Value-based approach to blood pressure telemonitoring and remote counseling in hypertensive patients

Purpose Blood pressure telemonitoring and remote counselling (BPTM) improves blood pressure (BP) control in patients with hypertension (HTN). Studies assessing the efficacy of BPTM from a value-based perspective are lacking. We investigated whether BPTM fits all principles of the value-based approach (clinical and economic effectiveness, improvement in patient-reported outcome/experience measures (PROM/PREM)). Materials and methods Two hundred and forty ambulatory patients with uncontrolled HTN were randomised in a 2: 1 manner to BPTM (n = 160, mean age 47 y.o.) and usual care (UC, n = 80; 49 y.o.) with baseline and 3-month follow-up clinic visits. BPTM employed a mobile application (for patients) and a desktop version (for clinician), which allowed communication and exchange of medical data. The main outcomes were changes in office and ambulatory systolic (S) BPs, rate of BP control. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were evaluated in economic analysis. The MOS SF-36 score was taken as a PROM, and the PEQ score was used as a PREM. Results Larger decreases in office and ambulatory SBPs (–16.8 and −8.9 mm Hg, respectively; p < .05) was achieved in BPTM group while the treatment intensity was equal (2.4 drugs). The ICER 11.1 EUR/–1 mm Hg 24-hour SBP/1 year was 75% effective as per willingness-to-pay threshold. BPTM improved PROM (+2.1 in mean MOS SF-36; p = .04), reduced long-term mortality (+0.11 life years gained), leading to +0.49 quality-adjusted life years (QALYs) gained as compared with UC. The ICUR was 4 169.4 EUR/QALY gained. Patient-reported experience was higher in the BPTM (+10 PEQ, p = .01). The UC group showed minor changes in MOS SF-36 and PEQ (+1.3; +6, respectively; p n.s.). Conclusions Being cost-effective, BPTM incorporates both clinical benefits and patient-perceived value. Larger randomised studies are needed to confirm our findings

Influence of the Filler Particles’ Surface Morphology on the Polyurethane Matrix’s Structure Formation in the Composite

This article presents the surface morphology effect of silicon carbide (SiC) particles on the polyurethane binder’s structure formation in a dispersed-filled composite. The difference in the morphology and surface relief of filler particles was ensured by the implementation of plasma chemical modification. As a result of this modification, the filler consisted of core-shell particles characterized by a SiC core and a carbon shell (SiC@C), as well as a carbon shell decorated with silicon nanoparticles (SiC@C/SiNP) or nanos (SiC@C/SiNW). The study of the relaxation properties of polyurethane composites has shown that the strongest limiting effect on the molecular mobility of boundary layer’s chain segments is exerted by a highly developed surface with a complex relief of SiC@C/SiNP and SiC@C/SiNW particles. An empirical method was proposed to find the polymer fractions spent on the formation of the boundary, transition and bulk layers of the polymer matrix in the composite. It was shown that the morphology of the filler particles’ surface does not affect the dependence of the boundary layer thickness on the filler’s volume fraction. However, with an increase in the degree of surface development, the boundary layer thickness decreases

Progression of obstructive sleep apnoea after renal denervation is not associated with hypertension exaggeration

Abstract Purpose In a cohort, observational prospective trial, we assessed the long-term dynamics of sleep-disordered breathing in patients with resistant hypertension after renal denervation and their association with blood pressure change at remote follow-up. Materials and methods Twenty-eight patients with stable hypertension who were recruited for endovascular radiofrequency renal denervation in 2012–2019 and had valid both baseline and follow-up sleep study, were included in the analysis. All patients underwent physical examination, anthropometry, office and ambulatory blood pressure measurements, blood and urine tests, kidney visualization, and full polysomnography before and within 12–36 months after renal denervation. Results The average follow-up comprised 30.1 ± 8.4 months. At long-term follow-up, no significant changes in creatinine level, estimated glomerular filtration rate, body mass index were registered. There was a significant increase in sleep apnea severity indices: the mean change in apnea-hypopnea index comprised 9.0(-21.1;25.2) episodes/h, in oxygen desaturation index 6.5(-16.8;35.9) episodes/h, in the average SpO2 -1.7(-5.6;1.9)%. Over 12-month follow-up, there were no significant differences in blood pressure response in patients with and without sleep apnea. The baseline apnea-hypopnea and oxygen desaturation indices and the mean SpO2 were associated with the circadian blood pressure profile at follow-up, but did not correlate with the blood pressure response. Conclusions Although the severity of sleep apnea worsens at > 12 months follow-up after renal denervation, this is not associated with hypertension exaggeration