Effectiveness of Nurse-Led Telehealth Intervention for Hypertension Control in Nepal

Background Hypertension (HTN) is a leading cause of cardiovascular disease and premature death worldwide. About 1.28 billion adults aged 30-79 years are estimated to have HTN; two-thirds of them are living in low and middle-income countries. Globally, 46% of adults with hypertension are estimated to be unaware that they have the condition, only 42% are diagnosed and treated, whereas only 21% have it under control. Hypertension is considered as a silent killer because most people with hypertension are not aware of the condition as it may not present warning signs and symptoms. In 2019, high systolic blood pressure was the top cause of disease burden worldwide, measured by DALYs (Disability-Adjusted Life Years). Despite the enormous burden, hypertension control remains a largely unmet challenge for public health systems, even in developed countries.

The overall prevalence of hypertension in the Asia-Pacific region ranged between 10.6% and 48.3%.6 According to a step survey 2019 in Nepal, 24.5% of adults were hypertensive, with 47.3% unaware of their condition, 29.6% of those with hypertension were receiving treatment, and among those receiving treatment, only 14.8% had their blood pressure under control. Hypertension control in Nepal faces significant challenges due to limited access to health facilities, particularly in rural areas, caused by geographical constraints and healthcare personnel shortages. Low public awareness and inadequate follow-up care further complicate the issue. Additionally, there is limited understanding of the importance of medication adherence and lifestyle modifications, hindering effective hypertension management.

Telemonitoring can help address these gaps by allowing remote monitoring of patients, enabling timely follow-up, and promoting better self-care and treatment adherence, all without the need for frequent visits to health centers. Studies in high-income countries have demonstrated that the telemonitoring of blood pressure effectively improves medication adherence and lifestyle modifications, leading to a reduction in systolic blood pressure (SBP) ranging from 5 mmHg to 32 mmHg. A study in Nepal assessed the effectiveness of mobile phone text messaging intervention where SBP was decreased by 6.5mmHg and diastolic blood pressure (DBP) was decreased by 4.6mmHg.

Traditional physician-led services are usually focused on the medical management of hypertension. However, as part of a holistic approach, counselling and education interventions are considered an essential supplement to medical management, and nurses play a key role in patient education, medication management, and chronic disease monitoring. Nurses can provide timely follow-up, track patient progress, and offer guidance on medication adherence and lifestyle changes, which are crucial for hypertension control.

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