@Article{info:doi/10.2196/53355,
author="Chen, Tingting
and Zhao, Wenbo
and Pei, Qianqian
and Chen, Yanru
and Yin, Jinmei
and Zhang, Min
and Wang, Cheng
and Zheng, Jing",
title="Efficacy of a Web-Based Home Blood Pressure Monitoring Program in Improving Predialysis Blood Pressure Control Among Patients Undergoing Hemodialysis: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Aug",
day="9",
volume="12",
pages="e53355",
keywords="hemodialysis; hypertension; home blood pressure monitoring; eHealth; randomized controlled trial",
abstract="Background: Hypertension is highly prevalent among patients undergoing hemodialysis, with a significant proportion experiencing poorly controlled blood pressure (BP). Digital BP management in this population has been underused. Objective: This study aimed to explore the efficacy of a web-based home BP monitoring (HBPM) program in improving predialysis BP control and enhancing knowledge, perception, and adherence to HBPM among patients with hypertension undergoing hemodialysis. Methods: A multicenter, open-label, randomized controlled trial was conducted at 2 hemodialysis units. Patients were randomly allocated in a 1:1 ratio to either the web-based HBPM program as the intervention group or to usual care as the control group over a 6-month period. The primary outcomes were the predialysis BP control rate, defined as less than 140/90 mm Hg, and the predialysis systolic and diastolic BP, assessed from baseline to the 6-month follow-up. Secondary outcomes included patient knowledge, perception, and adherence to HBPM, evaluated using the HBPM Knowledge Questionnaire, HBPM Perception Scale, and HBPM Adherence Scale, respectively. A generalized estimating equations analysis was used to analyze the primary outcomes in the intention-to-treat analysis. Results: Of the 165 patients enrolled in the program (n=84, 50.9{\%} in the web-based HBPM group and n=81, 49.1{\%} in the control group), 145 (87.9{\%}) completed the follow-up assessment. During the follow-up period, 11 instances of hypotension occurred in 9 patients in the web-based HBPM group, compared to 15 instances in 14 patients in the control group. The predialysis BP control rate increased from 30{\%} (25/84) to 48{\%} (40/84) in the web-based HBPM group after the 6-month intervention, whereas in the control group, it decreased from 37{\%} (30/81) to 25{\%} (20/81; $\chi$22=16.82, P<.001; odds ratio 5.11, 95{\%} CI 2.14-12.23, P<.001). The web-based HBPM group demonstrated a significant reduction after the 6-month intervention in the predialysis systolic BP (t163=2.46, P=.02; $\beta$=−6.09, 95 {\%} CI −10.94 to −1.24, P=.01) and the predialysis diastolic BP (t163=3.20, P=.002; $\beta$=−4.93, 95{\%} CI −7.93 to −1.93, P=.001). Scores on the HBPM Knowledge Questionnaire (t163=−9.18, P<.001), HBPM Perception Scale (t163=−10.65, P<.001), and HBPM Adherence Scale (t163=−8.04, P<.001) were significantly higher after 6 months of intervention. Conclusions: The implementation of a web-based HBPM program can enhance predialysis BP control and the knowledge, perception, and adherence to HBPM among patients undergoing hemodialysis. This web-based HBPM program should be promoted in appropriate clinical settings. Trial Registration: China Clinical Trial Registration Center ChiCTR2100051535; https://www.chictr.org.cn/showproj.html?proj=133286 ",
issn="2291-5222",
doi="10.2196/53355",
url="https://mhealth.jmir.org/2024/1/e53355",
url="https://doi.org/10.2196/53355"
}