नेफ्रोलॉजी और थेरेप्यूटिक्स जर्नल

Usefulness of Telemetric Blood Pressure Monitoring in Hypertensive Patients with Chronic Kidney Diseases

Abstract

Burnier M*,Bock A,Halabi G,Gasser UE,Pechère Bertschi A,Ambühl P,Forster C,Gabutti L,Giovannini M,Hess B,Meier P,Mohaupt M,Pfammatter R,Schönholzer C,Schwarz A,Steiger J,Wagner G,Würzner G

Introduction: The quality of Blood Pressure (BP) control remains poor among patients with Chronic Kidney Diseases (CKD). It is therefore crucial to develop therapeutic strategies enabling improvement in BP control in order to retard the progression of the underlying renal diseases. The cornerstones of therapy include the use of effective and well tolerated drugs and a good drug adherence. In this pilot study conducted in ambulant routine care we evaluated the potential clinical benefits of implementing a Telemonitoring System (TMS) in parallel to an anticipated change of treatment in hypertensive CKD patients with uncontrolled hypertension and/or adverse reactions due to the current antihypertensive treatment.

Methods: This is an observational study conducted by 13 Swiss nephrologists in patients with CKD stage III-IV and a BP >130/80 mmHg under treatment with an antihypertensive drug. A validated, automated TMS for home BP and Heart Rate (HR) monitoring and an electronic scale to measure Body Weight (BW) and a modem to transfer the measured parameters to a central database were provided to each patient. The protocol included a run-in phase and a drug titration phase of 1 month each and a 2 month maintenance phase. During the titration phase, the calcium antagonist lercanidipine could be introduced and up titrated in case of uncontrolled BP.

Results: The use of a TMS in conjunction with the introduction of lercanidipine resulted in a significant reduction of office systolic and diastolic BP of respectively -10 ± 21 mmHg (p=0.028) and -5.0 ± 11 mmHg (p=0.049). Home BP revealed a parallel significant reduction of -3 ± 1.4 mmHg systolic (p=0.043) and -3 ± 1.2 mmHg (p=0.021) diastolic, respectively. The fall in BP was associated with a slight but significant increase in serum creatinine and decrease in Estimated Glomerular Filtration Rate (eGFR).

Conclusion: The results of this observational pilot study suggest that a telemonitoring system enabling to follow home BP may be useful to improve BP control in hypertensive patients with CKD. However, a prospective randomized control study would be needed to assess the real added benefits of this strategy. Administration of lercanidipine in CKD patients was effective and well tolerated.