Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 2, 2022
Date Accepted: Sep 16, 2022
Date Submitted to PubMed: Sep 16, 2022
Differentiated effects and determinants of home blood pressure telemonitoring: lessons from a three-year cohort in Anhui Jieshou, China
ABSTRACT
Background:
Home blood pressure telemonitoring (HBPT) is witnessing rapid diffusion worldwide. Contemporary studies documented mainly short-term (6-12 month) effects of HBPT with little data about its uptake.
Objective:
This study aims to explore 3-year use and determinants of HBPT and its interactions with systolic and diastolic blood pressure (SBP/DBP) and blood pressure (BP) control rate.
Methods:
The study used HBPT records from a 3-year cohort of 5658 hypertensive patients in Anhui Jieshou, China and data from a structured household survey of a random sample (n=3005) from the cohort. The data analysis comprised: calculation and presentation, in time-line trajectories, rates of monthly active HBPT and mean SBP/DBP for overall and subgroups of patients with varied start-month SBP/DBP; and multivariable linear, logistics and percentile regression analysis using SBP/DBP, BP control rate and yearly times of HBPT as the dependent variable respectively.
Results:
HBPT followed mixed changes in mean monthly SBP/DBP for varied patient groups. The magnitude of changes ranged from -43 to +39 mmHg for SBP and -27 to +15 mmHg for DBP. The monthly rates of active HBPT all manifested a rapid and then slower and slower decline. When controlled for commonly researched confounders, times of HBPT in the last year were found with decreasing correlation coefficients for SBP/DBP (being decreased from 0.10 to -0.35 and from 0.11 to -0.35 respectively) and for BP control rate (from 0.53 to -0.62).
Conclusions:
HBPT had major and “target-converging” effects on SBP/DBP. The magnitude of changes was much greater than have commonly reported. BP, variation in BP and time were the most important determinants of HBPT uptake; while age, education, duration of hypertension, family history and diagnosis of hypertension complications were also linked to the uptake but at apparently weaker strength. There is a clear need for differentiated thinking over application and assessment of HBPT and for identifying and correcting/leveraging potential outdated/new opportunities or beliefs.
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