期刊
AMERICAN JOURNAL OF HYPERTENSION
卷 32, 期 7, 页码 629-639出版社
OXFORD UNIV PRESS
DOI: 10.1093/ajh/hpz049
关键词
ambulatory blood pressure monitoring; blood pressure; blood pressure telemonitoring; hypertension; pharmacy; telehealth; telemedicine
资金
- Italian Institute of Telemedicine
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.
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