Disease Management Program for the Care of Hypertensive Patients Using Telemedical Support
Under the Patronage of the Austrian Society of Hypertension
- Open Access
- 30.10.2025
- Originalie
Erschienen in:
Abstract
Preamble
Hypertension is globally the most relevant risk factor for premature death and life with disability. Nevertheless, management of the disease and achievement of blood pressure targets are inadequate. Disease management programs (DMPs) are highly effective for treatment optimization. The aim of this Austrian position paper is to set the cornerstone for a DMP for patients with hypertension using telemedicine and telecare and thus to create an incentive and a framework for the implementation of such a DMP.
The Austrian Society of Hypertension advocates for the implementation of a structured, telemedicine-supported DMP to address the persistent challenge of uncontrolled hypertension in Austria. Such a program would empower patients, enhance adherence, and enable interdisciplinary care through digital tools and standardized monitoring. Our goal is to improve blood pressure control, prevent hypertension-mediated organ damage, and reduce cardiovascular events across the population.
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Why Is a DMP Needed?
Hypertension is globally the most important risk factor for premature death and life with disability [1]. Nevertheless, the current situation of hypertension treatment worldwide and in Austria is inadequate [2]. This is especially true for achieving BP targets in hypertensive patients. In previous studies (SCREEN study [3], EURIKA study [4]), only 17 and 36% of patients, respectively, attained the BP goals.
A more recent trial conducted in Austria in 2015 that used standardized BP measurements in pharmacies in more than 4300 persons who were filling a prescription for antihypertensive medication showed that only 41% were normotensive [5].
Another study from 2016–2017 that measured BP in more than 10,000 pharmacy clients showed that 29.5% of persons with no history of hypertension and 57.3% of persons with known (and mostly treated) hypertension had elevated BP [6].
During the special “May Measurement Month” program held in Austria in 2017, BP was measured in a standardized way in 2711 persons in doctors’ offices, pharmacies, and public places. Hypertensive BP readings were seen in 43.2% of persons not receiving antihypertensive treatment and in 63.5% of persons on antihypertensive treatment [7].
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Considering the fact that cardiovascular disease is still the number one cause of death in Austria [8] and that this did not change (either locally or internationally) during the COVID-19 pandemic [9], there is a compelling need for action.
The inclusion of chronically ill patients into a network of healthcare professionals within the framework of a DMP leads to enhanced patient adherence. It can be assumed that effective data sharing among various healthcare providers can improve the efficiency of care for a large number of patients and also save time.
A publication from Japan shows how integrated care using telemedicine can be successful. A total of 390 patients were randomized into two groups: one was cared for digitally using the so-called HERB system and both groups were also trained with regard to lifestyle modification. The HERB program was based on an interactive smartphone app that aimed to help users implement non-pharmacologic interventions, e.g., salt restriction, weight control, regular exercise, or cutting back on alcohol; techniques from behavioral therapy were included. Study participants regularly measured their BP. Measured numbers were transmitted to the app via Bluetooth. The app, in turn, was connected to a user interface for physicians, so that they could contact their patients at any time.
After 12 weeks, 24-hour systolic BP (SBP) in the intervention group was 2.4 mm Hg lower than in the control group, the difference in home-measured SBP values was 4.3 mm Hg, and the difference in office-measured SBP values was 3.6 mm Hg. All three differences were statistically significant [10].
Standpoint of the Social Security Organization
Social security organizations (SSOs) aim to distinguish between various aspects in such a project, with clients/patients being at the center of such considerations. In addition, SSOs need to steer financing and focus on the potential for middle- to long-term cost reductions, whereby equal access and patient-relevant benefits at acceptable expenditures are inevitable.
From the patients’ point of view, telemedical care, independent of geographical and time constraints, creates a simplified means of access. Adherence to therapy, and thus the quality of treatment, can be increased by self-reliant gathering of vital parameters, e.g., with a smartphone. This accessed data is regularly checked by a healthcare provider. Using standardized data visualizations, exceeded thresholds are easily detected and therapies can be adjusted. Increased adherence to therapy strengthens the relationship between patient and physician as well as trust on both sides.
By offering such technologies, healthcare providers are able to support a healthy lifestyle for their clients and increase client proximity. Intensive training with telemedical help supports the health literacy of participants. Moreover, it becomes easier to introduce further prevention programs. Consequently, the healthcare system benefits significantly from a structured, interprofessional, and interdisciplinary care program by reducing the complications of HTN and therefore the associated costs.
Technological Aspects
In the age of digitalization, healthcare is undergoing transformation. Digitalization will not only improve medical outcomes but will also pave the way for possible new treatment forms that exceed currently existing barriers in space, time, access, and knowledge. Digital therapeutics (DTx [11]) may provide evidence-based therapeutic interventions [10], guided by high-quality software, in order to improve disease prevention, treatment, and management. Tailored telehealth solutions offer new possibilities for cooperation, coordination, communication, and treatment in the context of DMPs with a virtual multidisciplinary care team around the patient. Examples of telehealth services for heart failure are the HerzMobil programs in Tyrol, Styria, Carinthia, and Lower Austria [12, 13] or the Austria-wide Gesundheitsdialog Diabetes run by the healthcare provider BVAEB for patients with diabetes [14].
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These services, as well as the recently established service for the care of hypertensive patients in Tyrol, are built on a web-based telehealth platform to facilitate efficient and reliable daily data documentation and data transfer [13]. Usually, a telehealth application consists of a central data management system (DMS), a corresponding mobile app for the patients, and analysis software for decision support and automated limit value control as a certified medical device. The DMS enables access to a patient’s data for different user roles via web dashboards and supports professional users with various processes such as patient registration, documentation of notes, documentation of health data, documentation of feedback information, and communication with the patient via the linked mobile app. Every patient is equipped with a BP and heart rate monitor, a weighing scale, a pedometer, and a specially configured mobile app on the patient’s smartphone for daily data acquisition and transmission. The mobile app also collects other health diary data such as medication and subjective state of health. Additionally, feedback can be collected from the DMS via the mobile app. All the data recorded by the mobile app are synchronized with the DMS. Automatic event detection fosters attention on those patients who might require therapeutic intervention.
A personalized configuration using HL7 FHIR CarePlans and a modular, flexible software architecture enables efficient implementation of the telehealth-based DMPs to gain a better understanding of a particular disease pattern, speed up diagnostics and create individually tailored therapies for patients. Interoperability with hospital information systems and electronic health records using standard-compliant components (IHE, HL7/CDA, HL7 FHIR) supports sustainable integration into the existing healthcare system.
A Disease Management Program for Hypertension
Goals of a DMP for Hypertension
The main goal is to meet BP targets in as many hypertensive patients as possible. This is intended to reduce cardiovascular disease (especially heart failure) as well as renal failure and cerebrovascular disease.
Patients are encouraged to be involved in the program for 3 months (see “What Is the Appropriate Duration of a DMP?”). Disease-specific training to improve self-empowerment and early awareness for disease progression are of central importance. (see “DMPs in Austria—Status and Challenges” and [58]).
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Correct BP self-measurement is of the utmost importance, since it puts patients in a position to identify and control health targets themselves. The next step consists of adequate lifestyle changes. Moreover, improving adherence to both lifestyle changes and antihypertensive drugs often enables successful therapy. An interdisciplinary approach, including patient education by a registered nurse or dietician as well as medical support, has already been proven.
According to the recommendations of the Austrian Society of Hypertension from 2019 and the European Society of Hypertension from 2023, the following targets should be achieved (Table 1; note that the BPs in Table 1 are office BPs and that an office BP of 140/90 mm Hg is equivalent to an average home BP of 135/85 mm Hg).
Patient age | Target blood pressure |
|---|---|
18–64 years | < 130/80 mm Hg |
65–79 years | < 140/80 mm Hg |
< 130/80 mm Hg if well tolerated | |
65–79 years with ISH | SBP 140–150 mm Hg |
SBP 130–139 mm Hg if well tolerated | |
Caution if initial DBP < 70 mm Hg | |
≥ 80 years | SBP 140–150 mm Hg |
SBP 130–139 mm Hg if well tolerated | |
Caution if initial DBP < 70 mm Hg | |
Frail patients | Individualized BP targets |
Hypertension-Mediated Organ Damage and Cardiovascular Events
Arterial HTN is one of the main risk factors for development of cardiovascular disease. The earlier HTN develops, the sooner (asymptomatic) hypertension-mediated organ damage (HMOD) and ultimately cardiovascular events (myocardial infarction, stroke, heart failure, dementia, etc.) will appear.
In a trial involving 4851 hypertensive patients younger than 40 years, 228 events and 319 deaths prior to the age of 60 occurred in a follow-up period of 18.8 years [14]. A recent meta-analysis showed that lowering systolic BP by 5 mm Hg can significantly reduce cardiovascular events (Table 2).
Table 2
Reduction of target organ damage by reducing systolic blood pressure (BP). Source: [15]
−5 mm Hg systolic BP | |
|---|---|
Overall | −10% events |
Stroke | −13% events |
Heart failure | −13% events |
Coronary heart disease | −8% events |
Cardiovascular death | −5% events |
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The 2023 guidelines of the European Society of Hypertension define the following conditions as HMOD: left ventricular hypertrophy, nephropathy, the various forms of arterial vascular disease (peripheral, cardiac, and cerebral) including arterial stiffening, and retinopathy [16].
It is stressed that some changes are partly reversible with optimal BP control. Therefore, measurements of renal function, microalbuminuria, arterial stiffness, and myocardial thickness/mass should be performed both at baseline and either at the end of DMP participation or at regular 1‑year follow-up visits for reassessment of self-care skills (see “What Is the Appropriate Duration of a DMP?”).
Echocardiography (including measurement of left ventricular mass and/or septal or posterior wall thickness), serum and urine laboratory parameters, and pulse wave velocity/arterial stiffness (if available; could be performed in combination with 24-hour BP measurement) are recommended for detection of secondary organ damage. Diagnostic reassessment is realistically indicated after 1 year at the earliest [17‐22]. Measurement of regression of HMOD is an accepted surrogate endpoint for the success of hypertension treatment beyond BP readings.
Which Patients Should Be Included?
Neither patients whose BP is already well controlled nor patients who require acute and intensive treatment are suitable for a DMP. Patients newly diagnosed with HTN as well as those with inadequate BP control under ongoing treatment may be included. Patient selection must be based on the most efficient way to measure BP. A recently published review analyzed 52 trials with more than 200,000 participants. It turned out that practical BP measurement is subject to a wide range of variation and may well produce false information [23]. Automated office blood pressure measurements (AOBPM) as used in the SPRINT study are one good option [24, 25].
Better reproducibility can be achieved with 24-hour measurement with an automated device (ABPM) as compared to home blood pressure monitoring (HBPM), as shown in the SWICOS trial [26]. There are certain advantages of 24-hour measurements, like a lower error rate. Moreover, 24-hour BP measurement is a good predictor for HMOD and significantly increases the rate of those patients who bring their BP within the target range, most likely due to visualization and therefore improved adherence [27‐30]. ABPM is suggested in current guidelines for the diagnosis of HTN and is recommended for confirmation of the diagnosis before a patient is included in a prevention program [31].
As a means of primary screening, AOBPM could be used. When measurements exceed 140/90 mm Hg, ABPM is recommended. We suggest that readings higher than 160/100 mm Hg should result in direct and intensified care by the attending physician and therefore exclude the patient from a DMP.
Further inclusion criteria should depend on whether a patient is physically and mentally capable of participating in a DMP. More specifically, a patient must be able to correctly use the telemedicine technology of the DMP. Furthermore, patients with secondary arterial hypertension due to, e.g., renal artery stenosis or adrenal gland or thyroid diseases, which can be causally treated, are not eligible for a DMP. Patients with well-controlled hypertension are not candidates for hypertension DMPs.
How Can Patients Be Recruited?
Experience from other DMPs shows that recruitment of patients is crucial for the success of a care program. Successful motivation of patients and embedding the program in existing medical care structures are essential in order to impart a feeling of safety and transparency to patients.
A Cochrane review showed that about 50% of all planned studies of DMPs failed because of recruitment problems [32]. Therefore, different approaches to patient recruitment must be applied to reach the largest possible number of participants. Recruitment should be managed primarily by GPs and internists—the groups of physicians most often confronted with BP treatment. A great advantage of this approach is that a relationship of trust already exists between doctor and patient. Also, SSO invitations sent as automated emails as well as via the post office appear to be effective. For example, the Veterans’ Health Administration used comprehensive health data from their patients and was thus able to improve recruitment rates [33].
In the medium term, it is recommended that the DMP be linked to the nationwide ELGA infrastructure in Austria, as is already the case with the telemedical care program HerzMobil, for example [34]. Another possibility is to produce brochures as well as posters, media advertisements, and lettering on public transport vehicles, as was done in the SPRINT study. The decisive point is clarity, including the options for potential participants to contact the program administrators [35].
Another means of accessing potential participants is through outpatient clinics, such as a general hypertension outpatient clinic or consultations for hypertension. The use of ICD codes as screening criteria is also conceivable.
The use of social media in this context is also imaginable. In the DMP “HerzMobil Tyrol—Heart Failure,” patients are enrolled in the DMP during hospitalization for hypertension-triggered organ damage. Additionally, patients are referred to the program by their primary care and family physicians [36]. After completing the program, patients are referred back to their healthcare system with comprehensive documentation of the interventions performed. This should be exemplary for future DMPs to seamlessly integrate the program into primary care.
In summary, all of the methods described should be used judiciously to reach the greatest number of potential participants in the program. All medical facilities that select patients for the DMP must be intensely informed about the program.
Standpoint of the Social Security Organization
In most cases, SSOs have the information to decide which patients are eligible for a particular healthcare program (depending on the inclusion criteria) and can thus recommend the best program. Family physicians play a central role, because they know the available programs and their target groups and proactively assign patients to programs. In addition, hospitals could implement recommendations for a telemedicine program in their discharge management.
Under the label of “healthcare marketing,” regional or national health campaigns should be launched to increase awareness and clearly communicate the advantages of participating in such programs. A further way to increase awareness is to address target groups in personalized information letters, ideally from the SSOs.
How Should a Program Be Organized and how Should It Function?
Targeted and patient-centered care is based on a multiprofessional and interdisciplinary treatment network. This way, patients can be cared for seamlessly and close to home. Procedures need to be well coordinated and there must be a continuous exchange of information within the network. A basic condition for this is centrally led, close, and uniform coordination. It is mandatory that all healthcare providers and institutions as well as the patients have continuous access to the same level of information. This can be supported by modern digital solutions.
In the implementation of a DMP, personal contact between nursing staff and patients at the beginning and the end of care and, if necessary, virtual/telemedical contact in between are advisable. Patient education can also be provided via virtual patient contact.
Important pillars of a DMP:
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a central organizational unit (OU).
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suitable infrastructure (e.g., telemedical systems).
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a multidisciplinary approach.
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definition of roles and processes.
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definition of inclusion criteria and patient recruitment.
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education.
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continuous monitoring of BP self-measurement.
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optimization of therapy.
Organization of a central organizational unit:
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coordination of central organizational units (OUs) on a state level; alternatively, several decentralized care units (as smaller OUs) are conceivable that are supplied with uniform guidelines by a central OU, e.g., in quality circles that implement guidelines.
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24-hour BP measurements could be provided by the OU (for family physicians who do not have that tool in place).
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inclusion of primary care physicians in the stakeholder network.
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if patients do not reach the targets during the optimization phase, specialists should join in a second phase for further diagnostics and treatment.
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a specialist may act as a backup for the primary care physician and may be called in as needed.
Treatment process:
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clear allocation of the responsibilities of stakeholders and patients.
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clear inclusion criteria (24-hour BP measurement).
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defined training content, individual training methods, individual and group instruction.
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use of technical resources.
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nursing professionals take over a large part of the DMP but remain in constant contact with physicians who decide on pharmacological therapy.
In contrast to other DMPs, e.g., for heart failure, which have to be organized in a multisectoral way, this is not crucial for a hypertension DMP because hypertensive patients are mainly cared for at doctors’ offices and outpatient clinics.
As in every DMP, nursing professionals play a crucial role. Mainly physicians and internists will cover the medical treatment aspect. Further recommended professions are dieticians, personal trainers, and sports physicians. Usability of technical tools is important with a view to guaranteeing adherence across the entire age spectrum.
Cooperation of Different Professions
Cooperation of different professions in the care of hypertensive patients includes
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specialized nurse professionals.
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network physicians.
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(cardio)psychologists.
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sports scientists.
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physiotherapists.
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dieticians.
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psychotherapists.
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motivational trainers.
Collaboration between involved groups should be as direct, close, and respectful as possible.
What Is the Appropriate Duration of a DMP?
In large HTN studies (ACCOMPLISH [37], SPRINT [25], ADVANCE [38]) an improvement in target BP readings was seen within a few months. In order to allow for changes in treatment because of drug intolerance, adverse events, or necessary intensification of treatment, a period of 3 months, with an option for an additional 3 months, seems reasonable.
A further aspect is the duration of intensive support in order to move a suboptimally controlled patient into the BP target range. On the one hand, adherence will improve through direct contact within 3 months. On the other, possible treatment adjustments can be sufficiently monitored within that period. Follow-up visits after 12 months can improve the long-term outcome.
Costs and Cost-Effectiveness
As the implementation of a DMP for the care of hypertensive patients not only improves patient-relevant outcomes but also has an impact on resource utilization in the healthcare system, the cost-effectiveness of such a program needs to be considered. Particularly the inclusion of telemedical support in a DMP may entail substantial additional economic aspects. As HTN is a chronic disease, a sufficiently long time horizon must be considered, and therefore, usually short- and intermediate-term evidence from empirical studies must be combined using decision-analytic modeling [39‐42]. There is currently no direct evidence for such a DMP in the Austrian healthcare context. There are several original economic studies and reviews on DMPs, health programs, or community interventions for HTN in different settings and countries. Although there is substantial heterogeneity regarding the quality and findings of these studies, the following summary can be made: most authors conclude that a DMP for HTN that aims to reduce BP by focusing on the systolic BP is likely to be cost-effective (see below).
A systematic literature review by Zhang and colleagues [43] identified 34 economic evaluations including educational, self-monitoring, and screening interventions in the US, UK, Mexico, Canada, China, Korea, Argentina, Israel, South Africa, Japan, Pakistan, and Australia. Overall, the conclusion was that an intervention for high BP, no matter what type, is cost-effective or even cost-saving [43]. Since then, further comparative economic evaluations have been performed [44‐49] using different methods, endpoints, and efficiency measures. In the majority of the studies, the incremental cost-effectiveness ratios were below US $ 60,000 per quality-adjusted life year (QALY) gained or even saved costs.
Evidence to show the cost-effectiveness of DMPs using telemedical support is very scarce. A recent umbrella review of systematic reviews and meta-analyses of the clinical effectiveness of telemedicine interventions for diabetes, dyslipidemia, and HTN [50] showed effects on intermediate endpoints for diabetes (e.g., HbA1c) but no significant and clinically meaningful impact on BP. However, the GRADE assessment showed the evidence to be of low to very low quality. A recent review focusing on e‑health and telemonitoring in HTN management [51] states that telehealth is a promising feature, particularly when coupled with multimodal interventions involving a physician, a nurse, or a pharmacist and including education on lifestyle, risk factors, and drug management. But which approach will be effective, efficient, and sustainable in the long term remains to be determined in further research [51].
Regarding economic effects, the evidence is limited to a relatively short-term impact. An earlier review in 2013 by Omboni and colleagues [52] and a more recent economic evaluation by Dehmer et al. [53] showed increased initial costs for telemonitoring and comparable or lower medical costs for the intervention and usual care groups.
To date, none of the identified studies have quantified the efficiency-equity tradeoff, providing information on the reduction of inequality across different patient sections [54]. Investigation of this tradeoff may be of specific relevance in DMPs by improving access to effective, efficient and appropriate care for all hypertensive patients.
As the goal of medical care is not to save costs but to provide equal access and patient-relevant benefits at acceptable expenditures, further economic evaluations should conduct both empirical cost-effectiveness analyses along clinical trials for the (short) duration of follow-up as well as decision-analytic economic modeling studies to provide incremental cost-effectiveness ratios (e.g., cost per QALY gained) in order to assess the impact of telemedical support and its variants over a sufficiently long analytic time horizon, thereby capturing long-term benefits, risks, costs, savings, and equity aspects.
DMPs in Austria—Status and Challenges
A model country with respect to HTN and DMP is Canada. In the 1980s, only 13% of Canadian patients with HTN were in the target range. Since 1986, numerous initiatives have been undertaken in the field of HTN, and in the 1990s, the Canadian Hypertension Education Program (CHEP) was started. This program involves family physicians and other health professionals and institutions, as well as offering regular recommendations by various expert commissions and undertaking public relations work. In this way, between 1992 and 2013, the rate of HTN diagnoses rose from 57 to 84% in patients screened for HTN, the rate of pharmacological therapies from 35 to 80%, and the rate of attainment of target values from 13 to 68%. Moreover, a reduction in cardiovascular events was shown [55].
In Austria, a nationwide DMP for diabetes (Therapie aktiv—Diabetes im Griff) involves family physicians who care for patients for months and even years [56].
On the basis of this DMP, the program “Herz.Leben,” an educational program for hypertensive patients, was developed in 2007 and implemented in the state of Styria. It was designed to optimize BP readings in poorly controlled or newly diagnosed hypertensive patients. At the same time, background information was provided.
The program includes hypertensive patients with or without prior pharmacological therapy, with systolic BP > 160 mm Hg and diastolic BP > 95 mm Hg or > 140/90 mm Hg if measured by a physician. Additionally, patients need to have an elevated cardiovascular risk (New Zealand risk score, NZRS ≥ 15%).
Education is provided by specially trained physicians and nurses in the offices of family physicians or internists or in outpatient clinics. This is done in small groups of six to ten patients in four modules of two times 45 min each. Patients are encouraged to bring family members.
The following topics are elaborated:
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performing correct BP self-measurements.
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basic facts about a salt- and cholesterol-restricted diet (using presentation boards).
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recommendations for exercise programs, adapted for age and health status.
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information on smoking cessation.
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information on antihypertensive medication and how to react in case of a hypertensive crisis.
Additionally, during the education program, BP self-measurements are performed at home and discussed in each module with a physician; if needed, treatment is adjusted.
The contents of this education program agree with current guidelines issued by the European and the Austrian societies of hypertension [2, 16, 60]. The first results of the Herz.Leben education were published in 2011 in the Journal of Hypertension [57].
Of 2041 included patients (54% female, mean age 62 ± 11 years), 744 were analyzed after a follow-up of 1 year. The BP readings 1 year after education decreased significantly: systolic from 156.1 ± 20.8 to 139.2 ± 15.6 (p < 0.001) and diastolic from 88.9 ± 11.1 to 82.1 ± 9.5 mm Hg (p < 0.001). Cardiovascular risk according to the NZRS decreased significantly by 4%. Bodyweight, BMI, and total cholesterol decreased significantly as well.
The results of this study were subsequently confirmed in a randomized controlled trial that compared this education program with a conservative approach in a cross-over design [58]. After 6 months, systolic BP in the intervention group was significantly lower in office as well as home measurements. Subsequently, the control group also participated in the education program; after a further 6 months, the differences in BP disappeared. The effectiveness of the program seems to be based on the fact that participants had better knowledge about how to deal with their disease and its consequences as well as on the resulting improvement in adherence and motivation.
Since 2019, the BVAEB, in collaboration with the State of Tyrol, the Tyrol Health Fund, LIV, and AIT, has run the telemedical HerzMobil hypertension project. The goal is to care for newly diagnosed or already treated patients with elevated BP in Tyrol. The main goal is to normalize BP, based on standardized measurements that are performed twice daily and controlled via telemonitoring; this way, the patients receive feedback from specialized physicians and nurses. A patient remains in the program for 3 months, with a possible extension of another 3 months if BP targets are not met.
In addition to telemedical care, there are also educational group sessions aimed at improving lifestyle and self-empowerment. The focus of these sessions is on exercise, diet, psychological health, and medication [58, 59]. Preliminary results from project evaluation showed a reduction in systolic and diastolic 24-hour BP in adjustment phase I, a distinctive interim outcome. Thus, it appears that care in this pilot project has a substantial positive influence on patients’ health situation. It was also seen that the treatment path works very well. The quality of care is described by all actors involved as being very rewarding. However, implementation in the existing structure of care in doctors’ offices was seen to be problematic and is being addressed in the currently running project.
Discussion
Hypertension remains one of the most pervasive and modifiable risk factors for cardiovascular and cerebrovascular morbidity and mortality worldwide. Despite the availability of effective antihypertensive therapies and evidence-based guidelines, a significant gap persists between treatment and actual BP control in the population. Austrian data mirror global trends, with fewer than half of treated hypertensive individuals achieving target BP values. This gap underscores the urgent need for structured, scalable, and patient-centered interventions.
The implementation of a disease management program (DMP) supported by telemedical infrastructure presents a promising solution. Such programs have already demonstrated efficacy in managing chronic diseases like diabetes and heart failure, as seen in successful Austrian initiatives such as HerzMobil and the Gesundheitsdialog Diabetes. The proposed hypertension DMP leverages similar structures, offering a high degree of personalization, real-time monitoring, and improved communication between patients and healthcare providers.
Telemedical tools provide several distinct advantages. They remove barriers of time and geography, offer patients greater autonomy through daily health data logging, and allow for proactive adjustments to treatment plans based on real-time feedback. Moreover, by integrating behavioral health support, lifestyle coaching, and educational interventions, telemedical platforms can enhance patients’ health literacy and self-management capabilities—critical components for sustainable BP control.
The technological backbone of the program—featuring standardized data management systems, patient-facing mobile apps, and professional web dashboards—ensures robust data flow, interoperability within existing healthcare IT infrastructure (via HL7 FHIR and IHE standards), and compliance with medical device regulations. These features are essential for scalability, data security, and long-term sustainability within the public health system.
Nevertheless, the success of such a program hinges on several key factors. First, careful patient selection is necessary to identify individuals who will benefit most from the intervention—namely, those with uncontrolled BP but no immediate need for intensive care. Second, successful recruitment strategies must involve general practitioners and internists who have established relationships with patients, supported by broader outreach through health insurance providers, media campaigns, and outpatient clinics. Past experiences from other DMPs highlight that recruitment is often the most challenging aspect of implementation, warranting multifaceted strategies to ensure sufficient enrollment.
Interdisciplinary collaboration, with clearly defined roles for physicians, nurses, dieticians, and coordinators, is another cornerstone of effective DMPs. Regular reassessment of hypertension-mediated organ damage (HMOD) using diagnostic tools like echocardiography, ABPM, and laboratory parameters ensures that disease progression is monitored and treatment efficacy is measured not only by BP targets but also by improvements in surrogate endpoints.
Finally, cost-effectiveness remains a critical consideration for social security organizations and public health stakeholders. While initial investments in technology and training are required, long-term benefits include reduced complications, hospitalizations, and associated healthcare costs—aligning well with the goals of both patient-centric care and healthcare system sustainability.
In summary, this position paper presents a robust framework for the implementation of a telemedicine-supported DMP for hypertension in Austria. Drawing on international evidence and national experience, it offers a strategic path forward to improve BP control, reduce cardiovascular risk, and modernize chronic disease management in an aging population.
Practical Conclusion
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Hypertension (HTN) is globally the most important risk factor for premature death and life with disability.
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The current situation of HT treatment and control in Austria is not adequate. Disease management programs (DMPs) are needed to address this shortcoming.
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With telemedical support, healthcare providers can encourage healthy lifestyles among their clients and engage them in prevention programs.
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The main goal of DMPs for HTN is to bring as many patients as possible into the blood pressure (BP) target range.
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Inclusion criterium for an HTN DMP is uncontrolled BP without immediate need for acute and intensive treatment.
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A major challenge is the recruitment of patients for DMPs; various strategies are required.
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Necessary prerequisites for a DMP are a coordination center and a multidisciplinary approach. The roles of stakeholders and processes must be clearly defined
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Telemedicine-supported DMPs have already been successfully introduced in Austria for various diseases, e.g., diabetes and heart failure programs. A corresponding pilot project for BP management in Tyrol had a positive impact on BP control.
Declarations
Conflict of interest
C. Koppelstätter, E. Bode, B. Fetz, B. Haselwanter, F. Hoffmann, A. Huber, G. Mayer, R. Modre-Osprian, S. Perl, S. Puntscher, G. Schreier, U. Siebert, T. Weber, and G. Pölzl declare that they have no competing interests.
For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.
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