Mobile phone-based remote patient monitoring system for management of hypertension in diabetic patients.
BACKGROUND
Rising concern over the poor level of blood-pressure (BP) control among hypertensive patients has prompted searches for novel ways of managing hypertension. The objectives of this study were to develop and pilot-test a home BP tele-management system that actively engages patients in the process of care.


METHODS
Phase 1 involved a series of focus-group meetings with patients and primary care providers to guide the system's development. In Phase 2, 33 diabetic patients with uncontrolled ambulatory hypertension were enrolled in a 4-month pilot study, using a before-and-after design to assess its effectiveness in lowering BP, its acceptability to users, and the reliability of home BP measurements.


RESULTS
The system, developed using commodity hardware, comprised a Bluetooth-enabled home BP monitor, a mobile phone to receive and transmit data, a central server for data processing, a fax-back system to send physicians' reports, and a BP alerting system. In the pilot study, 24-h ambulatory BP fell by 11/5 (+/-13/7 SD) mm Hg (both P < .001), and BP control improved significantly. Substantially more home readings were received by the server than expected, based on the preset monitoring schedule. Of 42 BP alerts sent to patients, almost half (n = 20) were due to low BP. Physicians received no critical BP alerts. Patients perceived the system as acceptable and effective.


CONCLUSIONS
The encouraging results of this study provide a strong rationale for a long-term, randomized, clinical trial to determine whether this home BP tele-management system improves BP control in the community among patients with uncontrolled hypertension.
Logan
Alexander G
AG
Prosserman Centre for Health Research, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Canada. logan@mshri.on.ca
McIsaac
Warren J
WJ
Tisler
Andras
A
Irvine
M Jane
MJ
Saunders
Allison
A
Dunai
Andrea
A
Rizo
Carlos A
CA
Feig
Denice S
DS
Hamill
Melinda
M
Trudel
Mathieu
M
Cafazzo
Joseph A
JA
D000368:Aged; D040421:Cell Phone; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000628:therapy*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000379:methods*; D010865:Pilot Projects; D012648:Self Care; D017216:Telemedicine / Q000379:methods*