Efficacy of a Web-Based Home Blood Pressure Monitoring Program in Improving Predialysis Blood Pressure Control Among Patients Undergoing Hemodialysis: 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 underutilized. Objective: This study aimed to explore the efficacy of a Web-based home blood pressure monitoring (HBPM) program in improving pre-dialysis BP control and enhancing knowledge, perception and adherence to HBPM among hypertensive patients undergoing hemodialysis. Methods: A multicenter, open-label, randomized controlled trial was conducted at two 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 pre-dialysis BP control rate, defined as less than 140/90 mmHg, and the pre-dialysis systolic blood pressure (SBP), diastolic blood pressure (DBP), assessed from baseline to the 6-month follow-up. Secondary outcomes included patient knowledge, perception, and adherence to HBPM, evaluated using the home blood pressure monitoring knowledge questionnaire (HBPMKQ), home blood pressure monitoring perception scale (HBPMPS), and home blood pressure monitoring adherence scale (HBPMAS), respectively. The generalized estimating equations analysis was utilized to analyze the primary outcomes in the intention-to-treat analysis. Results: Of the 165 patients enrolled in the program (n=84, Web-based HBPM group; n=81, control group), 145 completed the follow-up assessment. During follow-up period, 11 instances of hypotension occurred in 9 patients in the Web-based HBPM group, compared to 15 events in 14 patients in the control group. The pre-dialysis BP control rate increased from 29.8% to 47.6% in the Web-based HBPM group after the 6-month intervention, while in the control group, it decreased from 37% to 24.7% (x2 =16.82, P <.001; OR = 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 pre-dialysis SBP (t =2.46, P =.02; β = −6.09, 95%CI −10.94 – −1.24, P =.01), and the pre-dialysis DBP (t =3.20, P =.002; β = −4.93, 95%CI −7.93 – −1.93, P =.001). Scores on HBPMKQ (t = -9.18, P <.001), HBPMPS (t = −10.65, P <.001), and HBPMAS (t =−8.04, P <.001) were significantly higher after 6-months of intervention. Conclusions: Implementation of a Web-based HBPM program can enhance pre-dialysis 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. Clinical Trial: China Clinical Trial Registration Center ChiCTR2100051535; https://www.chictr.org.cn/showproj.html?proj=133286