Effects of an ICT-supported hypertension management on antihypertensive medication: Results from the cluster-randomised controlled PIA-Study

Frauke Leupold, Arian Karimzadeh, Birgitta Weltermann

Keywords: eHealth, antihypertensive drugs, telemonitoring, hypertension

Background:
Hypertension is a worldwide problem causing stroke and heart attacks. Although effective antihypertensives are available, their dosing is insufficient frequently. Information communication technology (ICT) has the potential to improve blood pressure (BP) control. The newly developed PIA ICT with PIA app for patients and PIA practice management center for German general practices allowed for the electronic transmission of BP readings, medication plans and short messages. In a cluster-randomised controlled trial with 525 patients, BP control was 23.1% better in the intervention compared to the control group.

Research questions:
Which medication changes were observed in the intervention and control group of the PIA study?

Method:
In the cluster-randomised controlled trial, the prescribed antihypertensive drugs were analyzed using the medication plans at baseline and follow-up. The following parameters were calculated: medication classes according to guidelines (ACE/ARB, thiazide diuretics, calcium channel blockers, betablockers, and others), and the mean medication dose rates (the proportion of the prescribed daily dose relative to the maximum allowed daily dose per antihypertensive). We compared these parameters between study arms at follow-up, and between baseline and follow-up per study arm.

Results:
In the 525 patients, the medication classes followed guidelines: ACE/ARB (88,0%), thiazide diuretics (30,7%), calciumchannel blockers (47,9%), betablockers (44,9%), and others (19,2%). At follow-up, the intervention group received more antihypertensive groups compared to the control (intervention group: 2.42; control group; 2.20; p=0.039). Especially diuretics were prescribed more frequently (intervention: 57 ; control: 26, p<0,001). The mean dosing rates were significantly higher in the intervention compared to the control group (intervention 1.56; control 1.34; p=0.017). Compared to baseline, only the dosing rates of the intervention group increased (+0.12).

Conclusions:
The PIA ICT resulted in an uptitration of guideline-recommended medications with better BP control in the intervention compared to the control group.

Points for discussion:
What is your experience with uptitration of antihypertensives?

What is your opinion on ICT-supported hypertension management to improve hypertension control and uptitration of medications?