Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Business Administration, College of Management, National Taiwan University, Taipei, Taiwan.
J Med Internet Res. 2022 Jan 10;24(1):e22957. doi: 10.2196/22957.
Hypertension is associated with a large global disease burden with variable control rates across different regions and races. Telehealth has recently emerged as a health care strategy for managing chronic diseases, but there are few reports regarding the effects of synchronous telehealth services on home blood pressure (BP) control and variability.
The objective of this study is to investigate the effect of synchronous telehealth services with a digital platform on home BP.
This retrospective study was conducted by the Taiwan ELEctroHEALTH study group at the Telehealth Center of the National Taiwan University Hospital. We analyzed home BP data taken from 2888 patients with cardiovascular disease (CVD) enrolled in our telehealth program between 2009 to 2017. Of the 2888 patients with CVD, 348 (12.05%) patients who received home BP surveillance for ≥56 days were selected for BP analysis. Patients were stratified into three groups: (1) poorly controlled hypertension, (2) well-controlled hypertension, and (3) nonhypertension. The mean, SD, coefficient of variation (CV), and average real variability were calculated.
Telehealth interventions significantly and steadily reduced systolic blood pressure (SBP) in the poorly controlled hypertension group from 144.8.2±9.2 to 133.7±10.2 mmHg after 2 months (P<.001). BP variability reduced in all patients: SBP-SD decreased from 7.8±3.4 to 7.3±3.4 after 2 months (P=.004), and SBP-CV decreased from 6.3±2.5 to 5.9±2.6 after 2 months (P=.004). Event-free survival (admission) analysis stratified by SBP-SD showed longer time to first hospitalization for Q1 patients compared with Q4 patients (P=.02, odds ratio 2.15, 95% CI 1.18-3.89).
Synchronous telehealth intervention may improve home BP control and decrease day-by-day home BP variability in patients with CVD.
高血压与全球疾病负担密切相关，不同地区和种族的控制率存在差异。远程医疗最近已成为管理慢性病的一种医疗策略，但关于同步远程医疗服务对家庭血压（BP）控制和变异性的影响的报告很少。
本研究旨在探讨数字化平台同步远程医疗服务对家庭 BP 的影响。
本研究由台湾大学医院远程医疗中心的台湾电子医疗研究组进行回顾性研究。我们分析了 2009 年至 2017 年间参加我们远程医疗计划的 2888 例心血管疾病（CVD）患者的家庭 BP 数据。在 2888 例 CVD 患者中，选择了 348 例（12.05%）接受家庭 BP 监测≥56 天的患者进行 BP 分析。患者被分为三组：（1）血压控制不佳，（2）血压控制良好，和（3）非高血压。计算平均值、标准差、变异系数（CV）和平均真实变异性。
远程医疗干预可显著稳定地降低血压控制不佳组的收缩压（SBP）：从 144.8.2±9.2mmHg 降至 2 个月后的 133.7±10.2mmHg（P<.001）。所有患者的 BP 变异性均降低：SBP-SD 从 7.8±3.4mmHg 降至 2 个月后的 7.3±3.4mmHg（P=.004），SBP-CV 从 6.3±2.5mmHg 降至 2 个月后的 5.9±2.6mmHg（P=.004）。根据 SBP-SD 进行的无事件生存（入院）分析显示，Q1 患者的首次住院时间长于 Q4 患者（P=.02，优势比 2.15，95%置信区间 1.18-3.89）。
同步远程医疗干预可能改善 CVD 患者的家庭 BP 控制并降低日常家庭 BP 变异性。
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