Home BP Monitoring Using a Telemonitoring System is Effective for Controlling BP in a Remote Island in Japan

The purpose of this study was to assess whether a home blood pressure (HBP) telemonitoring system could improve BP control and overcome the problems of HBP monitoring in a remote location. The authors enrolled 60 subjects and randomized them to either a Telemonitoring group or a Control group. The outcomes were changes in HBP level, adherence to HBP monitoring, and visual analog scale (VAS; score 0–100) as a measure of the motivation to perform HBP measurements. The reductions in morning systolic BP (?5.5±0.9 mm Hg vs 0.7±0.7 mm Hg, P<.001) and evening systolic BP (?4.6±1.0 mm Hg vs 1.0±1.1 mm Hg, P<.001) and the change in VAS (12.8±3.3 vs ?1.6±2.2, P=.001) were significantly greater in the Telemonitoring group than in the Control group. The measure of the adherence to HBP monitoring tended to be better (P=.064) in the Telemonitoring group than in the Control group. These results indicate that an HBP telemonitoring system would be a beneficial healthcare measure in remote geographical locations.

Hypertension is one of the most common risk factors for cardiovascular disease, with a prevalence of approximately 30% to 45% of the general population.¹ Niijima, a small island located 160 km south of Tokyo, has 2933 residents (1410 men and 1523 women), 37% of whom are elderly (older than 65 years). In the 2013 health examination, the prevalence of hypertension was 35% among those older than 40 years. There has been an increasing number of elderly people living alone or living with elderly spouses on Niijima as a result of out‐migration of the young. In cases of acute illness, such as myocardial infarction or cerebral infarction, patients must be transported to a specialized medical center in Tokyo via 3‐hour flight by helicopter. In addition, there is no way off the island in the case of typhoons or other severe storms. Therefore, primary prevention by aggressive control of cardiovascular risk factors, especially hypertension, is of paramount importance.Home blood pressure (HBP) monitoring has been reported to be superior to office BP monitoring in predicting future cardiovascular events or mortality.², ³, ⁴, ⁵ When there is a discrepancy between the levels of HBP and office BP, HBP is superior to office BP in predicting cardiovascular risk.⁶, ⁷ However, in clinical practice, HBP monitoring is sometimes difficult to carry out adequately, especially in the elderly. With regard to HBP measurements, the biggest concern is the limited accuracy of the measurement techniques reporting by the subjects. With respect to the reporting of HBP measurements, the major problems are excess reports, insufficient reports, and reports of phantom records.⁸ In addition, patients sometimes forget to bring their log books in which the results of HBP measurements are written. On Niijima Island, it has been estimated that only 10% to 20% of hypertensive outpatients measure their HBP correctly.To overcome these shortcomings of HBP, the HBP telemonitoring system was developed.⁹ In the HBP telemonitoring system, HBP data are stored and transmitted to a secure Web site and doctors can check them in real time. Subjects do not need to manually record their BP data and physicians can check all of their data on the Web site. Studies have shown that the HBP telemonitoring system improves BP control, self‐efficacy, and adherence to antihypertensive medication.¹⁰, ¹¹, ¹², ¹³, ¹⁴, ¹⁵ However, it has not been established whether an HBP telemonitoring system would be effective in an elderly population, most of whom are living alone or with elderly spouses, in a remote geographical location.In this study, we hypothesized that an HBP telemonitoring system would improve BP control and solve the problems of HBP monitoring related to adherence and motivation in the population of Niijima Island, a very remote location off the east coast of Japan.