Hypertension Subtypes among Thai Hypertensives: An Analysis of Telehealth-Assisted Instrument in Home Blood Pressure Monitoring Nationwide Pilot Project

Abstract

Background. White-coat hypertension (HT), masked HT, HT with white-coat effect, and masked uncontrolled HT are well-recognized problems of over- and undertreatment of high blood pressure in real-life practice. However, little is known about the true prevalence in Thailand. Objectives. To examine the prevalence and characteristics of each HT subtype defined by mean home blood pressure (HBP) and clinic blood pressure (CBP) using telemonitoring technology in Thai hypertensives. Methods. A multicenter, observational study included adult hypertensives who had been diagnosed for at least 3 months based on CBP without the adoption of HBP monitoring. All patients were instructed to manually measure their HBP twice a day for the duration of at least one week using the same validated automated, oscillometric telemonitoring devices (Uright model TD-3128, TaiDoc Corporation, Taiwan). The HBP, CBP, and baseline demographic data were recorded on the web-based system. HT subtypes were classified according to the treatment status, CBP (≥or <140/90 mmHg), and mean HBP (≥or <135/85 mmHg) into the following eight subtypes: in nonmedicated hypertensives, there are four subtypes that are normotension, white-coat HT, masked HT, and sustained HT; in treated hypertensives, there are four subtypes that are well-controlled HT, HT with white-coat effect, masked uncontrolled HT, and sustained HT. Results. Of the 1,184 patients (mean age 58 ± 12.7 years, 59% women) from 46 hospitals, 1,040 (87.8%) were taking antihypertensive agents. The majority of them were enrolled from primary care hospitals (81%). In the nonmedicated group, the prevalence of white-coat and masked HT was 25.7% and 7.0%, respectively. Among the treated patients, the HT with white-coat effect was found in 23.3% while 46.7% had uncontrolled HBP (a combination of the masked uncontrolled HT (9.6%) and sustained HT (37.1%)). In the medicated older subgroup (n = 487), uncontrolled HBP was more prevalent in male than in female (53.6% vs. 42.4%, p=0.013). Conclusions. This is the first nationwide study in Thailand to examine the prevalence of HT subtypes. Almost one-fourth had white-coat HT or HT with white-coat effect. Approximately half of the treated patients especially in the older males had uncontrolled HBP requiring more intensive interventions. These results emphasize the role of HBP monitoring for appropriate HT diagnosis and management. The cost-effectiveness of utilizing THAI HBPM in routine practice needs to be examined in the future study.

Home Blood Pressure Control and Drug Prescription Patterns among Thai Hypertensives: A 1-Year Analysis of Telehealth Assisted Instrument in Home Blood Pressure Monitoring Nationwide Pilot Project

“…Patients from 46 hospitals across Thailand participated in the THAI HBPM project as previously reported [ 15 ]. Twelve patients were lost to follow-up and 1 patient died during the 1-year period after the project was launched.…”

“…This study is a one-year follow-up analysis of the THAI HBPM project. The study design and method have been published [ 15 ]. Briefly, the THAI HBPM project was a prospective observational study conducted at 46 centers across all regions of Thailand (see Supplementary Material for the detail of all participating sites).…”

“…Treated or untreated hypertensive patients who were older than 18 years old and had been diagnosed with HT for more than 3 months based on CBP, without prior regular HBP monitoring, were enrolled in this project. The cross-sectional data analysis of the prevalence and characteristic of each HT subtype obtained from the first 7-day HBP records has been recently published [ 15 ].…”

“…Patients who had complete 7-day HBP records at the end of follow-up will be included in the analysis. We discarded the measurements taken on the first day and used the mean value of all the remaining HBP records for the data analysis [ 15 ]. The patient characteristics (e.g., sex, age, waist circumference, body mass index, and comorbid metabolic diseases) were collected at baseline.…”

“…Recently, a telemonitoring technology with remote electronic BP data transfer has been introduced as part of the out-of-clinic BP monitoring [ 6 , 12 – 14 ]. Thailand implemented this technology in its TeleHealth Assisted Instrument in Home Blood Pressure Monitoring (THAI HBPM) nationwide pilot project, which was initiated in 2016 aiming to engage hypertensive patients in the self-monitored BP program [ 15 ]. It was designed to be a proof-of-concept multicenter study using telemonitoring technology with a cloud-based transmission system.…”