School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China.
Division of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
JMIR Mhealth Uhealth. 2024 Aug 9;12:e53355. doi: 10.2196/53355.
Hypertension is highly prevalent among patients undergoing hemodialysis, with a significant proportion experiencing poorly controlled blood pressure (BP). Digital BP management in this population has been underused.
This study aimed to explore the efficacy of a web-based home BP monitoring (HBPM) program in improving predialysis BP control and enhancing knowledge, perception, and adherence to HBPM among patients with hypertension undergoing hemodialysis.
A multicenter, open-label, randomized controlled trial was conducted at 2 hemodialysis units. Patients were randomly allocated in a 1:1 ratio to either the web-based HBPM program as the intervention group or to usual care as the control group over a 6-month period. The primary outcomes were the predialysis BP control rate, defined as less than 140/90 mm Hg, and the predialysis systolic and diastolic BP, assessed from baseline to the 6-month follow-up. Secondary outcomes included patient knowledge, perception, and adherence to HBPM, evaluated using the HBPM Knowledge Questionnaire, HBPM Perception Scale, and HBPM Adherence Scale, respectively. A generalized estimating equations analysis was used to analyze the primary outcomes in the intention-to-treat analysis.
Of the 165 patients enrolled in the program (n=84, 50.9% in the web-based HBPM group and n=81, 49.1% in the control group), 145 (87.9%) completed the follow-up assessment. During the follow-up period, 11 instances of hypotension occurred in 9 patients in the web-based HBPM group, compared to 15 instances in 14 patients in the control group. The predialysis BP control rate increased from 30% (25/84) to 48% (40/84) in the web-based HBPM group after the 6-month intervention, whereas in the control group, it decreased from 37% (30/81) to 25% (20/81; χ22=16.82, P<.001; odds ratio 5.11, 95% CI 2.14-12.23, P<.001). The web-based HBPM group demonstrated a significant reduction after the 6-month intervention in the predialysis systolic BP (t163=2.46, P=.02; β=-6.09, 95 % CI -10.94 to -1.24, P=.01) and the predialysis diastolic BP (t163=3.20, P=.002; β=-4.93, 95% CI -7.93 to -1.93, P=.001). Scores on the HBPM Knowledge Questionnaire (t163=-9.18, P<.001), HBPM Perception Scale (t163=-10.65, P<.001), and HBPM Adherence Scale (t163=-8.04, P<.001) were significantly higher after 6 months of intervention.
The implementation of a web-based HBPM program can enhance predialysis BP control and the knowledge, perception, and adherence to HBPM among patients undergoing hemodialysis. This web-based HBPM program should be promoted in appropriate clinical settings.
高血压在接受血液透析的患者中非常普遍，其中相当一部分患者的血压控制不佳。在该人群中，数字血压管理的应用不足。
本研究旨在探讨基于网络的家庭血压监测（HBPM）方案在改善透析前血压控制以及提高高血压血液透析患者对 HBPM 的知识、认知和依从性方面的疗效。
在 2 家血液透析中心进行了一项多中心、开放标签、随机对照试验。患者按照 1:1 的比例随机分配至基于网络的 HBPM 方案组（干预组）或常规护理组（对照组），随访时间为 6 个月。主要结局为透析前血压控制率，定义为收缩压<140mmHg 和舒张压<90mmHg，从基线到 6 个月随访进行评估。次要结局包括使用 HBPM 知识问卷、HBPM 感知量表和 HBPM 依从量表分别评估患者对 HBPM 的知识、认知和依从性。采用广义估计方程分析对意向治疗分析中的主要结局进行分析。
共有 165 名患者（n=84，50.9%在基于网络的 HBPM 组，n=81，49.1%在对照组）入组并完成了随访评估。在随访期间，基于网络的 HBPM 组有 9 名患者发生 11 例低血压，对照组有 14 名患者发生 15 例低血压。经过 6 个月的干预后，基于网络的 HBPM 组的透析前血压控制率从 30%（25/84）增加到 48%（40/84），而对照组则从 37%（30/81）下降到 25%（20/81；χ22=16.82，P<.001；优势比 5.11，95%置信区间 2.14-12.23，P<.001）。基于网络的 HBPM 组在 6 个月的干预后，透析前收缩压（t163=2.46，P=.02；β=-6.09，95%置信区间-10.94 至-1.24，P=.01）和透析前舒张压（t163=3.20，P=.002；β=-4.93，95%置信区间-7.93 至-1.93，P=.001）显著降低。HBPM 知识问卷（t163=-9.18，P<.001）、HBPM 感知量表（t163=-10.65，P<.001）和 HBPM 依从量表（t163=-8.04，P<.001）的评分在 6 个月的干预后均显著升高。
实施基于网络的 HBPM 方案可以提高血液透析患者的透析前血压控制水平，以及他们对 HBPM 的知识、认知和依从性。这种基于网络的 HBPM 方案应在适当的临床环境中推广。
