Difficult-to-control hypertension: identification of clinical predictors and use of ICT-based integrated care to facilitate blood pressure control

Abstract

Difficult-to-control (DTC) hypertension represents a burden in real life that can be partially solved through identification of the characteristics of clinical patterns and tailoring antihypertensive strategies, including ICT-enabled integrated care (ICT-IC). In the quest for clinical predictors of DTC hypertension, we screened 482 hypertensive patients who were consecutively referred to the departmental hypertension clinic. Following a data quality check, patients were divided into controlled (C, 49.37%) and uncontrolled (UC, 50.63%) groups based on their systolic blood pressure (BP) at follow-up. We then performed statistical analysis on the demographic, clinical, laboratory, and ultrasound data and observed that older age, female sex, higher BP levels, and a family history of hypertension were predictors of DTC hypertension. We then developed a pilot service of ICT-IC, including weekly home visits by nurses and patient education on self-monitoring of BP, heart rate, body weight, and oxygen saturation using 3G-connected devices. Self-monitored data were transmitted to the hospital servers on the electronic chart of the patient for remote assessment by the hospital hypertension specialists. A total of 20 UC patients (M/F = 10/10; age: 72.04 ± 2.17 years) were enrolled to verify the efficacy of BP control without changes in medical treatment. After 1 month of the ICT-IC program, BP was reduced both at the office assessment (systolic BP (SBP): 162.40 ± 2.23 mm Hg, beginning of the program vs. 138.20 ± 4.26 mm Hg at 1 month, p < 0.01) and at home (SBP: 149.83 ± 3.44, beginning of the program vs. 134.16 ± 1.67 mm Hg at 1 month, p < 0.01). We concluded that DTC hypertension can be predicted based on the clinical characteristics at the first visit. For these patients, ICT-IC is a feasible therapeutic strategy to achieve BP control.

Hypertension and Drug Adherence in the Elderly

“…In order to avoid frequent and costly hospitalizations, physicians should periodically reassess the pertinence of all prescribed medications including those prescribed to lower blood pressure, in order to prevent potentially inadequate medications. In addition, elderly patients may benefit from supports provided by other health care providers, who are closer to their home such as pharmacists (93) or visiting nurses in the context of integrated care system (94). In recent years, even follow-up by non-medical professionals such as barbers in the US or hairdressers in Europe have been shown to offer a feasible and valid alternative for the screening and follow-up of hypertension (95,96).…”

Serum Uric Acid and Left Ventricular Mass in Essential Hypertension

“…The need for biomarkers for the stratification of CV risk among hypertensives is a sensitive issue. Indeed, in the general definition of hypertension, we include multiple intermediate phenotypes: males and females, easy and difficult to treat, young and old, lean and obese and so on (24,25). In the attempt to identify novel biomarkers that facilitate the identification of patients with a greater risk to develop CV events, sUA levels recently attained renewed emphasis (8).…”

Rethinking palliative care in a public health context: addressing the needs of persons with non-communicable chronic diseases

“…When home care services are activated upon hospital discharge with concomitant monitoring (protected discharge), they allow to contain the number and the duration of hospital stays, at the same time ensuring the best assistance possible. 'Beyond Silos' is an EU project that addresses the issue of de-hospitalization (Pascale et al, 2016;Visco et al, 2017Visco et al, , 2018.…”