PL 03-2 REMOTE BLOOD PRESSURE MONITORING IN HYPERTENSION CARE: PRACTICE OF HYPERTENSION BY TELETRANSMISSION OF HOME BLOOD PRESSURE.

It has been confirmed that clinical significance of home blood pressure measurements (HBPM) is higher than clinic BP measurements and ambulatory BP monitoring. However, several drawbacks of HBPM have also been mentioned, e.g. selection and reporting biases, difficulties of calculation of multiple measurements, difficulties of onsite judgement of numerous recordings, etc. Recent devices for HBPM incorporate memory function. This function can overcome such drawbacks of HBPM. These memorized data can transmit, storage, retrieve, be arithmetic and control, be judged based on algorithm and be got feedback. These functions are available for telemonitoring and telemedicine. The purpose of telemedicine based on HBPM is as a tool for proper diagnosis and treatment of hypertension, as a supporting system for practice of hypertension through rapid and proper feedback and as a tool of self-medication. Telemonitoring using HBPM is useful for clinical pharmacology of antihypertensive drugs and can be applied to large scale intervention trial of antihypertensive drugs such as THOP Study and HOMED-BP study. We have successfully conducted HOME-BP study, a randomized controlled study, based on HBPM and interactive system using Internet, where 3500 hypertensive subjects were followed for maximal 10 years by 300 general practitioners. HOMED-BP study indicated that telemedicine has been practiced without trouble and accepted readily by practitioners and patients. In general, it has been demonstrated that patients show a high degree of adherence to telemonitoring program and regular use of these technologies in predisposition of hypertensive patients to use electronic BP monitors at home. However, older patients may express difficulty in using the HBP transmitting system.Home telemedicine of HBPM brings correct and reliable data during HOMED-BP study and HOMED-BP study provided goal HBP level for mild to moderate hypertensive patients; ie, 130 mmHg of systolic HBP. New telemedicine system such as Medical-Link (Omron Health Care, Japan) is commercially available in Japan and the utility of this system has been proved extensively.It has widely been reported that telecommunication service improves BP control. Patients who need a tight control of BP such as high risk patients with chronic disease as well as non-adherent patients may particularly benefit from HBP telemonitoring. It seems that patients' acceptance to telemonitoring/telemedicine of HBP is influenced by doctors' timely feedback; lack of feedback may lead to lower motivation for sustained use of telemonitoring system. For the effective application of telemonitoring/telemedicine of HBPM, following desirable features for uptake of telemonitoring/telemedicine are necessary; selection of educated patients, sufficient pre-set instruction, practical design of the device, user-friendly and accseptable system, affordable cost, compliance with ethical, privacy and safety requirement, etc. For the success of home telemonitoring/telemedicine, timely availability of quality data for clinical decision making is indispensable and thus very few errors and technical problems should be avoided.Telemonitoring/telemedicine may detect symptom early, resulting in immediate intervention and in avoiding exacerbation; determine inherent BP level and determine antihypertensive effect simultaneously; decide adequate medication; get feedback to life-style modification; improve drug adherence; improve adherence of consultation; improve communication between patient and doctor; curtail of medical expenditure; and connect with self-control of blood pressure.The modern society is aging societies with increase in chronic diseases. Furthermore, recent medical competence is centralized and medical service coverage has decreased especially in rural area. Social isolation such as one-person households and loss of support network inside and outside of family are expanded. Under such social circumstances, telemonitoring/telemedicine using HBPM may improve general health care of public and patients as well as screening, diagnosis and control of hypertension. Telemonitoring/telemedicine of HBPM may be particularly useful for patients who need a constant monitoring of multiple vital sign such as old person who lives in solitude.In conclusion, telemonitoring/telemedicine based on HBPM is promising method for practice of hypertension. An evolved feature of telemedicine would be a supporting system in practice of hypertension and a tool for self-care, self-medication, and life-style modification, and can improve the quality of practice of hypertension and health care of public.