Blood pressure control and treatment adherence in hypertensive patients with metabolic syndrome: protocol of a randomized controlled study based on home blood pressure telemonitoring vs. conventional management and assessment of psychological determinants of adherence (TELEBPMET Study)

Gianfranco Parati, Stefano Omboni, Angelo Compare, Enzo Grossi, Edward Callus, Achille Venco, Maurizio Destro, Giuseppe Villa, Paolo Palatini, Enrico Agabiti Rosei, Simonetta Scalvini, Stefano Taddei, Dario Manfellotto, Stefano Favale, Carmine De Matteis, Michele Guglielmi, TELEBPMET Study Group, Laura Lonati, Francesco Della Rosa, Ellen Tosazzi, Anna Maria Grandi, Andrea Maria Maresca, Christian Mongiardi, Micaela Mare, Alessandra Rossi Ricci, Francesca Cagnoni, Joannhe Georgatos, Valeria Besostri, Viviana Ferrari, Ombretta Omodeo, Francesca Dorigatti, Elisa Bonso, Chiara Guarnieri, Lorenza Muiesan, Anna Paini, Deborah Stassaldi, Angelo Cinelli, Palmira Bernocchi, Silvana Rocchi, Armando Magagna, Lorenzo Ghiadoni, Irene Del Frate, Francesca Boresi, Antonella Guidi, Maria Antonietta Re, Luisa Pellicciotti, Antonia Florio, Giuliana Morani, Silvana Di Lillo, Antonietta Ambrosio, Antonio Casciello, Maria Quaglia, Cinzia Forleo, Maria Annunziata Ardito, Stefania Gerunda, Mariligia Panunzio, Gianfranco Parati, Stefano Omboni, Angelo Compare, Enzo Grossi, Edward Callus, Achille Venco, Maurizio Destro, Giuseppe Villa, Paolo Palatini, Enrico Agabiti Rosei, Simonetta Scalvini, Stefano Taddei, Dario Manfellotto, Stefano Favale, Carmine De Matteis, Michele Guglielmi, TELEBPMET Study Group, Laura Lonati, Francesco Della Rosa, Ellen Tosazzi, Anna Maria Grandi, Andrea Maria Maresca, Christian Mongiardi, Micaela Mare, Alessandra Rossi Ricci, Francesca Cagnoni, Joannhe Georgatos, Valeria Besostri, Viviana Ferrari, Ombretta Omodeo, Francesca Dorigatti, Elisa Bonso, Chiara Guarnieri, Lorenza Muiesan, Anna Paini, Deborah Stassaldi, Angelo Cinelli, Palmira Bernocchi, Silvana Rocchi, Armando Magagna, Lorenzo Ghiadoni, Irene Del Frate, Francesca Boresi, Antonella Guidi, Maria Antonietta Re, Luisa Pellicciotti, Antonia Florio, Giuliana Morani, Silvana Di Lillo, Antonietta Ambrosio, Antonio Casciello, Maria Quaglia, Cinzia Forleo, Maria Annunziata Ardito, Stefania Gerunda, Mariligia Panunzio

Abstract

Background: Inadequate blood pressure control and poor adherence to treatment remain among the major limitations in the management of hypertensive patients, particularly of those at high risk of cardiovascular events. Preliminary evidence suggests that home blood pressure telemonitoring (HBPT) might help increasing the chance of achieving blood pressure targets and improve patient's therapeutic adherence. However, all these potential advantages of HBPT have not yet been fully investigated.

Methods/design: The purpose of this open label, parallel group, randomized, controlled study is to assess whether, in patients with high cardiovascular risk (treated or untreated essential arterial hypertension--both in the office and in ambulatory conditions over 24 h--and metabolic syndrome), long-term (48 weeks) blood pressure control is more effective when based on HBPT and on the feedback to patients by their doctor between visits, or when based exclusively on blood pressure determination during quarterly office visits (conventional management (CM)). A total of 252 patients will be enrolled and randomized to usual care (n = 84) or HBPT (n = 168). The primary study endpoint will be the rate of subjects achieving normal daytime ambulatory blood pressure targets (< 135/85 mmHg) 24 weeks and 48 weeks after randomization. In addition, the study will assess the psychological determinants of adherence and persistence to drug therapy, through specific psychological tests administered during the course of the study. Other secondary study endpoints will be related to the impact of HBPT on additional clinical and economic outcomes (number of additional medical visits, direct costs of patient management, number of antihypertensive drugs prescribed, level of cardiovascular risk, degree of target organ damage and rate of cardiovascular events, regression of the metabolic syndrome).

Discussion: The TELEBPMET Study will show whether HBPT is effective in improving blood pressure control and related medical and economic outcomes in hypertensive patients with metabolic syndrome. It will also provide a comprehensive understanding of the psychological determinants of medication adherence and blood pressure control of these patients.

Trial registration: Clinical Trials.gov: NCT01541566.

Figures

Figure 1
Figure 1
Flow chart of the TELEBPMET study design. ATP, Adult Treatment Panel; BP, Blood pressure; CM, Conventional management; HBPT, Home blood pressure telemonitoring; W, Week.
Figure 2
Figure 2
The Morepress web-based telemedicine system used in the TELEBPMET Study. GPRS, General Packet Radio Service; HBPT, Home blood pressure telemonitoring; SSL, Secure Sockets Layer.
Figure 3
Figure 3
Timing and content of study assessments. ABPM, Ambulatory blood pressure monitoring; BP, Blood pressure; HBPT, Home blood pressure telemonitoring.

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