ABSTRACT
Objective: Main issues in the treatment of hypertension are the low level of blood pressure (BP) control and the economic burden for health care systems. Mobile application with telemonitoring of BP could contribute to better control and lower costs by reducing office visits. This could be useful nowadays with difficult access to health system due to covid-19. The purpose of this study was to investigate if an innovative management strategy of hypertension, such as the use of ESH care application for smartphones combined with a dedicated platform, could improve hypertension control and replace frequent office visits. Design and method: 30 uncontrolled hypertensive patients, treated or untreated [mean age 53 ± 9 years, mean office BP (OBP) 146.3 ± 6.2 / 92.5 ± 9 mmHg, 53% men, 33% smokers, 23% with hypercholesterolemia] were randomized to the application assisted strategy (AAS) (17 patients), where a mobile phone application was offered to communicate home BP measurements (HBPm), or to regular office visits (13 patients). Patients BP measurements (HBPm for AAS and OBP for standard care group) were evaluated in 1 and 3 months with treatment titration if uncontrolled. In all patients OBP and ambulatory BP measurement (ABPM) were evaluated in 6 months. Results: In both groups the reduction in OBP and ABPM was significant in 6 months. In the AAS group the reduction in systolic/diastolic OBP and 24 h systolic/ diastolic BP in 6 months was -26.5 ± 5.6 / -19.4 ± 8.2 mmHg (p < 0,001) and -19.6 ± 7.7 / -13.8 ± 4.8 mmHg (p < 0.001), respectively. In the standard care group, the reduction in systolic/diastolic OBP and 24 h systolic/diastolic BP in 6 months was -22.6 ± 9.7 / -9.6 ± 11 mmHg (p < 0.005) and -18.4 ± 6.0 / - 8.8 ± 4.4 mmHg (p < 0.001). In AAS group compared to standard care group there was a greater reduction in 24 h diastolic BP (-13.8 ± 4.8 mmHg vs -8.8 ± 4.4 mmHg, p = 0.016) and in diastolic OBP (-19.4 ± 8.2 mmHg vs -9.6 ± 11.0 mmHg, p = 0.04). Conclusions: The present results indicate that the monitoring of patients through a mobile health tool could be useful in hypertension management as it is correlated with better BP control compared to office visits. The trial is still enrolling patients.
ABSTRACT
Objective: Few data have been published regarding the holistic approach of post- Covid patients, examining physical health. The purpose of our study was to examine the impact of arterial hypertension in the cardiopulmonary status of post-covid patients 3 months after the first day of infection. Design and Method: All participants who recovered Covid-19 infection underwent cardiorespiratory exercise using either Bruce or modified Bruce protocol where all parameters were evaluated and transthoracic echocardiogram. The population was separated into two groups based on history of hypertension. Group I (n = 29) included hypertensive subjects and Group II (n = 75) included normotensive subjects. Results and Conclusion: A total of 104 patients were assessed 3 months after the onset of COVID-19 symptoms. We recorded a mean age of 49 ± 15 years, 50.5% of them were males, 8.7% had a history of coronary heart disease. Hypertensives had higher BMI (29.24 ± 24 vs 26.64 kg/m2 p < 0.01) and BSA (2.09 ± 0.25 vs. 1.95 ± 0.58, p = 0.001). They were hospitalized in higher percentage comparing to normotensives (72.4% vs. 41.3%, p < 0.01). Left atrial diameter (41 ± 6 vs. 35 ± 5.5 mm, p < 0.001) was significantly larger in hypertensives. Furthermore, A wave (79 ± 21 vs. 58 ± 18 cm/s p < 0.001) and ratios of E/A (1.01 ± 0.42 vs. 1.28 ± 0.44, p < 0.01) and E/E (7.3 ± 3.7 vs. 5.9 ± 4.3, p < 0.01) differed between two groups. Finally, LVEF (%) was significantly impaired in hypertensive comparing to normotesive subjects (53 ± 13% vs. 59 ± 7%). This finding was depicted in lower maximum oxygen consumption (VO2 22 ± 4.5 vs. 28 ± 8 ml/kg/min p < 0.001), metabolic equivalents (METS) at peak, 9.1 ± 3 vs. 14 ± 20 p < 0.001), maximum heart rate (maxHR 147 ± 17 vs. 165 ± 21 bpm p < 0.001) and HR1st minute recovery (123 ± 28 vs. 138 ± 21 bpm, p: 0.02) comparing to normotensive. Systolic blood pressure (SBP 180 ± 29 vs. 165 ± 25mmHg, p: 0.02) during the 1st minute of recovery was higher in hypertensives. Finally, the duration of exercise was significantly lower in patients with hypertension (7.3 ± 2.7 vs. 9 ± 4 min, p:0.02). To conclude, the current study highlighted the negative impact of hypertension in the ability to exercise. Regardless of the disease severity, post-covid patients need a comprehensive approach for rehabilitation including the modification of risk factors like hypertension and obesity.