The use of a telematic connection for the follow-up of hypertensive patients improves the cardiovascular prognosis

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. Objectives: 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%, χ² = 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%; χ² = 5.047, P <0.02). CS predicts fewer MACE in multiple binary regression analysis (β:-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]. Conclusion: Our results support the idea that telemedicine can achieve better control of BP and TCVR.