Digital Health Safety and Effacious Discussion Assignment
Abstracts e137
data were adjusted for baseline demographic and clinical variables involved in CV risk. In contrast, an increased frequency of BP control to either <140/90 mmHg or <130/80 mmHg did not have any effect on incidence and adjusted risk of myocardial infarction and heart failure. A more frequent BP control reduced the incidence of the primary outcome (combined fatal and non fatal CV events) only for the <140/90 target.
Conclusion: In patients at high CV risk achieving the target BP values rec- ommended by guidelines may lead to cerebral and renal protection but not to cardiac protection, the relative prevalence of these events determining the overall effect on cardiovascular events combined. Thus, the appropriateness of these recommendations and the clinical conditions in which they should be implemented need to be further clarified.
9A.09 BENEFITS AND PSYCHOLOGICAL RISKS OF M-HEALTH REMOTE PATIENT MONITORING OF HYPERTENSION IN DIABETES: A 1-YEAR RANDOMIZED CONTROLLED TRIAL
A. Tisler1, J. Irvine2, W. McIsaac2, D. Feig2, J. Cafazzo2, A. Logan2
1Semmelweis University, Budapest-Hungary, 2University of Toronto, Toronto-Canada
Objectives and Design: Home blood pressure (BP) monitoring actively engages patients in their own care, but the psychological consequences of enhancing self- care are unknown. We undertook a 1-year RCT to test the effectiveness of a mobile BP telemonitoring (TM) system in reducing BP and assess its effect on several psychological variables.
Methods: Adult diabetic patients with uncontrolled systolic hypertension were randomly assigned to monitor their BP at home in the standard manner (n = 55, control group) or using a fully automated TM system (n = 55, TM group). After each reading, TM patients automatically received progress and coaching messages, and if necessary, alerts and reminders. Physicians were sent sum- mary reports and critical alerts. All patients had two different BP measures (24-h ambulatory BP monitoring and 7-days of home BP readings) and com- pleted a set of psychological questionnaires at entry and exit. Primary care physicians made all treatment decisions.
Results: There was a significant decrease in daytime, nighttime, and 24-h systolic BP of 9.1 ± 15.6, 6.7 ± 15.9, and 8.7 ± 14.7 mm Hg (mean ± SD), respectively (p < 0.003 for all) in the TM group and no significant changes in the control group. Mean between-group differences in daytime and 24-h systolic BP of 7.1 ± 2.3 and 6.8 ± 2.4 mm Hg (mean ± SE) respectively were also significant (p < 0.005 for both) and in 7-day home readings, systolic 9.0 ± 2.4 (p = 0.0002). Mean between-group differences in diastolic BP also were highly significant (data not shown). In the Anxiety Sensitivity Index, there was a significant decrease in the control group (p = 0.034) and no change in the TM group, although there was no time by group interaction effect. In the Hospital Anxiety and Depression Scale, depression worsened significantly in the TM group (p = 0.016) and remained unchanged in the control group, and there was a borderline time by group interaction effect (p = 0.061). Both groups demonstrated a significant decrease in comfort with self-measurement of BP (p < 0.003) with no between-group difference. There was no significant between-group differences in the number of antihypertensive drug classes pre- scribed or number of doctor visits in the study year.
Conclusions: The highly beneficial effects of a mobile phone-based TM sys- tem on reducing BP in diabetic patients with uncontrolled systolic hyperten- sion were obtained at a possible cost of psychological well-being and comfort.
any difference between the three groups. PWV did not change significantly. AIx, adjusted for changes in heart rate, decreased by 3.6 ± 13.7% for the whole group, which decrease was significant only for nebivolol (–5.4 ± 11.1%). In linear regression models, changes in heart rate and in brachial systolic pressure were strong predictors of changes in AIx elicited by carvedilol and metoprolol (r2 = 0.41, and r2 = 0.46 for carvedilol and metoprolol, respectively), but did not explain changes in AIx caused by nebivolol (r2 = 0.09).
Conclusion: The “classical” beta-blocker metoprolol and the newer beta blockers carvedilol and nebivolol decrease central blood pressure equally. Their impact on pressure augmentation seems to be different, however, with nebivolol having the largest potential of decreasing heart rate-adjusted AIx. While AIx changes associated with carvedilol and metoprolol treatment are strongly driven by peripheral blood pressure and heart rate changes, those associated with nebivolol treatment seem to be the result of other mechanisms.
9A.08 BLOOD PRESSURE TARGETS RECOMMENDED BY GUIDELINES AND INCIDENCE OF CARDIOVASCULAR AND RENAL EVENTS IN THE ONTARGET TRIAL
G. Mancia1, H. Schumacher2, J. Redon3, P. Verdecchia4, R. Schmieder5, G. Jennings6, K. Yusoff7, L. Ryden8, G.L. Liu9, R. Fagard10, K. Teo11, P. Sleight12, S. Yusuf11. 1University of Milano Bicocca - San Gerardo Hospital, Milano- Italy, 2Boehringer-Ingelheim, Ingelheim-Germany, 3Carlos III, Hospital Clinico Universitario, Valencia-Spain, 4Struttura Complessa di Medicina, Ospedale di Assisi, Assisi-Italy, 5Nephrologie und Hypertensiologie, Universitätsklinikum, Erlangen-Germany, 6Baker Medical Research Institute,, Melbourne-Australia, 7Universiti Teknologi Mara, Selangor- Malaysia, 8Karolinska Intitutet, Karolinska Universitetssjukhuset Solna, Stockholm-Sweden, 9Chinese Academy of Medical Sciences, Dept. of Hypertension, Beijing-China, 10Division on Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, Leuven-Belgium, 11Population Health Research Institute, McMaster University, Hamilton-Canada, 12CV Medicine, John Radcliffe Hospital, Oxford-United Kingdom
Background: Hypertension treatment guidelines recommend to lower blood pressure (BP) to <140/90 mmHg in all hypertensive patients but to be more aggressive, i.e. to reach <130/80 mmHg in patients with a high cardiovascular risk (CV) profile. We investigated the cardiovascular and renal benefits asso- ciated with these BP targets in the high cardiovascular risk population of the ONTARGET trial.
Methods and Results: We analyzed ‘post hoc’ 14.490 patients with a base- line BP > 140/90 mmHg (systolic/diastolic) who were divided into 4 groups according to the proportion of in-treatment visits in which BP was reduced to <140/90 mmHg: <25%, 25% to 49%, 50% to 74%, >75%. The same analysis was carried out in patients with a baseline BP > 130/80 mmHg (n = 19631) the target BP value being <130/80 mmHg. A progressive increase in the pro- portion of visits in which BP was controlled either to <140/90 mmHg and to <130/80 mmHg was associated with a progressive reduction in the incidence and the risk of stroke and renal events (endstage renal disease or doubling of serum creatinine). Compared to the group in which BP control to <140/90 mmHg was rarest in the group in which it was most frequent BP fell from 155/84 to 125/73 mmHg and stroke and renal events were reduced by 42% and 72%. For BP control to <130/80 mmHg the most frequent control was associated with a BP fall from 145/82 to 116/67 mmHg, the stroke and renal events reduction being 49% and 66%. There were also in the same groups marked beneficial effects on proteinuria. Similar findings were obtained when