title: The use of a telematic connection for the follow-up of hypertensive patients improves the cardiovascular prognosis.
abstract: BACKGROUND
  Inadequate blood pressure (BP) control could be due to incorrect management of hypertensives caused by the lack of interaction between general practitioners (GP) and hypertension specialists.
  
  
  OBJECTIVE
  To test the effectiveness on BP and total cardiovascular risk (TCVR) control of an internet-based digital network connecting specialists and GPs.
  
  
  METHODS
  We created a network among the Hypertension Clinic, Federico II University (Naples, Italy), 23 hospital-based hypertension clinics and 60 GPs from the area (CampaniaSalute Network, CS). Randomized GPs enrolled in CS could update online records of patients (n = 1979). As a control, we included 2045 patients referred to the specialist clinics by GPs from outside the network. All patients completed a 2-year follow-up.
  
  
  RESULTS
  CS provided a larger reduction in BP [systolic/diastolic BP (SBP/DBP): 7.3 +/- 0.4/5.4 +/- 0.3 versus 4.1 +/- 0.4/3.1 +/- 0.26 mmHg, CS versus control; P < 0.001 for both] and percentage of patients with BP < 140/90 mmHg (CS versus control: baseline, 33 versus 34%, NS; end of follow-up, 51 versus 47%, chi = 13.371; P < 0.001). A European Society of Hypertension-European Society of Cardiology (ESH/ESC) TCVR score was calculated [from 1 (average) to 5 (very high TCVR)]. The CS group showed a reduction in the mean TCVR score (CS: from 3.5 +/- 0.02 to 3.2 +/- 0, P < 0.01, ANOVA; control group: 3.5 +/- 0.03 to 3.4 +/- 0.03, NS) and, accordingly, fatal and non-fatal major cardiovascular events (MACE) were less frequent (2.9 versus 4.3%; chi = 5.047, P < 0.02). CS predicts fewer MACE in multiple binary regression analysis (beta:-7.27, P < 0.008) reducing the risk for MACE compared to control [odds ratio (OR): 0.838; 95% confidence interval (CI): 0.73-0.96].
  
  
  CONCLUSIONS
  Our results support the idea that telemedicine can achieve better control of BP and TCVR.
authors.affiliation: Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche. Università degli studi Federico II, Napoli, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: De Luca
authors.forename: Raffaele
authors.initials: R
authors.lastname: Izzo
authors.forename: Guido
authors.initials: G
authors.lastname: Iaccarino
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Malini
authors.forename: Carmine
authors.initials: C
authors.lastname: Morisco
authors.forename: Francesco
authors.initials: F
authors.lastname: Rozza
authors.forename: Gianni Luigi
authors.initials: GL
authors.lastname: Iovino
authors.forename: Maria Assunta Elena
authors.initials: MA
authors.lastname: Rao
authors.forename: Clara
authors.initials: C
authors.lastname: Bodenizza
authors.forename: Francesca
authors.initials: F
authors.lastname: Lanni
authors.forename: Luigi
authors.initials: L
authors.lastname: Guerrera
authors.forename: Oreste
authors.initials: O
authors.lastname: Arcucci
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001795:Blood Pressure Determination; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D016009:Chi-Square Distribution; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D020407:Internet; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012307:Risk Factors; D017216:Telemedicine; D013997:Time Factors