Usefulness of Telemetric Blood Pressure Monitoring in Hypertensive Patients with Chronic Kidney Diseases
Burnier M1*, Bock A2, Halabi G3, Gasser UE4, Pechère Bertschi A5, Ambühl P6, Forster C6, Gabutti L6, Giovannini M6, Hess B6, Höfliger N6, Meier P6, Mohaupt M6, Pfammatter R6, Schönholzer C6, Schwarz A6, Steiger J6, Wagner G6 and Würzner G6
- *Corresponding Author:
- M. Burnier
Department of Nephrology and Hypertension
Rue du Bugnon 17, CHUV
1011 Lausanne, Switzerland
E-mail: [email protected]
Received Date: May 09, 2012; Accepted Date: June 26, 2012; Published Date: June 29, 2012
Citation: Burnier M, Bock A, Halabi G, Gasser UE, Bertschi PA, et al. (2012) Usefulness of Telemetric Blood Pressure Monitoring in Hypertensive Patients with Chronic Kidney Diseases. J Nephrol Therapeut 2:122. doi:10.4172/2161-0959.1000122
Copyright: © 2012 Burnier M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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.