The results obtained by this telemedicine approach in patients with poor control of hypertension would seem to confirm the importance of a much higher level of compliance with respect to regular BP measurement, drug compliance and therapy adjustments [23, 24]. Technology alone will likely fail to increase patient’s self-management goals and to improve patient’ outcomes. Thus, patients with out-of-range BP may benefit from more intensive intervention that can be provided by nurses in a structured model connected with physicians.
In comparison with the previous studies, the educational program run by the nurses is fundamental; the physicians are immediately made aware when BP values are outside the range. This leads to re-evaluation of drug compliance or drug therapy. Moreover, when the patients realize that their adherence is constantly and carefully checked, they acquire a feeling of greater control and consequently higher compliance which contributes to positive effects that can be observed in the first few weeks.
Through telemedicine, symptoms of hypertension or hypotension, malaise, or requests for comfort or simple communications needs can be relayed in real time leading to greater patient satisfaction. Moreover, the continuous monitoring of patients followed by appropriate intervention is a critical attribute of the program. This is probably the reason why in the HBT group there was a higher number of patients (70%) in whom the drug therapy was modified compared to those in the UC group (23%). The complete optimization of the treatment probably requires a longer period with more frequent nurse-patient contacts. In this respect, telemedicine could be an excellent addition which could reduce the number of office visits .
It is true that in both groups, at final visit, both SBP and DBP were significantly lower but only in the HBT group there was a clinically relevant BP reduction, with values overlapping the BP levels which are recognized as the target according to International Guidelines .
A number of meta-analysis studies have shown that a BP monitoring, compared to a single office visit measurement, has the potential to better manage uncontrolled hypertension [9, 14–17].
We have obtained positive results thanks to the use of a well-organized telemedicine program in which nursing and specialist medical staff play an important role [8, 22, 25]. Another important factor was that the technique was easy to use and was reliable with no major complaints from the patients.
BP is usually sub-optimally controlled due to various factors including the fact that it is often asymptomatic, requires continuous treatment for life, with drug related side effects leading to poor drug compliance [26–28]. The importance of self BP measurement is an educational goal for the patient. This goal cannot be achieved by a single office visit. Furthermore, because of the issues with cost containment, repeated office visits are discouraged. In addition, the Telemedicine approach which combines nurse support plus remote monitoring, reduces the problem of “white coat syndrome” . An effective monitoring program for a period of 2–4 months associated with a structured physician-nurse approach can lead to beneficial overall effect for patients with uncontrolled hypertension.
Telemedicine services provide an additional value to standard of care with only a small cost addition. In view of the results obtained (greater significant reduction in the HBT group vs. the SC group), it would be crucial to plan randomized studies with a longer home follow-up to confirm these findings and to verify the efficacy of Telemedicine intervention in the reduction of acute cardiovascular events, which are known to increase by 30% for every 10 mmHg increase in BP .
Limitation of the study
One limitation of the study is that it was carried out following a non-randomized design.
Another limitation is the lack of baseline ABPM since the study was conducted in the real clinical practice where ABPM is not always performed.
The cost analysis considers only the services provided to the patient in the HBT group and does not evaluate the cost effectiveness of the service.