Effectiveness of a chatbot in remote monitoring of arterial hypertension in patients over 65 years of age (an open, randomized, controlled study)

BACKGROUND. Improving treatment adherence in elderly patients with hypertension remains an important challenge in modern cardiology. One promising approach is the use of remote monitoring technologies.

OBJECTIVE. The objective of this study was to evaluate the feasibility of remote monitoring and its impact on adherence to blood pressure measurement and data transmission via a chatbot in patients with hypertension over 65 years of age.

MATERIALS AND METHODS. This open-label, randomized, controlled trial included 95 patients aged ≥65 years who were randomized into 2 groups: 1) remote monitoring (RM) (n = 50; median age 70 years; 27 % men) and 2) control (n = 45; median age 71 years; 40 % men). The RM group utilized remote monitoring, which included daily patient surveys via a chatbot in a messenger. In case of systolic blood pressure (SBP) decrease <100 mm Hg, a questionnaire to assess symptomatic hypotension was also offered. In the control group, patients were observed on an outpatient basis without the use of remote monitoring. The observation period was 3 months. The criteria for assessing the effectiveness of the intervention were adherence to filling out the chatbot (assessed by counting the number of completed questionnaires during the entire observation period) and SBP level.

RESULTS. After 3 months, 45 patients in  the UN  group and 45  patients in  the control group completed the study. An increase in SBP above 150 mm Hg during home measurement was significantly more frequent in the control group (UN 6 (13 %); control group 20 (44 %); p = 0.001). The absolute reduction in SBP in both groups was statistically significant. In the UN group, the absolute reduction in SBP was 7.5 mm Hg (p < 0.001), in the control group 5 mm Hg (p = 0.003). Adherence to the chatbot and blood pressure data transmission for more than 50 % of the observation time was observed in 43 patients (95 %), and more than 75 % in 27 patients (60 %). Symptomatic hypotension was observed in 22 patients (49 %) in the remote monitoring group.

CONCLUSION. Digital platforms for remote monitoring can be effective in hypertension management, promoting increased engagement in the treatment process in patients over 65 years of age. Patient adherence for more than 50 % of the observation time via messenger was 95 %.

1. Global report on hypertension: the race against a silent killer. [Electronic resourse] // World Health Organization. — 2023 Accessed mode: https://www.who.int/publications/i/item/9789240081062,free.

2. Kobalava Zh. D., Konradi A. O., Nedogoda S. V., et al. 2024 Clinical practice guidelines for Hypertension in adults. Russian Journal of Cardiology. 2024 ; 29 (9) : 6117 (In Russ.). doi: 10.15829/1560-4071-2024-6117.

3. Balanova Yu. A., Drapkina O. M., Kucenko V. A., et al. Hypertension in the Russian population during the COVID-19 pandemic: sex differences in prevalence, treatment its effectiveness. Data from the ESSE-RF3 study. Cardiovascular Therapy and Prevention. 2023 ; 22 (8S) : 3785 (In Russ.). doi: 10.15829/1728-8800-2023-3785.

4. Mihevc M., Lukančič M. M., Zavrnik Č., et al. Impact of 12-month mHealth Home Telemonitoring on clinical outcomes in older individuals with hypertension and type 2 diabetes: Multicenter randomized controlled trial. JMIR Mhealth Uhealth. 2025 ; 13 (1) : e59733. doi: 10.2196/59733.

5. McManus R. J., Mant J., Franssen M., 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) : 949–959. doi: 10.1016/S0140-6736(18)30309-X.

6. Persell S. D., Petito L. C., Anthony L., et al. Prospective cohort study of remote patient monitoring with and without care coordination for hypertension in primary care. Appl Clin Inform. 2023 ; 14 (3) : 428–438. doi: 10.1055/a-2057-7277.

7. Gong K., Yan Y. L., Li Y., et al. Mobile health applications for the management of primary hypertension: A multicenter, randomized, controlled trial. Medicine (Baltimore). 2020 ; 99 (16) : e19715. doi: 10.1097/MD.0000000000019715.

8. Echeazarra L., Pereira J., Saracho, Chatbot Assistant for Self-Managed in-House Pressure Checking. J Med Syst. 2021; 45 (4) : 54 doi: 10.1007/s10916-021-01730-x.

9. Mehta S. J., Volpp K. G., Troxel A. B., et al. Remote blood pressure monitoring with social support for patients with hypertension: A randomized clinical Network Open. 2024 ; 7 (6) : e2413515. doi: 10.1001/jamanetworkopen.2024.13515.

10. Arshed M., Mahmud A., Minhat H. S., et al. Effectiveness of a multifaceted mobile health intervention (multi-aid-package) in medication adherence and treatment outcomes among patients with hypertension in a low- to middle-income country: Randomized controlled trial. JMIR Mhealth Uhealth. 2024 ; 12 : e50248. doi: 10.2196/50248.

11. Zhou H., Wang X., Yang Y., et al. Effect of a multicomponent intervention delivered on a web-based platform on hypertension control: A cluster randomized clinical trial. JAMA Netw Open. 2022 ; 5 (12) : e2245439. doi: 10.1001/jamanetworkopen.2022.45439.