Sakulsupsiri Anut, Chattranukulchai Pairoj, Siwamogsatham Sarawut, Boonchayaanant Patchaya, Naeowong Witthawat, Ariyachaipanich Aekarach, Lertsuwunseri Vorarit, Rungpradubvong Voravut, Satitthummanid Sudarat, Puwanant Sarinya, Srimahachota Suphot, Buddhari Wacin, Boonyaratavej Smonporn, Sitthisook Surapun, Shantavasinkul Prapimporn, Buranakitjaroen Peera, Sukonthasarn Apichard, Sangwatanaroj Somkiat
Pharmacy Department, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand.
Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand.
Int J Hypertens. 2021 Apr 14;2021:8844727. doi: 10.1155/2021/8844727. eCollection 2021.
Several interventions have been proposed to improve hypertension control with various outcomes. The home blood pressure (HBP) measurement is widely accepted for assessing the response to medications. However, the enhancement of blood pressure (BP) control with HBP telemonitoring technology has yet to be studied in Thailand.
To evaluate the attainment of HBP control and drug prescription patterns in Thai hypertensives at one year after initiating the TeleHealth Assisted Instrument in Home Blood Pressure Monitoring (THAI HBPM) nationwide pilot project.
A multicenter, prospective study enrolled treated hypertensive adults without prior regular HBPM to obtain monthly self-measured HBP using the same validated, oscillometric telemonitoring devices. The HBP reading was transferred to the clinic via a cloud-based system, so the physicians can adjust the medications at each follow-up visit on a real-life basis. Controlled HBP is defined as having HBP data at one year of follow-up within the defined target range (<135/85 mmHg).
A total of 1,177 patients (mean age 58 ± 12.3 years, 59.4% women, 13.1% with diabetes) from 46 hospitals (81.5% primary care centers) were enrolled in the study. The mean clinic BP was 143.9 ± 18.1/84.3 ± 11.9 mmHg while the mean HBP was 134.4 ± 15.3/80.1 ± 9.4 mmHg with 609 (51.8%) patients having HBP reading <135/85 mmHg at enrollment. At one year of follow-up after implementing the HBP telemonitoring, 671 patients (57.0%) achieved HBP control. Patients with uncontrolled HBP had a higher prevalence of dyslipidemia and greater waist circumference than the controlled group. The majority of uncontrolled patients were still prescribed only one (36.0%) or two drugs (34.4%) at the end of the study. The antihypertensive drugs were not uptitrated in 136 (24%) patients with uncontrolled HBP at baseline. Calcium channel blocker was the most prescribed drug class (63.0%) followed by angiotensin-converting enzyme inhibitor (44.8%) while the thiazide-type diuretic was used in 18.9% of patients with controlled HBP and 16.4% in uncontrolled patients.
With the implementation of HBP telemonitoring, the BP control rate based on HBP analysis was still low. This is possibly attributed to the therapeutic inertia of healthcare physicians. Calcium channel blocker was the most frequently used agent while the diuretic was underutilized. The long-term clinical benefit of overcoming therapeutic inertia alongside HBP telemonitoring needs to be validated in a future study.
已经提出了几种干预措施来改善高血压控制情况，并产生了各种结果。家庭血压（HBP）测量被广泛用于评估药物治疗反应。然而，HBP远程监测技术对血压（BP）控制的改善作用在泰国尚未得到研究。
在全国范围内开展的家庭血压监测远程医疗辅助仪器（THAI HBPM）试点项目启动一年后，评估泰国高血压患者的HBP控制达标情况和药物处方模式。
一项多中心前瞻性研究纳入了此前未进行过常规HBP测量的接受治疗的高血压成年患者，使用经过验证的同一示波法远程监测设备每月进行一次自我HBP测量。HBP读数通过基于云的系统传输到诊所，以便医生在每次随访时根据实际情况调整药物。控制良好的HBP定义为随访一年时的HBP数据在规定目标范围内（<135/85 mmHg）。
来自46家医院（81.5%为初级保健中心）的1177例患者（平均年龄58±12.3岁，59.4%为女性，13.1%患有糖尿病）纳入研究。诊所平均血压为143.9±18.1/84.3±11.9 mmHg，而平均HBP为134.4±15.3/80.1±9.4 mmHg，609例（51.8%）患者在入组时HBP读数<135/85 mmHg。在实施HBP远程监测一年后的随访中，671例患者（57.0%）实现了HBP控制。HBP未得到控制的患者血脂异常患病率更高，腰围也比控制组更大。在研究结束时，大多数未得到控制的患者仍仅服用一种（36.0%）或两种药物（34.4%）。136例（24%）基线时HBP未得到控制的患者未增加抗高血压药物剂量。钙通道阻滞剂是最常处方的药物类别（63.0%），其次是血管紧张素转换酶抑制剂（44.8%），而噻嗪类利尿剂在HBP得到控制的患者中使用率为18.9%，在未得到控制的患者中为16.4%。
随着HBP远程监测的实施，基于HBP分析的血压控制率仍然较低。这可能归因于医护人员的治疗惰性。钙通道阻滞剂是最常用的药物，而利尿剂未得到充分利用。克服治疗惰性与HBP远程监测相结合的长期临床益处需要在未来的研究中得到验证。
