ABC | Volume 113, Nº5, November 2019

Short Editorial Rodrigues Self-monitoring with or without telemonitoring Arq Bras Cardiol. 2019; 113(5):976-978 practice as ABPM does to identify patients with white‑coat HTN; masked HTN; sustained control, uncontrolled, resistant, or refractory HTN like the authors found in the analyzed paper. 1,2,5,6 Nevertheless, it’s important to consider some limitations. It is a retrospective unblinded study that is capable of identifying a feasibility issue but not design specifically to extract data. The majority of the records was taken from patients that live in Northeast of Brazil and it’s a possible bias admitted for the authors. We don’t know how the patients comply with making the arterial pressure measurements in almost 30 different centers from nine states of the Brazilian geographic regions. It is a huge effort in training all patients and maintaining the devices well-calibrated and checked for accuracy periodically using a standard method with proper cuffs size and correctly positioned. Another patient-barrier is that HBPM requires literacy so that individuals are able to apply a standard measurement of BP using the same calibrated automatic oscillometric devices. Training of health professionals and patients is obligatory in all centers and is known that is time-consuming. 5 Finally, we have other variables to consider like the presence of records signal artifact by movements or cardiac arrhythmia. Is expected that in the future with an increasing use of digital medicine we will have new technologies like a next- generation BP monitoring devices, including smartphones and Bluetooth-enable telemonitoring, using cuffless and continuous BP monitoring systems that will be able to provide novel, accurate and validated solutions in clinical setting, improving outcomes of hypertensive patients. 12,13 Maybe at this time, even ABPM will be part of the past. An example of this new technology is the experimental watch-type prototype proposed by Woo et al. 14 which uses a wearable device with a pressure sensor close to the radial artery, giving an accurate continuous BP measurement on a personal smartphone. On the other hand, transmitted data from these home equipment and personal devices will create expectations of therapeutic decision making, if required. Another point to consider is that better levels of privacy and sensitive data security, integrity and safety control are essential, since flaws may occur with data sharing between patients and their health managers. In many countries, like in Brazil, we did not have clear technical, legal and ethical regulatory rules for e-health interventions and these are important tools to guide doctors in their clinical settings in an era of growing artificial intelligence. The study of Barroso WKS et al., 10 brings us the results that out-of-office BP monitoring into Brazilian professional’s practice is an important complement to office HTN screening measures and is expected that a rigorous process of telemonitoring can break some barriers. In conclusion, HBPM telemonitoring seems to be a promising patient management approach, particularly in cases of patients at high risk, that produces accurate and reliable data but there is a need to additional prospective randomized controlled trials of self-monitoring BP with and without telemonitoring compared with usual care and ABPM, with larger sample size and longer follow-up to confirm the results in literature about clinical effects on diagnosing , controlling and impact on morbidity and mortality of HTN patients. Cost-effectiveness of each strategy compared to another, impacts on services utilization, acceptance by professionals and patients are also essential for allowing scientific recommendations on the employment of these new tools in daily care for diagnosis and management HTN. 1. 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CDC Grand Rounds: A Public Health Approach to Detect and Control Hypertension (MMWR). Weekly. 2016;65(45):1261-4. 5. Muntner P, Shimbo CD, Carey RM, Charleston JB, Gaillard T, Misra S, et al. Measurement of blood pressure in humans: a scientific statement from the American Heart Association. Hypertension. 2019;73:e35–e66. 6. Nobre F, Mion Jr D, Gomes MAM, Barbosa ECD, Rodrigues CIS, Neves MFT, et al. 6ª Diretrizes de Monitorização Ambulatorial da Pressão Arterial e 4ª Diretrizes de Monitorização Residencial da Pressão Arterial. Arq Bras Cardiol. 2018;110(5 Supl 1):1-29. 7. Magid DJ, Green BB. Home blood pressure monitoring: take it to the bank. JAMA. 2013;310(1):40-1. 8. McManus RJ, Mant J, Franssen M, Nickless A, Schwartz C, Hodgkinson J, et al. Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial. Lancet. 2018;391(10124):949-59. 9. 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