Arterial hypertension in clinical practice: study and analysis of biotechnological and telemedicine models E-Book

Michele Karaboue

• Herausgeber: Youcanprint
• Kategorie: Gesellschafts- und Liebesromane
• Sprache: Englisch

Veröffentlichungsjahr: 2025

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Arterial hypertension in clinical practice: study and analysis of biotechnological and telemedicine models opera di Michele Karaboue

Das E-Book Arterial hypertension in clinical practice: study and analysis of biotechnological and telemedicine models wird angeboten von Youcanprint und wurde mit folgenden Begriffen kategorisiert:
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Contents

Titolo

Diritto d'autore

1. Glossary

2. Abstract

3. Introduction

4. Background

5. Rationale

6. Methodology

7. Results

8. Discussion

9. Summary

10. References

11. Appendices

Guide

Copertina

Titolo

Start

Di

MICHELE AHMED ANTONIO KARABOUE

Arterial hypertension in clinical practice: study and analysis of biotechnological and telemedicine models

Titolo | Arterial hypertension in clinical practice

Autore | Michele Karaboue

ISBN | 9791224016182

© 2025 - Tutti i diritti riservati all'Autore

Questa opera è pubblicata direttamente dall'Autore tramite la piattaforma di selfpublishing Youcanprint e l'Autore detiene ogni diritto della stessa in maniera esclusiva. Nessuna parte di questo libro può essere pertanto riprodotta senza il preventivo assenso dell'Autore.

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1. Glossary

Definitions for specialised terminology and abbreviations used throughout this systematic review of literature can be found in the glossary below:

BP: Blood pressure

ABP: Average blood pressure

NHS: National Health Service

Hypertension: High blood pressure

QALY: A unit used in the prediction of both quality and duration of life after medical or surgical treatment.

DALY: The disability-adjusted life year (DALY) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.

CEA: Cost-effectiveness analysis (CEA) is a form of economic analysis that compares the relative costs and outcomes (effects) of different courses of action. Cost-effectiveness analysis is distinct from cost–benefit analysis, which assigns a monetary value to the measure of effect.

CUA: A type of economic evaluation that allows comparison of the costs and effects of alternative interventions. CUA measures health effects in terms of both quantity (life years) and quality of life.

PROM: Patient Reported Outcome Measures (PROMs) assess the quality of care delivered to NHS patients from the patient perspective.

Sensitivity: Measures the ability of an investigation to correctly identify patients with positive findings. A high sensitivity indicates that the method is effective at detecting true cases of a disease.

Specificity: Assesses the ability of virtual data collection to correctly identify patients without hypertension. High specificity means that the method accurately rules out individuals who do not have the condition.

2. Abstract

INTRODUCTION Hypertension, or high blood pressure, is a prevalent chronic disease affecting approximately 32% of adults living in UK private households in the UK. Traditional approaches to blood pressure monitoring primarily rely on intermittent clinic visits with calculation of patient ABPs that depend on collection and processing of hardcopy data. However, the advancement of digital health technologies has introduced the potential for virtual data collection. This systematic review aims to assess the feasibility of effectively telemonitoring home blood pressure for patients with chronic diseases in the UK.

METHODOLOGY Systematic review of literature guided by the following search criteria - Study Design: Any study design. Study Sample: Studies with sample size ≥ 3. Type of Participants: General practice clinics in the United Kingdom, all patients with chronic diseases in the United Kingdom. Type of Intervention: Telemonitoring of home blood pressure using digital platforms. Outcomes: Clinical accuracy and reliability, financial viability, organizational feasibility, patient acceptability, and satisfaction. Comparator: Traditional methods of home blood pressure review. Unit of Analysis: Unspecified. Follow Up: Unspecified. Time period: 20 years (2003-2023). Location: Unspecified. Language: Unspecified. Publication status: Published articles. Exclusion Criteria: Studies not focused on telemonitoring of home blood pressure, studies with inappropriate study designs.

RESULTS This literature review encompasses 50 eligible studies that explore the multifaceted landscape of telehealth interventions. Within this extensive collection of studies, 43 presented quantifiable results that substantiated conclusions drawn in this review. These studies encompass a range of research designs, including systematic reviews (19 studies), meta-analyses (5 studies), randomised control trials (11 studies), individual research studies (8 studies) and narrative reviews (7 studies).

DISCUSSION The evidence presented by the reviewed literature demonstrates the benefits and shortfalls of virtual data collection, indicating a wide range of applications across various healthcare settings where technology can bridge the efficiency gap in the review process of chronic disease. Virtual data collection is versatile in its benefits, extending beyond specific conditions or healthcare settings. By empowering patients, it enhances clinical decision-making, improves healthcare access, and contributes to efficient and cost-effective healthcare delivery. The role of virtual data collection in modern healthcare is likely to expand as technology continues to advance and healthcare systems adapt to new challenges, bringing increasing advantages to patients and providers alike.

CONCLUSION Technology proves the potential to empower patients, enhance clinical accuracy, and reap financial benefits. However, change is not without challenges. Addressing data privacy concerns, workflow disruptions, financial considerations, and barriers to patient engagement is essential to maximise positive impact. As we shift towards patient-centred, data-informed healthcare, effective navigation of these challenges by healthcare providers and policymakers is crucial. The results of such changes include improved outcomes and enhanced quality of life for patients with chronic diseases.

3. Introduction

Hypertension, or high blood pressure, is a prevalent chronic disease affecting approximately 32% of adults living in UK private households in the UK (ONS, 2020). It is both a major contributing factor and consequence of cardiovascular diseases, including stroke, heart failure, and kidney disease (WHO, 2023). Managing blood pressure is crucial in preventing these complications and improving patient outcomes.

Traditional approaches to blood pressure monitoring primarily rely on intermittent clinic visits with calculation of patient ABPs that depend on collection and processing of hardcopy data. However, the advancement of digital health technologies has introduced the potential for virtual data collection, enabling patients to conveniently measure and track their blood pressure from the comfort of their own homes, while ensuring that data is handled accurately, safely, and promptly.

This systematic review aims to assess the feasibility of effectively telemonitoring home blood pressure for patients with chronic diseases in the UK. By evaluating the clinical accuracy and reliability, financial viability, organizational feasibility, and patient acceptability and satisfaction of digital methods compared to traditional approaches, this review will provide valuable insights into the potential benefits and challenges associated with implementing telemonitoring systems in clinical practice.

The clinical accuracy and reliability of telemonitoring devices for blood pressure measurement are crucial considerations. Studies have shown promising results regarding the accuracy of digital blood pressure monitors, but it is essential to assess their performance in real-world settings and compare them to standard sphygmomanometers used in healthcare facilities. By synthesizing existing evidence, this review will determine whether telemonitoring devices can provide reliable blood pressure measurements that align with clinical standards. Additionally, it will explore factors that may affect accuracy, such as patient compliance and device calibration.

Financial viability is another critical aspect of implementing telemonitoring systems. This review will examine the economic implications of adopting digital methods for blood pressure monitoring, considering factors such as equipment costs, maintenance expenses, and potential savings in healthcare utilization. Understanding the cost-effectiveness of telemonitoring interventions is essential for healthcare providers, policymakers, and payers to make informed decisions regarding resource allocation and reimbursement.

Organizational feasibility encompasses the readiness of healthcare systems and infrastructure to support the implementation of telemonitoring programs. This review will explore the technical requirements, data management protocols, and healthcare provider training necessary for successful telemonitoring implementation. Furthermore, it will identify potential barriers and facilitators at the organizational level, such as workflow integration, interoperability with electronic health records, and clinician engagement.

Patient acceptability and satisfaction are vital for the successful adoption and long-term engagement with telemonitoring systems. This review will assess patients' experiences, preferences, and perceptions regarding home blood pressure telemonitoring. Factors influencing patient acceptance, such as ease of use, convenience, perceived benefits, and concerns related to privacy and data security, will be explored. Understanding patient perspectives will help identify strategies to optimize user experience and address potential barriers to adoption.

In conclusion, this systematic review aims to evaluate the feasibility of effectively telemonitoring home blood pressure for patients with chronic diseases in the UK. By comprehensively assessing the clinical accuracy and reliability, financial viability, organizational feasibility, and patient acceptability and satisfaction of digital methods compared to traditional approaches, this review will contribute to the evidence base surrounding telemonitoring interventions. The findings will inform healthcare providers, policymakers, and researchers about the potential benefits, challenges, and considerations associated with implementing telemonitoring systems for blood pressure management in the UK. Ultimately, this review aims to facilitate evidence-based decision-making and the development of patient-centred strategies to enhance the care and outcomes of individuals with chronic diseases, particularly hypertension.

4. Background

Chronic high blood pressure, also known as hypertension, is a prevalent condition affecting a significant number of individuals in the UK, with approximately one in four adults in the UK are diagnosed with hypertension, accounting for an estimated 13.5 million individuals (GOV UK, 2017). This high prevalence highlights the importance of effective blood pressure management to reduce the risk of associated cardiovascular diseases and improve patient outcomes.

Blood pressure monitoring is crucial for the management of various chronic diseases beyond hypertension. Conditions such as diabetes, chronic kidney disease, and cardiovascular diseases often require regular blood pressure assessment to guide treatment decisions and monitor disease progression (NICE, 2022). Accurate and timely blood pressure measurements are essential for clinicians to make informed decisions regarding medication adjustments, lifestyle interventions, and overall disease management (NICE, 2022).

In the traditional process of collecting and processing blood pressure data for patient annual reviews in UK general practice, patients typically visit their healthcare provider at scheduled intervals to have their blood pressure measured using a standard sphygmomanometer. These intermittent measurements provide a limited snapshot of the patient's blood pressure status, potentially missing important variations that occur outside of the clinic setting. This approach may lead to inadequate management decisions, as the data collected during these visits may not fully capture the patient's true blood pressure profile.

The current process for handling blood pressure data in general practice has shown limitations that can negatively impact patient care. Inadequate handling of blood pressure data can result in misdiagnosis, improper medication management, and suboptimal patient outcomes (Wood et al., 2017). Research has shown that a significant number of patients with hypertension are misdiagnosed, mis-medicated, or poorly managed due to errors and inconsistencies in blood pressure data handling (Omboni et al., 2020). This can lead to unnecessary medication changes, inadequate control of blood pressure, and increased risks of complications (McKoy et al., 2015).

Figure 1 Process mapping for collection of blood pressure data as part of chronic disease and medication review.

To address these challenges, the application of process optimization and digitization principles in organizational management can be leveraged to improve the handling of blood pressure data in general practice. Process optimization focuses on identifying inefficiencies, streamlining workflows, and enhancing the overall quality and reliability of processes (Kettinger et al., 1995). By implementing digital solutions for blood pressure monitoring, such as telemonitoring systems, the process of data collection, transmission, and analysis can be streamlined and optimized (Sands & Wald, 2014).

Digital solutions for blood pressure monitoring enable patients to measure and record their blood pressure at home using user-friendly devices (Goldstein, 2008). These measurements can be transmitted securely to healthcare providers, allowing for continuous monitoring and more comprehensive assessment of blood pressure trends. By adopting digital methods, the potential for human errors and transcription inaccuracies associated with manual data handling can be minimized, ensuring more reliable and accurate data for patient reviews (Padwal & Wood, 2021).

Moreover, the digitization of blood pressure data enables the implementation of data analytics and decision support tools, allowing clinicians to identify patterns, detect anomalies, and make evidence-based treatment decisions (AbuDagga et al., 2010). This digitized approach not only improves clinic efficiency by reducing the need for frequent in-person visits but also enhances patient outcomes by enabling proactive monitoring and timely interventions (Teo et al., 2021).

In summary, the current approach to blood pressure data handling in general practice in the UK has limitations that can lead to misdiagnosis, mis-medication, and poor management of patients with chronic diseases. Leveraging the principles of process optimization and digitization offers an opportunity to improve the handling of blood pressure data, enhance clinic efficiency, and ultimately improve patient outcomes. By exploring the feasibility and assessing the various aspects of telemonitoring home blood pressure for patients with chronic diseases in the UK, this systematic review aims to provide valuable insights into the potential benefits and challenges of adopting digital methods in blood pressure monitoring.

5. Rationale

The aim of this systematic review is to determine the feasibility of optimising the process of blood pressure monitoring by replacing traditional methods with digital solutions for collecting and processing blood pressure data for chronic disease and medication review in the UK. Feasibility of modern, compared with the traditional process described above, will be measured according to four objectives:

Figure 2 Objectives used to measure the feasibility of shifting to virtual means of BP data collection & processing in primary care.

Chronic diseases pose a significant public health challenge in the UK and globally. As the prevalence of these conditions continues to rise, there is urgent need to explore innovative approaches to manage and monitor them effectively within the primary care setting. Virtual methods of collecting blood pressure data for regular reviews, which involves patients measuring their blood pressure at home and transmitting the data to healthcare providers remotely, has emerged as a promising solution.

Figure 3 Breakdown of rationale & potential benefits for exploring feasibility of virtually collecting & processing health data.

Investigating the feasibility of virtually monitoring blood pressure within UK primary care is not only well-timed but also holds potential to revolutionize the management of chronic diseases, enhance patient outcomes, and develop sustainability of the healthcare system.

6. Methodology

6.1 Protocol

The protocol for this systematic review was designed to guide this project and is provided as supplementary information (Appendix 1).

6.2 Eligibility Criteria

The following criteria were constructed to select the most relevant and up-to-date literature that was freely accessible and review studies for eligibility. Authors were only contacted twice within a month for provision of inaccessible papers and studies not published in English were excluded.

Study Design

Any study design, including prospective, and retrospective of any type, randomized controlled trials (RCTs), non-randomized controlled trials, cohort studies, and cross-sectional studies.

Study Sample

Studies with sample size ≥ 3

Type of Participants

• General practice clinics in the United Kingdom.

• All patients with chronic diseases in the United Kingdom.

Type of Intervention

Telemonitoring of home blood pressure using digital platforms.

Outcomes

Clinical accuracy and reliability, financial viability, organizational feasibility, patient acceptability, and satisfaction.

Comparator

Traditional methods of home blood pressure review

Unit of Analysis

Unspecified.

Follow Up

Unspecified.

Inclusion Criteria

Studies with relevant data on clinical accuracy, financial viability, organizational feasibility, patient acceptability, and satisfaction.

• Time period: 20 years (2003-2023).

• Location: Preferably studies based in the UK, but studies in similar settings may be considered.

• Language: English and non-English with translation.

• Publication status: Published articles.

Exclusion Criteria

• Studies not focused on telemonitoring of home blood pressure.

• Studies lacking relevant data.

• Studies with inappropriate study designs.

Table 1 Eligibility criteria for literature search.

The chosen eligibility criteria aim to include studies that specifically address the feasibility of telemonitoring home blood pressure for patients with chronic diseases in the UK. By including different study designs, the review can capture a comprehensive range of evidence. While studies conducted in the UK are preferred, this study will not be geographically restricted as initial search has revealed many useful studies conducted in similar settings with results that could reflect on in the UK setting.

6.3 Information Sources

The following databases were searched for relevant literature: Medline (via PubMed); Cochrane Library; Google Scholar. The last search was performed 16.4.2023. One specific search strategy was applied for all three databases and is provided as supplementary information (Appendix 2).

Assuming that necessary libraries have been imported and can be accessed with appropriate API or tools, the following Boolean search code is designed to conduct a full, repeatable, and reproducible initial search on all three chosen databases:

("(chronic diseases OR chronic conditions OR long-term conditions) AND (telemonitoring OR remote monitoring OR home monitoring OR virtual data collection OR remote data collection) AND (traditional methods OR standard care) AND (blood pressure OR blood pressure data OR blood pressure review) AND (feasibility OR acceptability OR patient satisfaction OR clinical accuracy OR financial viability OR organizational feasibility OR cost utility OR Cost benefit OR Cost effectiveness OR Patient acceptability OR Patient adherence OR Patient reported outcomes OR Clinical reliability OR Sensitivity OR Specificity OR Quality of added life years (QALY) OR Disability of added life years (DALY) OR Workflow optimisation OR Adoption rate OR Resource utilisation OR Staff satisfaction OR Process timespan) AND (randomized controlled trial OR non-randomized controlled trial OR cohort study OR cross-sectional study)")

Search terms and categories may be adapted as per the specific research question and eligibility criteria. Furthermore, search strategy may be adjusted based on any specific syntax requirements or operators of the API or tool that is being used to access the chosen databases. The search strategy will be documented in Appendix 2 for transparency and reproducibility purposes, and will include search terms, databases used, dates of search and changes to search strategy.

6.4 Study Selection

Following the search strategy, the selected databases were screened by the author of this review. There was no blinding concerning any aspects of this review as there was one reviewer. Titles and abstracts were evaluated first, before full text was read to evaluate eligibility and non-eligible studies were excluded. Full text was read once more and summaries for all relevant papers were written to finalise studies eligible for critical appraisal and review. Tables and summaries are included as supplementary information (Appendix 3).

Figure 4 Selection process.

6.5 Data Collection Process

Data will be collected using a standardized data extraction form. The author of this study will independently extract the following data from included studies:

•Study characteristics (Authors, title, year of publication, study objectives & study design).

•Participant characteristics (sample size, demographic details if mentioned and relevant).

•Material/Intervention (type of digital platform used, method of blood pressure data collection).

•Outcome measures (examples for the measures of following objectives include but are not limited to):

∘ Clinical accuracy & reliability

∘ Financial impact

∘ Impact on organisational health & function

∘ Patient experience

•Comparison/control group (type and characteristics if mentioned).

• Funding sources and conflicts of interest.

6.6 Risk of Bias

The search was designed to be as accurate and broad as possible, including multiple sources and types of studies, to minimise potential reporting biases such as publication bias and duplicate reports. Nevertheless, the author will assess the eligible studies for risk of bias at a study and outcome level.

Examples of potential biases include but are not limited to:

• Recruitment of subjects from inappropriate populations.

• Failure to blind participants and assessors where necessary.

• Failure to report participants lost to follow-up.

• Prematurely ending trials for benefit.

• Inappropriate statistical analysis.

Risk of bias in individual studies will be assessed using the Newcastle-Ottawa Scale (Wells et al., 2013), as this has been deemed the most appropriate to assess risk of bias across all studies. This widely used tool is an 8-item checklist that evaluates studies by assessing three domains:

• Selection of study groups.

• Comparability of groups.

• Ascertainment of exposure/outcome of interest.

The assessment will be conducted at study and outcome level, with evaluation of study limitations and the impact of these limitations on the validity of the study outcomes. Modifications to the tool will be made where appropriate and according to the Cochrane Handbook for Systematic Reviews of Interventions (Higgins et al., 2023), however assessment will fundamentally follow the structure detailed in Appendix 1. The resulting information on risk of bias will be considered during data synthesis and interpretation of the results, with outcomes of this assessment presented under results and discussed as limitations of the studies reviewed.

Finally, risk of bias across studies will be assessed by careful examination and cross-referencing studies with their protocols. Examples of potential biases include but are not limited to:

• Publication bias.

• Selective reporting bias.

6.7 Summary Measures

The principal summary measures will vary depending on the outcome measures reported in the included studies. These may include:

•Clinical accuracy: Sensitivity, specificity, positive predictive value, negative predictive value.

•Financial viability: CEA, CUA, QALY, DALY, cost per unit change in blood pressure.

•Organizational feasibility: Adoption rates, implementation barriers, resource utilisation, staff satisfaction, process timespan.

•Patient acceptability and satisfaction: Patient-reported outcomes, satisfaction scores, adherence rates.

The following measures used to report the results of eligible studies were included if provided, but not limited to:

• Odds ratios

• Relative risk

• Mean differences

• Confidence intervals

6.8 Synthesis of Results

The potential methods for handling and combining data will depend on the homogeneity or heterogeneity of the collected data. Evaluation of populations studied, interventions and comparisons used, and outcomes measured, was used to determine consistency of results. In case of high consistency across studies, results are pooled and presented graphically in a meta-analysis using appropriate statistical methods (e.g., random-effects models). In case of heterogeneity, a narrative synthesis will be conducted, summarizing the findings across the included studies, and exploring potential sources of heterogeneity.