Texting service helps patients reduce their blood pressure

A simple telehealth intervention could be an effective way to reduce blood pressure (BP) in patients, research suggests.

Researchers found that encouraging patients to regularly measure their BP at home using an electronic sphygmomanometer and text the results to a secure server, called Florence, improved their BP significantly, especially if they did not have chronic kidney disease (CKD).

Florence integrates an interactive service that reminds patients to text their BP readings to the server each day and sends reminders if a reading is not received within 2 hours. The service also sends automatic responses to patients detailing any further actions required based on the BP readings, such as asking for a repeat reading if an error is detected, or advising patients to contact their doctor or practice nurse.

The patient's general practitioner or nurse will then log into a secure server to review the results and send the patient advice on continuing management.

Elizabeth Cottrell (Keele University, Staffordshire, UK) and team allocated the telehealth intervention to 124 patients that either had CKD stages 3 or 4 with a BP persistently over 130/85 mmHg, or were older than 50 years old without CKD stages 3-5 and had a BP persistently over 140/90 mmHg despite being prescribed antihypertensive medication.

Three hypertensive control patients for each intervention patient underwent usual clinical care (n=364).

They found that patients with uncontrolled hypertension without CKD stage 3-5 who used Florence became normotensive (≤140/90 mmHg) by the second month of the intervention.

Despite Florence patients having a significantly increased systolic BP (SBP) compared with control patients at baseline and 1 year prior, intervention patients had no significant difference in their average SBP to control patients from the first month of the program.

As reported in the British Medical Journal Open, average BP readings from patients with CKD stages 3-4 only fell into the normotensive range (≤130/85 mmHg) during the third month of the intervention.

The changes in BP from baseline at each month among intervention patients were greatest and most significant among patients without CKD stages 3-5 who had systolic hypertension at baseline. These patients experienced significant reductions of 15-16 mmHg in SBP during the 3 months of the program, and a significant reduction of at least 10 mmHg continued to be observed up to 6 months after recruitment. Controls who were hypertensive at baseline did not have an equivalent reduction in BP identified until the third month, the authors note.

"There may be a place for wider utilization of this technology to assist in the diagnosis of hypertension, monitoring hypertension and remote clinical management, and in those who find it difficult to attend their general practitioner surgery," they conclude.

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