 1 and 2 was 134 mm Hg, in groups 3 and 4 – 129 mm Hg; diastolic blood pressure in groups 1 and 2 – 78.5 mm Hg, in groups 3 and 4 – 77.5 mm Hg.Conclusion. The maximum impact on adherence to AH treatment can be achieved with the introduction of a set of measures. However, the introduction of RBPM has a number of limitations associated with the additional economic burden and the lack of an approved methodology. However, the provision of treatment and prevention facilities with EMs does not require additional development of methodology and is significantly cheaper than the cost of modern blood pressure monitors.

Objective — the main objective of the study is to test the hypothesis that achieving lower recommended target levels (LRT) of blood pressure (BP) in elderly and senile patients with arterial hypertension (HTN) will be no less safe than achieving higher recommended target levels (HRT) of BP in elderly and senile patients with HTN, which will be assessed using home BP measurement data and a remote monitoring system for the effectiveness and safety of antihypertensive therapy. Design and methods. The study is expected to include 60 patients aged 65 years and older, who will be randomly assigned to the LRT or HRT BP group with the achievement of recommended target levels of SBP (according to home BP measurement data) of less than 125 or less than 135 mmHg. The effectiveness of the intervention will be assessed by the following indicators: the frequency of episodes of arterial hypotension (SBP less than 100 mmHg) with or without clinical manifestations; frequency of fainting or pre-syncope; frequency of falls in general and traumatic falls; assessment using the AHT tolerability scale (scale developed by Duarte-Silva D. et al., 2014); assessment of quality of life using the disease- specific Quality of Life Questionnaire on Hypertension scale; duration of the period during which SBP will be in the therapeutic range as a percentage of the total observation period. In addition, it is supposed to assess the indicators of frailty and indicators of cognitive functions. The analysis of the obtained data will be performed using the Win Ratio method in a hierarchical order. Expected results. The study will provide data on the possibilities of remote monitoring with the selection of AHT in individuals aged 65 years and older in order to achieve target BP levels, as well as information on the tolerability of AHT when it is selected in order to achieve lower recommended BP levels in such patients.

Remote blood pressure telemonitoring in hypertensive pregnancies: Feasibility and preliminary outcomes from a regional program.

Aim.To assess the effects of moxonidine-based combination therapy on clinical status, laboratory parameters, and target organs in patients with metabolic syndrome (MS).Material and methods.In total, 60 MS patients with Stage 1-2 arterial hypertension (AH) were randomised into 3 groups. Group I was administered moxonidine (0,2-0,4 mg/d) and amlodipine (5-10 mg/d); Group II received moxonidine (0,2-0,4 mg/d) and hydrochlorothiazide (12,5 mg/d); Group III was treated with moxonidine (0,2-0,4 mg/d) and enalapril (10-20 mg/d). At baseline and after 24 weeks of treatment, the following characteristics were assessed: waist circumference (WC), body mass index (BMI), 24-hour blood pressure monitoring (BMP) parameters, left ventricular myocardial mass index (LVMMI), E/A ratio, isovolumetric relaxation time (IVRT), deceleration time (DT) of early diastolic velocity, peak Em velocity at interventricular septum and lateral wall levels, E/Em ratio (myocardial tissue Doppler echocardiography), pulse wave velocity (PWV) between descending aorta and aortic bifurcation levels (ultrasound method), and stiffness index β of ascending aorta. In addition, lipid, carbohydrate, and purine metabolism parameters were assessed; glomerular filtration rate (GFR) was calculated (MDRD method); and urine albumin levels were measured.Results.In Group I (moxonidine + amlodipine), target blood pressure (BP) levels were achieved in 70% of the patients. Systolic BP (SBP) levels, LVMMI, and DT decreased by 19,3±11,4 mm Hg, 4,4 g/m2 (p=0,09), and 10,6 ms (p<0,05), respectively. The increase in E/A ratio and Em annular velocity (Em av) reached 0,4 (p<0,05) and 1,4 cm/s (p<0,05), respectively, while E/Em av ratio decreased by 0,8 (p<0,05), and PWV decreased by 1,6 ms (p<0,05). The BMI decrease reached 0,7 kg/m2 (p<0,05). In Group II (moxonidine + hydrochlorothiazide), target BP levels were achieved in 40% of the participants, with a decrease in SBP levels by 14,7 mm Hg (p<0,05). DT was reduced by 9,4 ms (p<0,05), E/A ratio increased by 0,1 (p<0,05), while PWV, BMI, and GFR decreased by 1,3 m/s (p<0,05), 0,8 kg/m2 (p<0,05), and 5,6 ml/min/1,73 m2 (p<0,05), respectively. In Group III (moxonidine + enalapril), 60% of the patients achieved target BP levels, and SBP levels were reduced by 21,1 mm Hg (p<0,05). LVMMI decreased by 5,1 g/m2 (p<0,05), Em av increased by 0,3 cm/s (p<0,05), while the respective reduction in PWV, WC, and BMI reached 1,1 m/s (p<0,05), 1,8 cm (p<0,05), and 0,5 kg/m2 (p<0,05). All three groups demonstrated a significant reduction in urine albumin levels.Conclusion.The moxonidine-based combination therapy effectively reduced the levels of BP and urine albumin. The combination of moxonidine with amlodipine or enalapril improved cardiac structure and function, as well as renal excretory function. The combination of moxonidine and hydrochlorothiazide, however, negatively affected renal excretion. All three variants of combination therapy were metabolically neutral and demonstrated beneficial effects on visceral obesity.

A cross-sectional study was conducted of 404 diabetic patients attending King Abdulaziz University Hospital medical clinic from June 1998 to January 2000 in order to determine their rates of reaching target levels for blood glucose, blood pressure, serum lipids and body mass index. Greatest difficulty was found in reaching target levels for low-density lipoprotein and glycated haemoglobin. Target levels for blood pressure were harder to achieve for Saudis than non-Saudis. Significantly fewer females reached target levels for blood glucose, body mass index, low-density lipoprotein or all targets than males [both Saudi and non-Saudi]. Efforts are needed to improve compliance to diet and drug regimens and to identify and treat risk factors in each patient.

Aim. To study the effect of «treat-to-target» antirheumatic therapy on diastolic dysfunction of the left (DDLV) and right (DDLV) ventricles in patients with early rheumatoid arthritis (RA) during 18 months of observation. Material and methods. The study included patients with early RA (n=66; 71% women; age - 56 [46; 61] years) with moderate/high activity (DAS28 5.3 [5.0; 6.2]), seropositive on rheumatoid factor (77%) and/or cyclic citrullinated peptide antibodies (100%), disease modifying anti-rheumatic drugs (DMARD) and glucocorticoids naive. Treatment with methotrexate (MTX) with the escalation of the dose up to 25-30 mg/week subcutaneously was initiated in all the patients. After 3 months in 47 (71%) patients biologics were added to MTX due to its inefficiency. In 18 months remission of RA was achieved in 44% of the patients. 51 (77%) patients had a cardioprotective therapy. The target blood pressure (BP) level was achieved in 38 (58%) patients. Evaluation of traditional cardiovascular risk factors, 24-hour BP monitoring and echocardiography were performed in all patients initially and in 18 months of MTX/MTX + biologics use. Results. After 18 months DDLV incidence decreased by 7% (from 49% to 42%; p>0.05) and DDRV incidence decreased by 5% (from 24% to 17%; p>0.05). A more significant decrease in DDLV incidence [from 23 (62%) to 18 (49%)] and of DDRV incidence (from 12 (32%) to 6 (16%)] (р=0.05), was found in MTX + biologics group than in MTX only group [DDLV incidence remained unchanged - 7 (28%), and DDRV incidence increased from 3(12%) to 4 (16%); p>0.05]. The normalization of left ventricle (LV) diastolic function in early RA patients depended primarily on the efficacy of antihypertensive treatment, and of right ventricle (RV) diastolic function - on the achievement of target BP level and RA remission. Reduced erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) plasma levels were associated with the improved LV diastolic function [E/A LV and ΔESR (r=-0,3; p<0,04), E/A LV and CRP (r=-0,2; p<0.05), A LV and ESR (r=0.3; p<0.01)] and improved RV diastolic function [ΔA RV and ΔCRP (r=0.4; p<0.003), ΔE RV and ΔCRP (r=0.3; p<0.01), E/A RV and DAS28 (r=-0.5; p<0.001), E/A RV and CRP (r=-0,3; p<0.05)] by the 18th month of the study. Conclusion. In early RA patients after 18 months the downward trend of DDLV incidence and a significant reduction of DDRV incidence were found, more expressed in patients treated with MTX + biologics. The achievement of RA remission and target BP level is a prerequisite for the normalization of LV and RV diastolic function and slowing the progression of heart failure.

Aim. To study the pharmacoepidemiological features of the prescription of antihypertensive fixed dose combinations and their efficacy in hypertensive patients in the real outpatient practice in Vladivostok city. Material and methods . Hypertensive patients aged 1 8 years and older (n=268) observed in Vladivostok polyclinics from October to December 2017 were included into the study. All patients did not have target blood pressure (BP) levels. The analysis of the medical prescriptions of antihypertensive fixed dose combinations in Vladivostok polyclinics was performed. Two-component (perindopril + amlodipine) or three-component (perindopril + amlodipine + indapamide) fixed dose combinations were prescribed by physician in accordance with instructions for medical use and their pharmacological characteristics. The study was non-interventional and included 3 visits for the initial examination, prescription and correction of therapy, considering its efficacy. All patients were determined for glomerular filtration rate using CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration Formula), changes in BP. Patients performed self-esteem on a 1 0-point visual analogue scale (VAS). Results. Only 23.4% of patients reached target BP levels in the first month of observation, and 84.5% of patients after 3 months of observation. 30 (1 1.2%) patients had replacement with double antihypertensive fixed dose to triple combination combinations during the study. 68.6% of patients did not have a replacement for the initial prescribed antihypertensive fixed dose combinations due to the achievement of target BP. The number of patients with moderately and markedly reduced glomerular filtration rate was reduced significantly. Initially, the patients included into the study assessed health (according to adapted VAS) for 5.6±1.4 points, and after 3 months of follow-up - for 7.9±1.7 points. Conclusion. The use of antihypertensive fixed dose combinations containing ACE inhibitor (perindopril), calcium channel blocker (amlodipine) and thiazide-like diuretic (indapamide) resulted in achievement of target BP levels in 84.5% of patients after 3 months of follow-up. Also, the use of double and triple fixed dose combinations had a nephroprotective effect, manifested in an increase in the number of patients ( + 19.3%) with a glomerular filtration rate more than 60 ml/min/1,73 м 2 and a positive effect on the patient's well-being.

900 The impact of postpartum blood pressure monitoring amongst women with hypertensive disorders of pregnancy

Актуальность. Сочетанное течение первичной артериальной гипертензии (АГ) и абдоминального ожирения (АО) характеризуется рефрактерностью к антигипертензивной терапии и значительным повышением сердечно-сосудистого риска. Перспективным подходом к терапии данных больных является раннее применение фиксированных комбинаций антигипертензивных препаратов первой линии. Цель работы состояла в исследовании эффективности фиксированной комбинации периндоприла, индапамида и амлодипина в сравнении с нефиксированной комбинацией указанных препаратов у больных с АГ в сочетании с АО. Материалы и методы. Обследованы 75 больных с АГ II–III степени в сочетании с АО І–ІІ степени (45 мужчин и 30 женщин) в возрасте от 48 до 66 лет. Все больные были разделены на две подгруппы в зависимости от вида антигипертензивной терапии. Первая подгруппа больных (26 пациентов) получала нефиксированную комбинацию периндоприла, индапамида и амлодипина. Вторая подгруппа (29 больных) получала фиксированную комбинацию указанных препаратов. Обследование проводили до начала лечения и через 3, 6 и 9 месяцев. В качестве гиполипидемического препарата все больные получали аторвастатин в суточной дозе 20 мг. Указанная терапия проводилась на фоне рекомендаций по коррекции образа жизни. Результаты. Установлено, что частота достижения целевых уровней артериального давления (АД) у больных, которые получали фиксированную комбинацию препаратов, через 9 месяцев лечения была достоверно выше, чем у больных, которые получали нефиксированную комбинацию. По данным суточного мониторирования АД, фиксированная комбинация назначенных препаратов значительно лучше нормализовала такие параметры, как среднесуточное и среднедневное диастолическое АД (ДАД), средненочное систолическое АД (САД) и ДАД, а также степень ночного снижения и среднесуточную вариабельность САД и ДАД. Апробированная трехкомпонентная фиксированная комбинация давала возможность достичь целевых уровней АД на более низких дозах примененных компонентов, чем нефиксированная комбинация. Выводы. Фиксированная комбинация периндоприла, индапамида и амлодипина в сравнении с нефиксированной у больных АГ в сочетании с АО проявляет достоверно большую антигипертензивную эффективность по данным как офисного измерения АД, так и суточного мониторирования АД на фоне большей приверженности больных к лечению. Для достижения целевых уровней АД у больных АГ в сочетании с АО требуются более низкие дозы компонентов фиксированной комбинации, чем нефиксированной.

Guidelines recommend using telehealth for hypertension management, but insufficient evidence is available to guide strategies for incorporating telehealth data into clinical practice. To describe how primary care teams responded to elevated remote blood pressure (BP) alerts in the electronic health record (EHR) in a randomized clinical trial of BP telemonitoring conducted in routine practice settings. This retrospective cohort study reviewed EHR documentation from May 8, 2018, to August 9, 2019, in a single urban academic family practice site. Primary care teams comprising 28 attending physicians and nurse practitioners, residents, and nurses cared for 162 patients in a text-based clinical trial of remote BP monitoring remote BP monitoring. Data were analyzed from October 21, 2019, to April 30, 2021. Clinicians received a direct message in their EHR inbox when patients submitted at least 3 elevated BP readings. Categories and frequencies of clinician action, created via review of EHR-documented clinician responses to EHR alerts by 2 physicians. Patients in this study (n = 162) were predominantly female (111 [68.5%]) and Black or African American (146 [90.1%]), whereas attending physicians (n = 21) were predominantly female (13 [61.9%]) and non-Hispanic White (19 [90.5%]) with a mean (SD) age of 51.6 (11.1) years. Five hundred fifty-two alerts fell into 12 categories of clinical actions. Clinicians acted on 343 alerts (62.1%). Common remote activities were to reconcile medications and assess adherence (120 of 552 alerts [21.7%]) and verify BP measurement technique (65 of 552 alerts [11.8%]). Clinicians also commonly requested appointments (120 of 552 alerts [21.7%]) and/or saw the patient in a subsequent office visit (114 of 552 alerts [20.7%]). Ninety-six alerts (17.4%) resulted in medication changes; half of these changes were remote (48 of 96 [50.0%]), and the other half were visit-based. For 209 of 552 alerts (37.9%), no changes were made to the care plan, typically without documenting clinical rationale (196 of 209 instances [93.8%]). Exploratory EHR review was used to infer potential clinical rationale for 106 (54.1%) of such cases, but there was insufficient information for the remaining 90 (45.9%). These findings suggest that EHR alerts for elevated BP during remote monitoring were effective in prompting a mix of remote and office-based management. It was also common for the plan of care to remain unchanged, possibly suggesting need for more refined alerts and improved clinician support.

Purpose: To evaluate the achievement of target blood pressure (BP) level in patients with coronary heart disease and hypertension who were under follow-up of cardiologists of the State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative Department Materials and methods: We evaluated 1120 electronic medical records (medical software program “ESCUL’ap”) and carried out an analysis of target BP level’s achievement in 512 patients with coronary heart disease and hypertension who were under follow-up of cardiologists of the Therapeutic department of our institution and were reviewed by a cardiologist in 2019. The percentage of female patients was 30,1±2,0%. Patient`s age ranged from 37 to 91 years, the mean age was 72,1±0,4 years, 72,8±0,6 years in woman and 71,8±0,4 years in mans. We used statistical software programs (Statistica v. 6.0) and Microsoft Excel 2007 applications for data analysis. Categorical data were presented as absolute and relative (%) frequency. To enable comparisons, we calculated the mean value (M), and the the standard error of the mean (m). Student's t-test was used to compare the mean of data for groups. Results and discussion: According to data of the medical records the target level of BP (&lt;140/90 mm Hg) was attained in 343 of 512 patients (67,0±2,1%) – in 70,1±2,4% of male patients and 59,7±4,0% of women (р&gt;0,05). The highest rate of target BP achievement – 83,3±6,8% – was in 50-59 years old, the lowest – 61,5±3,2% – in 70-79 years old. Our results were significantly better than in the EUROASPIRE IV survey – according to the results of this study the target BP levels were achieved only by 38% of men and 47% of women in Ukraine and by 35% of men and 48% of women in other European countries. Conclusions. Our study demonstrates that 67,0±2,1% (70,1±2,4% of mans and 59,7±4,0% of women) of patients with coronary heart disease and hypertension who were under follow-up of cardiologists achieved the target level of BP (&lt;140/90 mm Hg). These data confirms the effectiveness of the model of medical care for patients with hypertension, introduced in the State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative Department

Goal: to study the effectiveness of combination antihypertensive therapy (AHT) and its influence on the indices characterizing the arterial stiffness of various types in patients with arterial hypertension (AH) in combination with obesity and severe obstructive sleep apnea (OSA). Material and methods. The study included 27 male patients with hypertension [143.0 (142.0; 150.0)/91.0 (85.3; 94.8) mm Hg. century], obesity [body mass index of 33.8 (32.0; 37.2) kg/m2] and OSA was severe [the index of apnea/hypopnea - AHI - 46.8 (33.3; 63.4) events per hour] who underwent AHT titration to achieve target values of blood pressure (BP), a fixed combination of the calcium antagonist amlodipine (10 mg) and the angiotensin-converting enzyme inhibitor perindopril (5-10 mg). At baseline and after 4-6 weeks when reaching target blood pressure was assessed pulse wave velocity (PWV) using different instrumental techniques. Carotid-femoral PWV (CFSP) was determined by applanation tonometry (SphygmoСor AtCor, Australia), aortic PWV - ultrasonic technique in the descending aorta (thoracic spine), the ankle-brachial PWV - using volumetric sphygmography (VaseraVS-1000 Fukuda Dens, Japan). Results. The target pressure (according to clinical blood pressure, daily monitoring blood pressure) on the background of amlodipine 10 mg and perindopril 5 mg was 58% patients and 42% of patients reached the target level of blood pressure against the background amlodipine 10 mg and perindopril 10 mg. On a background of 4-6 weeks of admission AHT 33.8% increase in the number of patients with a normal circadian profile of blood pressure - «dipper». Upon reaching the target blood pressure revealed a significant decrease CFSP, ankle-brachial PWV and aortic PWV 11.4, 11.0 and 15.4%, respectively. Conclusion. A fixed combination of perindopril arginine and amlodipine in patients with arterial hypertension of the 1st degree in the presence of obesity and OSA allows achieving a good level of BP control, to improve the performance of the daily profile and to improve the elastic properties of large arteries, which has a beneficial protective effect in these patients.

Measuring blood pressure (BP) at home and remote monitoring can improve the patient’s adherence to BP control and vascular outcomes. This study evaluated the feasibility of a trial regarding the effects of an intensive mobile BP management strategy versus usual care in acute ischemic stroke patients. A feasibility-testing, randomized, open-labeled controlled trial was conducted. Remote BP measurement, data transmission, storage, and centralized monitoring system were organized through a Bluetooth-equipped sphygmomanometer paired to the participants’ smartphones. Participants were randomized equally into intensive management (behavioral intensification to measure BP at home by texting, direct telephone call, or breakthrough visit) and control (usual care) groups. The primary feasibility outcomes were: 1) recruitment time for the pre-specified number of participants, 2) retention of participants, 3) frequency of breakthrough visit calls, 4) response to breakthrough visit call, and 5) proportions satisfying BP measurement criteria. Sixty participants were randomly assigned to the intensive management (n = 31) and control (n = 29) groups, of which 57 participants were included in the primary analysis with comparable baseline characteristics. Recruitment time from the first to the last participant was 350 days, and 95% of randomized participants completed the final visit (intensive, 94%; control, 98%). Eight breakthrough visit calls were made to 7 participants (23%), with complete and immediate responses within 3 ± 4 days. The median of half-day blocks fulfilling the BP measurement criteria per patient were 91% in the intensive group and 83% in the control group (difference, 12.2; 95% confidence interval, 2.2–22.2). No adverse events related to the trial procedures were reported. The intensive monitoring, including remote BP measurement, data transfer, and centralized monitoring system, engaged with behavioral intensification was feasible if the patients complied with the intervention. However, the device utilized would need further improvement prior to a large trial.

Measuring blood pressure (BP) at home and remote monitoring can improve the patient's adherence to BP control and vascular outcomes. This study evaluated the feasibility of a trial regarding the effects of an intensive mobile BP management strategy versus usual care in acute ischemic stroke patients. A feasibility-testing, randomized, open-labeled controlled trial was conducted. Remote BP measurement, data transmission, storage, and centralized monitoring system were organized through a Bluetooth-equipped sphygmomanometer paired to the participants' smartphones. Participants were randomized equally into intensive management (behavioral intensification to measure BP at home by texting, direct telephone call, or breakthrough visit) and control (usual care) groups. The primary feasibility outcomes were: 1) recruitment time for the pre-specified number of participants, 2) retention of participants, 3) frequency of breakthrough visit calls, 4) response to breakthrough visit call, and 5) proportions satisfying BP measurement criteria. Sixty participants were randomly assigned to the intensive management (n = 31) and control (n = 29) groups, of which 57 participants were included in the primary analysis with comparable baseline characteristics. Recruitment time from the first to the last participant was 350 days, and 95% of randomized participants completed the final visit (intensive, 94%; control, 98%). Eight breakthrough visit calls were made to 7 participants (23%), with complete and immediate responses within 3 ± 4 days. The median of half-day blocks fulfilling the BP measurement criteria per patient were 91% in the intensive group and 83% in the control group (difference, 12.2; 95% confidence interval, 2.2-22.2). No adverse events related to the trial procedures were reported. The intensive monitoring, including remote BP measurement, data transfer, and centralized monitoring system, engaged with behavioral intensification was feasible if the patients complied with the intervention. However, the device utilized would need further improvement prior to a large trial.

Decisions about antihypertensive treatment should focus on reducing cardiovascular risk