The Effect Of Home Blood Pressure Monitoring Combined With Remote Management On Blood Pressure Control In Hypertensive Patients

Objective:As a convenient and accessible blood pressure measurement method,home blood pressure monitoring can reflect the blood pressure level of the measurer in the real environment,and is widely used in the self-blood pressure monitoring of hypertensive patients.Long-term elevated blood pressure can lead to dysfunction of multiple related target organs such as heart,brain and kidney,and reduce the quality of life to varying degrees.Therefore,comprehensive treatment and effective management are needed for hypertensive patients to strengthen blood pressure control.The combination of remote management and home blood pressure monitoring makes use of the advantages of going deep into the family to establish close contact between patients and clinicians,so as to achieve the purpose of improving blood pressure control.This paper discusses the effect of some hypertensive patients participating in the remote online management of home blood pressure monitoring by doctors and nurses in two hospitals in Hefei.The main evaluation criteria include the clock-in rate and the rate of reaching the standard of family blood pressure measurement,so as to summarize the management experience of implementing remote blood pressure monitoring for hypertensive patients.Methods:From April to June 2021,563 adult hypertensive patients with clinic blood pressure≥140/90mmHg were selected as the study subjects,who were measured in the grade hospital(the First Affiliated Hospital of Anhui Medical University in Hefei)and the community medical institution(Hongguang Community Health Service Center).After signing the informed consent form,a unified and validated upper arm electronic sphygmomanometer was distributed to all patients.Clinicians and nurses guide patients to conduct standardized self-blood pressure monitoring at home.The sphygmomanometer can automatically upload the daily blood pressure data.Doctors can timely grasp the blood pressure of patients through the WeChat platform and give appropriate feedback,and the platform sends blood pressure measurement and medication reminder to patients.The study was divided into two stages.The first stage:563 hypertensive patients from two medical institutions participated in the study.The intervention period was 8 weeks,and follow-up was conducted every 4 weeks.Record and compare the home blood pressure control rate of the patients in the 4th and 8th weeks.The second stage:397 patients recruited from the First Affiliated Hospital of Anhui Medical University will continue to receive home blood pressure monitoring and remote online support from doctors/nurses.The deadline is August 17,2021.The home blood pressure value measured for the last time will be obtained,and the patients will be grouped according to their age and comorbidities,and the last blood pressure compliance of different groups of people with different characteristics will be compared.Results:A total of 563 eligible hypertensive patients were included in the first phase of the study(April to June 2021),including 353 male patients,accounting for 62.7%,405 patients with family history of hypertension,accounting for 71.9%,392(69.6%)patients with diagnosis time≥1 year,and 511 patients with hypertension who finally completed two home blood pressure follow-up,including 361 cases from the First Affiliated Hospital of Anhui Medical University and 150 cases from the Hongguang Community Health Service Center.In the second phase of the study,only 397 hypertensive patients with uncontrolled blood pressure in grade hospitals were included.According to whether diabetes,coronary heart disease,cerebral infarction,transient ischemic attack and chronic kidney disease were combined,they were divided into group A and group B,312 cases(78.6%)and 85 cases(21.4%)respectively.Among them,there were 284 patients aged ≤60 years old and 113 patients aged>60 years old,accounting for 71.5%and 28.5%respectively.(1)The proportion of male patients,with family history of hypertension or cardiovascular risk factors,the time of diagnosis of hypertension≥1 year,drinking,high school education and above in the community hospital was higher than that in the grade hospital,with statistically significant difference(P<0.05),but there was no significant difference in the grading of hypertension,age,and dietary taste between the two institutions.(2)At the 4th week,the home blood pressure control rate of patients in the grade hospital and community hospital was 75.1%and 63.3%,respectively.At the 8th week,the corresponding blood pressure standard rate was 77.1%and 67.3%,respectively,with significant difference between the groups(P<0.05).(3)The clocking rate of home blood pressure of patients with hypertension in the first to eighth week in the grade hospital and all age groups showed a downward trend,among which the clocking rate of patients≥81 years old was higher than that of other age groups.(4)The rate of reaching the standard of the last blood pressure of patients in group A and group B in the grade hospital was 89.4%and 90.6%respectively.There was no significant difference between the two groups(P>0.05).(5)The control rate of the last home blood pressure of patients in group C and group D of the grade hospital was 89.8%and 89.4%,and there was no significant difference between the two groups(P>0.05).Conclusion:Applying WeChat platform to implement remote online management of home blood pressure monitoring with medical participation can improve the home blood pressure control in 8 weeks for hypertensive patients whose blood pressure does not reach the standard in the consulting room.With the extension of time,the compliance of hypertensive patients to clock in for home blood pressure monitoring decreased.