ABC | Volume 113, Nº5, November 2019

Short Editorial Self-Monitoring with or Without Telemonitoring: Is a New Time for Diagnosis and Management Hypertension? Cibele Isaac Saad Rodrigues 1, 2 Faculdade de Ciências Médicas e da Saúde - Departamento de Medicina - Área de Nefrologia, 1 Sorocaba, SP – Brazil Pontifícia Universidade Católica de São Paulo (PUC-SP), 2 São Paulo, SP – Brazil Short Editorial related to the article: Prevalence of Masked and White-Coat Hypertension in Pre-Hypertensive and Stage 1 Hypertensive patients with the use of TeleMRPA Mailing Address: Cibele Isaac Saad Rodrigues • Rua Joubert Wey, 290. Postal Code 18030-070, Vila Boa Vista, Sorocaba, SP – Brazil E-mail: cisaad@pucsp.br; cibele.sr@gmail.com Keywords Cardiovascular Diseases; Telemedicine; Hypertension/ prevention and control; White Coat Hypertension; Masked Hypertension; Hypertension Self-Monotoring. DOI: https://doi.org/10.36660/abc.20190701 According to the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline for the prevention, detection, evaluation, and management of high blood pressure (BP) in adults, 46% of US adults have hypertension (HTN). 1 In Brazil, because the levels of systolic and diastolic BP that define HTN 2 differ from ACC/AHA Guideline, the percentage is about 25%, according to VIGITEL. 3 HTN is an important public health issue and the major risk factor for heart disease, stroke, and chronic kidney disease. Heart disease and stroke are among the most prevalent and costly health problems worldwide, and controlling BP is the best effective intervention in life-saving, preventing deleterious comorbidities, but only about half of those with HTN have it under control even in developing countries. 1,2,4 BP is one of the most important monitoring parameters in clinical medicine. Measuring BP properly is a crucial point in the diagnosis and management of HTN in clinical practice, in office settings or outside the office. 5 Home BP monitoring with validate automatic devices become an alternative to Ambulatory Blood Pressure Measurement (ABPM), that is recommended as the preferred out-of-office BP method in the majority of guidelines 1,2,5,6 because of its superior precision, unique ability to measure nocturnal BP identifying non-dippers and risers (reverse dipping), detects circadian variability and appears to correlate best with prognosis. In contrast to ABPM, HBPM is well-tolerated, more easily available, with lower cost, and also has a stronger association with renal and cardiovascular risk than office BP. Additionally, HBPM can give patients empowerment and a more active role in the management of their chronic disease, which is useful for monitoring the efficacy of antihypertensive treatment, thus improving BP control by diminishing medical therapeutic inertia. However, the scientific data at the moment recognized that HBPM, instead of being cost-effective and a good approach, is underutilized in the United States and other countries, 7 and a few well-designed trials are available. TASMINH4, 8 a study conducts by National Institute for Health Research in United Kingdom, recently published in Lancet, found that self-monitoring, with or without telemonitoring, when used by general practitioners in primary care to titrate antihypertensive medication in individuals with uncontrolled BP, determined significantly lower systolic BP in intervention group than titration guided by office clinic readings. The results showed that self‑monitoring with or without telemonitoring is beneficial in HTN management in primary care. The Telescot 9 is a Scottish trial that included seven studies on the implementation of telemonitoring in a primary care setting for the long-term management of HTN, diabetes and other chronic diseases. The results showed a high approval rate by patients, who found the new strategy empowering and useful. Physicians also considered telemonitoring encouragingly; however, some of them expressed criticism on software characteristics, which may denote obstacles to widespread implementation of telemonitoring in the routine of daily care. In the study “Prevalence of Masked and White-Coat Hypertension in Pre-Hypertensive and Stage 1 Hypertensive Patients with the Use of TeleMRPA” in this issue, Barroso WKS et al. 10 used the strategy of HBPM associated to telemedicine (TeleMRPA platform). The sample consisted of 1,273 participants, 58.1% were women, mean age was 52.4 ± 14.9 years, mean body mass index 28.4 ± 5.1 kg/m 2 . The casual in-office BP was higher than the HBPM (+7.6mmHg for systolic and +5.2 mmHg for diastolic BP (p < 0.001). They found 558 (43.8%) normotensive individuals; 291 (22.9%) with sustained HTN; 145 (11.4%) with masked HTN (MH) and 279 (21.9%) with white-coat HTN (WCH), with a diagnostic error by casual BP in the total sample in 424 (33.3%) patients. In stage 1 hypertensive, the prevalence of WCH was 48.9%; in prehypertensive patients, the prevalence of MH was 20.6%. They concluded that MH and WCH have a high prevalence in the adult population, particularly in pre-hypertensive and stage 1 hypertensive patients and out-of-office BP measurements in these patients is particularly indicated to prevent misdiagnosing. In fact, it is an important result because prehypertension is a warning sign of developing long term HTN and at this stage, and even more at stage 1 HTN, they are both associated with target organ damage by increasing risk for cardiovascular and renal disease. 11 As described above, telemonitoring is now successful used in primary care worldwide and we have to consider this strategy as a possibility to do our work in Brazil in terms of diagnosing and management of HTN. HBPM with or without telemonitoring can be used systematically in the daily 976