Managing hypertension in urban underserved subjects using telemedicine-A clinical trial
Managing hypertension in urban underserved subjects using telemedicine-A clinical trial
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DOI：
10.1016/j.ahj.2013.01.004
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发表时间：
2013-04-01
影响因子：
4.8
通讯作者：
Elliott, Daniel J.
中科院分区：
文献类型：
--
作者：
Bove, Alfred A.;Homko, Carol J.;Elliott, Daniel J.
背景我们评估了一个基于互联网和电话的远程医疗系统，以降低血压（BP）在服务不足的subjects with hypertension.Methods收缩压>= 140毫米汞柱的患者共241例，随机分为常规护理（C; n = 121）或远程医疗（T; n = 120）。T组报告血压、心率、体重、每天步数和每周两次的烟草使用情况。结果平均年龄为59.6岁，平均体重指数为33.7 kg/m2，79%为女性，81%为非洲裔美国人，15%为白色，53%处于或低于联邦贫困线，18%为吸烟者，32%患有糖尿病。对206例受试者进行了6个月随访（C组：107例，T组：99例）。C组和T组分别有52.3%和54.5%达到目标血压（P = 0.43）。两组的收缩压变化（C：-13.9 mm Hg，T：-18.2; P = 0.118）相似。T组受试者报告BP 7.7 +/- 6.9 d/mo。结果不受年龄，性别，种族，教育或收入的影响。在非糖尿病T型受试者中，58.2%达到目标血压，而糖尿病T型受试者为45.2%（P = 0.024）。非糖尿病T组受试者的收缩压下降幅度更大（T：-19 +/- 20 mm Hg，C：-12 +/- 19 mm Hg; P = 0.037）。在糖尿病患者中，C和T之间的血压反应没有差异。结论对于高血压受试者，参与有或没有远程医疗的护理系统可显着降低血压。与常规护理相比，非糖尿病患者的远程医疗导致收缩压降低更大。远程医疗可能是管理高血压的有用工具，特别是在非糖尿病受试者中。(Am Heart J 2013;165：615-21.）
Background We evaluated an Internet-and telephone-based telemedicine system for reducing blood pressure (BP) in underserved subjects with hypertension.Methods A total of 241 patients with systolic BP >= 140 mm Hg were randomized to usual care (C; n = 121) or telemedicine (T; n = 120). The T group reported BP, heart rate, weight, steps/day, and tobacco use twice weekly. The primary outcome was BP control at 6 months.Results Average age was 59.6 years, average body mass index was 33.7 kg/m(2), 79% were female, 81% were African American, 15% were white, 53% were at or below the federal poverty level, 18% were smokers, and 32% had diabetes. Six-month follow-up was achieved in 206 subjects (C: 107, T: 99). Goal BP was achieved in 52.3% in C and 54.5% in T (P = .43). Systolic BP change (C: -13.9 mm Hg, T: -18.2; P = .118) was similar in both groups. Subjects in the T group reported BP 7.7 +/- 6.9 d/mo. Results were not affected by age, sex, ethnicity, education, or income. In nondiabetic T subjects, goal BP was achieved in 58.2% compared with 45.2% of diabetic T subjects (P = .024). Nondiabetic T subjects demonstrated a greater reduction in systolic BP (T: -19 +/- 20 mm Hg, C: -12 +/- 19 mm Hg; P = .037). No difference in BP response between C and T was noted in patients with diabetes.Conclusion In hypertensive subjects, engagement in a system of care with or without telemedicine resulted in significant BP reduction. Telemedicine for nondiabetic patients resulted in a greater reduction in systolic BP compared with usual care. Telemedicine may be a useful tool for managing hypertension particularly among nondiabetic subjects. (Am Heart J 2013;165:615-21.)