Telemonitoring of 24-Hour Blood Pressure in Local Pharmacies and Blood Pressure Control in the Community: The Templar Project

Abstract

BACKGROUND The analysis of ambulatory blood pressure monitorings (ABPMs) performed in 639 Italian pharmacies in the context of a telehealth-based service allowed to evaluate the level of blood pressure (BP) control in the community. METHODS Twenty-four-hour ABPMs were performed by a clinically validated, automated, upper-arm BP monitor. Recordings were uploaded on a certified web-based telemedicine platform (www.tholomeus.net) and remote medical reporting provided. In each subject, an automatic BP measurement was obtained in the pharmacy and clinical information collected before starting the ABPM. RESULTS A total of 20,773 subjects (mean age 57 ± 15 years; 54% females; 28% receiving antihypertensive medications, 31% with any cardiovascular [CV] risk factor) provided valid ABPMs. BP control was poor, but better in ambulatory conditions (24-hour BP <130/80 mm Hg 54% vs. pharmacy BP < 140/90 mm Hg 43%; P < 0.0001) and in drug-treated subjects. Sustained normotension was reported in only 28% subjects. Isolated nocturnal hypertension (16%; nighttime BP ≥120/70 mm Hg with normal daytime BP) was more common (P < 0.0001) than isolated daytime hypertension (9%; daytime BP ≥ 135/85 mm Hg with normal nighttime BP). Sustained hypertension (43%) was more common in younger males at the lowest CV risk, with daytime hypertension. White-coat hypertension (14%) was more common in females. Masked hypertension was not uncommon (15%) and more often observed in older males with an elevated nocturnal BP. CONCLUSIONS A telemedicine-based service provided to community pharmacies may facilitate access to ABPM, thus favoring a more accurate hypertension screening and detection. It may also help describe the occurrence of different 24-hour BP phenotypes and personalize the physician’s intervention.

A survey on feasibility of telehealth services among young Italian pharmacists

“…Telepharmacy may offer unique opportunity to improve access to screening and healthcare for cardiovascular patients. 20 , 34 , 35 …”

“…To the best of our knowledge, no governmental or private entity has studied the effects of the 2010 Pharmacy of Services Decree in the area of telemedicine, and there is no information about the impact of this decree in the Italian pharmaceutical context, or the extent to which telemedicine approaches have been adopted. 20 …”

“…To the best of our knowledge, no governmental or private entity has studied the effects of the 2010 Pharmacy of Services Decree in the area of telemedicine, and there is no information about the impact of this decree in the Italian pharmaceutical context, or the extent to which telemedicine approaches have been adopted. 20 The present study has therefore investigated how telemedicine/telehealth service are used in Italian pharmacies, by administering a questionnaire to members of the National Federation of Associations of Italian Young Pharmacists (FENAGIFAR). This federation is made up of pharmacists aged under 38.…”

Evidence and Recommendations on the Use of Telemedicine for the Management of Arterial Hypertension

“…More recently, the TEMPLAR project documented an improved screening of high BP by the introduction of 24-hour ABPM with medical telereporting and telecounseling in Italian community pharmacies [72].…”

Telemedicine During the COVID-19 in Italy: A Missed Opportunity?

“…We have provided clinical evidence of the effectiveness of our health care model in some publications. [4][5][6] Before the epidemic began, we provided hundreds of medical reports and consultations daily. Such a decentralized approach would have been disruptive in a time of emergency when hospitals are almost completely converted to COVID-19 management, and thus, have to cancel or delay the necessary assistance to patients with multiple chronic conditions.…”