Combining proteomics, home blood pressure telemonitoring and patient empowerment to improve cardiovascular and renal protection.

There is a clear-cut need to improve prevention of cardiovascular and renal diseases. Several interventions focused on hypertension-mediated risk reduction have been advocated including multi-omics approach, home blood pressure telemonitoring and patient empowerment. Genetics, metabolomics and proteomics, facilitated by recent advances in high-throughput technologies, have given us unprecedented insight into pathways involved in cardiometabolic disease development and progression [1–3]. However, omics-based discoveries have not resulted in rapid translation into clinical practice [4], and routine omic testing for hypertensive patients is not recommended [5]. Telemonitoring of home blood pressure has potential to change the current management of hypertension [6]. Unfortunately, the strength of available evidence supporting wider use of this method is relatively low, and it is generally agreed that well-designed randomised controlled trials are needed to further investigate its real impact on clinical outcomes [7]. Finally, all guidelines stress that patients should be encouraged to take responsibility for their own cardiovascular health. Whether combining urinary peptidomic profiling (UPP), home blood pressure telemonitoring (HTM) and patient empowerment improves cardiorenal protection is unknown. In this issue of Blood Pressure, Thijs et al. [8] present the rationale and protocol for the Urinary Proteomics Combined with Home Blood Pressure Telemonitoring for Health Care Reform (UPRIGHT-HTM) randomised clinical trial. This study will compare UPP combined with HTM (experimental group) with HTM alone (control group) in the risk profiling and as guide to starting or intensifying management of risk factors to prevent established disease. The investigators’ hypothesis is that early knowledge of urinary peptidomic risk profile will lead to more rigorous risk factor management and result in clinical benefit. This 5-year clinical trial will randomise 1148 patients. Throughout the study, HTM data will be collected and freely accessible for patients and caregivers. The proteomic risk profile, measured at enrolment only, will be communicated early during follow-up to 50% of patients and their caregivers (intervention arm), but only at trial closure in the remaining 50% of patients (control arm). The primary endpoint is a composite of new-onset intermediate and hard cardiovascular and renal outcomes. Secondary endpoints include a definition of the molecular signatures of early renal and cardiovascular diseases. The protocol of the trial is very precise as illustrated by the 31-page supplement accompanying the main article [8]. There are several unique characteristics of the trial. First, the findings generated by the trial may be translated into new concepts for better prevention and treatment of hypertension and cardiovascular disease. Second, the trial will run in different countries and continents, and will be open for patients of multiple ethnicities. Demonstrating that combining UPP with HTM is feasible and beneficial in a multicultural context will have global implications. Third, the trial is patient-oriented. It will be carried out in the patients’ homes and in the practices of their caregivers by implementation of modern information technology, under the supervision of the patients’ own primary or specialist care providers. Results of HTM, a powerful instrument in educating and empowering patients, will be accessible for all patients. The results of the trial might have important implications for future hypertension and diabetes guidelines. The trial might become a ‘game-changer’, leading to implementation of proteomics in clinical practice and shifting emphasis from treating to preventing cardiovascular and renal diseases.