Problem Statement: Many studies have supported the benefits of home blood pressure
monitoring (HBPM) and telemonitoring in improving hypertension awareness and
control. However, little was known about the use of HBPM and telemonitoring by
hypertensive patients in the Republic of Trinidad and Tobago.
Methods and Design: A six-month prospective observational study using HBPM and
telemonitoring was conducted on hypertensive patients in two public sector health centres
in the Republic of Trinidad and Tobago. Newly diagnosed and poorly controlled adult
patients were eligible for enrollment if they spoke English and were willing to participate
in HBPM and telemonitoring. All enrolled patients received the HBPM and
telemonitoring intervention and were given a blood pressure goal based on the presence
or absence of diabetes. The primary endpoint was change in mean arterial pressure
(MAP) between baseline and the six-month follow-up point. Patients who provided
blood pressure readings at baseline, three-month and six-month visits were included in
the analysis.
Results: A total of 171 patients were screened, 157 completed the baseline visit and 118
ultimately engaged in HBPM and telemonitoring for a six-month study period. Of the
118 final participants, 96% expressed a preference for the home monitoring vs traditional
management, 87% successfully transmitted their HBPM results via telemonitoring more
than once a month and 70% showed a reduction in MAP. Mean systolic blood pressure
decreased by 9.2 mm Hg (95% CI 5.4-12.9), mean diastolic blood pressure decreased by
ii6.9 mm Hg (95% CI 4.4-9.4) and MAP decreased by 7.7 mm Hg (95% CI 4.9-10.4;
p=0.0000) from baseline to the six-month visit.
Conclusion: Home blood pressure monitoring and telemonitoring can be effectively
utilized in the Republic of Trinidad and Tobago public sector primary care setting to
improve hypertension management. Ministry of Health officials and primary care
providers should strongly consider promoting these technologies. Follow-up studies with
larger sample size and randomized study design should be conducted to validate these
non-randomized feasibility study findings and gain further insight about the
generalizability of these findings across the Republic of Trinidad and Tobago and other
Caribbean nations.