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. 2024 May 31;103(22):e38179. doi: 10.1097/MD.0000000000038179

Influence of intelligent management mode based on Internet of Things on self-management ability and prognosis of elderly patients with hypertensive heart disease: An observational study

Yaning Xu a, Wenxin Zai b, Ming Yang a, Lei Zhu a, Yun Zhang a, Xin Fu a, Ting Dai a,*
PMCID: PMC11142800  PMID: 39259109

Abstract

Hypertensive heart disease was difficult to cure with drugs, and most patients had poor compliance, leading to recurrent disease and poor quality of life. The intelligent management mode based on the Internet of Things avoided the excessive dependence of the elderly patients on medical institutions in the traditional medical model and enabled patients to monitor themselves. This study aimed to explore the impact on self-management ability and prognosis of elderly patients with hypertensive heart disease. A total of 150 elderly patients with hypertensive heart disease who received treatment from April 2020 to April 2022 were selected and divided into control group (n = 75 cases) and observation group (n = 75 cases) by random number table method. The control group was given routine intervention, and the observation group was given intelligent management mode based on the Internet of Things. Blood pressure fluctuation, self-management ability, and prognosis of the 2 groups were compared after intervention. After the intervention of the intelligent management mode based on the Internet of Things, the systolic and diastolic blood pressure levels in the observation group were lower than those in the control group (P < .05). After intervention, the scores of self-management ability in diet control, self-care skills, rehabilitation exercise, and self-monitoring in observation group were higher than those in control group (P < .05). After intervention, the total incidence of chest tightness, dyspnea, arrhythmia, edema, and nausea in the observation group was 5 (6.67%), which was significantly lower than that in the control group 12 (16.00%) (P < .05). The application of intelligent management mode based on the Internet of Things could effectively improve patients’ blood pressure level, improve patients’ self-management ability, and significantly improve the prognosis, which was worthy of popularization and application.

Keywords: hypertensive heart disease, intelligent management mode, internet of things, prognosis, self-management ability, the elder

1. Introduction

Hypertensive heart disease is a common disease in clinical practice. It mainly refers to that the body circulation arterial pressure of patients in a high state for a long time leading to the weight gain of heart disease, leading to the hypertrophy and enlargement of patients’ left ventricle and the limitation of cardiac function.[1,2] In severe cases, cardiac function deterioration, cardiac insufficiency, and heart failure could even occur.[3,4] With the rapid development of China economy and society in recent years, the aging population has gradually increased, and the risk of various chronic diseases has also gradually increased, leading to the rise of the incidence rate of hypertensive heart disease.[5,6] Hypertensive heart disease was difficult to cure with medicine.[7,8] Most patients had poor compliance and could not insist on medication, which led to a large number of patients suffering from recurrent disease and poor quality of life. In addition, it also increased the economic burden of the patient’s family.[9,10] The main reason for this phenomenon was that the subjective attention of elderly patients was not enough. On the other hand, some large hospitals were overcrowded, and it was difficult and expensive to see a doctor.[11,12] For this reason, how to achieve the refined and individualized management of elderly patients with this type of hypertensive heart disease, so that patients could establish a correct awareness of disease risk factor control, correct bad living habits, and improve drug treatment compliance was an urgent problem for the treatment of hypertensive heart disease.[13,14] The intelligent management mode based on the Internet of Things connects any physical object through the Internet, that was, the Internet client was extended to objects with labels to achieve information exchange and communication between projects.[15,16] Some scholars proposed to explore the application mode in the field of intelligent medical care, focusing on collecting and analyzing information related to human physiology and medical parameters, and developing telemedicine services for families and communities.[17,18] Use a short-range mobile phone to control the sphygmomanometer to monitor blood pressure and heart rate, and transmit the sphygmomanometer data to the patient’s mobile APP through Bluetooth transmission, and then the patient will upload the monitored blood pressure, heart rate, and other relevant data to the cloud terminal through the mobile APP.[19,20] In this way, doctors could monitor the changes of patients’ blood pressure and heart rate through APP, and provide targeted online drug guidance, disease education, psychological and behavioral intervention, and other measures for patients according to their conditions.[21,22] This avoided the excessive dependence of elderly patients on medical institutions in the traditional medical model, and enabled elderly patients with hypertensive heart disease to monitor themselves.[23–25] Therefore, this study focused on 150 elderly patients with hypertensive heart disease receiving treatment to explore the impact of intelligent management mode based on the Internet of Things on the self-management ability and prognosis of elderly patients with hypertensive heart disease.

2. Materials and methods

2.1. Research objects

This study was approved by the Ethics Committee of The Sixth Hospital of Wuhan. A total of 150 elderly patients with hypertensive heart disease who received treatment from April 2020 to April 2022 were selected. The patients were divided into control group (n = 75 cases) and observation group (n = 75 cases) by random number table. In the control group, there were 44 males and 31 females, aged (60–83) years, average age (73.47 ± 3.45) years, course of disease (1–11) years, average course of disease (7.82 ± 1.33) years; in the observation group, there were 42 males and 33 females, aged (61–85) years, average age (74.05 ± 2.71) years, course of disease (1–12) years, average course of disease (8.19 ± 1.25) years. All patients carefully read and signed the informed consent form, and the hospital ethics committee approved the implementation of this clinical trial protocol.

Inclusive criteria: all patients were diagnosed as hypertensive heart disease,[26] systolic blood pressure > 140 mm Hg, diastolic blood pressure ≥ 90 mm Hg; patient age ≥ 60 years old; no immune disease. Exclusion criteria: those with poor compliance; patients with senile dementia; patients with severe liver dysfunction or terminal disease.

2.2. Methods

The patients in the control group were given routine intervention, instructed by doctors to take antihypertensive drugs, paid attention to dietary taboos, exercised appropriately, and monitored the blood pressure level.

Intervention group would be given to the observation group based on the intelligent management mode of the Internet of Things on this basis. Conduct professional training for intervention personnel. Training on basic knowledge, clinical knowledge, drug adjustment, and return visit process of hypertensive heart disease; download blood pressure monitoring APP for patients, remotely control ECG and sphygmomanometer through mobile phones to monitor blood pressure and heart rate, transmit the sphygmomanometer data to the patient’s APP terminal through Bluetooth transmission, and upload the monitored blood pressure and heart rate to the cloud. The doctor checks the patient’s blood pressure and heart rate through the APP every day, handles the APP intelligent alarm, and conducts drug adjustment, question answering, lifestyle, and other related interventions.

2.3. Observation indicators

Blood pressure index level. The diastolic blood pressure and systolic blood pressure of the 2 groups were measured before and after the intervention, twice a week, and the average value was taken to compare the blood pressure fluctuation. Self-management level. Self-management behavior scale (ESCA) was used to evaluate the self-management level of the 2 groups of patients.[27] It includes 4 aspects: diet control, self-care skills, rehabilitation exercise, and self-monitoring. The scores are statistically analyzed, and each item is scored 0 to 10 points. The higher the score, the higher the self-management level. Prognosis. Statistical analysis was made on chest tightness, dyspnea, arrhythmia, edema, and nausea in the 2 groups after intervention.

2.4. Statistical analysis

SPSS25.0 software was used to the statistical analysis process. The count data n (%) was adopted by χ2. test, and the t test was adopted for the measurement data, which was expressed by (x¯±s). The difference was statistically significant (P < .05).

3. Results

3.1. Comparison of clinical data between the 2 groups

There was no statistically significant difference between the 2 groups in terms of gender, age, smoking history, drinking history, left ventricular ejection fraction (LVEF), 6-minute walking distance (6MWD), cardiac function grading, and plasma brain natriuretic peptide (BNP) (P > .05). A comparative study can be conducted, as shown in Table 1 (Fig. 1).

Table 1.

Comparison of clinical data between the 2 groups (n (%), x¯±s).

Items Control group (n = 75) Observation group (n = 75) t/X2 P
Gender (male/female, n) 43/32 45/30 1.072 .981
Age (y old) 73.37 ± 1.43 74.24 ± 1.82 0.871 .264
Smoking history (n (%)) 64 62 1.976 .432
Drinking history (n (%)) 71 (94.67) 70 (93.33) 1.048 .560
Left ventricular ejection fraction (LVEF) (%) 33.37 ± 1.43 32.64 ± 1.82 0.942 .761
6-minute walking distance (6MWD) (m) 163.37 ± 11.25 160.24 ± 12.37 1.174 1.014
Cardiac function grading 3.37 ± 0.43 3.64 ± 0.82 0.988 .465
Plasma brain natriuretic peptide (BNP) (ng/L) 363.37 ± 21.24 365.24 ± 19.42 1.424 1.321
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Figure 1.

Figure 1.

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Comparison of systolic and diastolic blood pressure (*P < .05).

3.2. Comparison of systolic and diastolic blood pressure between the 2 groups

There was no significant difference in systolic blood pressure and diastolic blood pressure between the 2 groups before the intervention of intelligent management mode based on the Internet of Things (P > .05); After intervention, the systolic blood pressure and diastolic blood pressure of patients in the observation group were lower than those in the control group (P < .05), as shown in Table 2.

Table 2.

Comparison of systolic blood pressure and diastolic blood pressure between the 2 groups (x¯±s).

Groups n Systolic blood pressure (mm Hg) Diastolic blood pressure (mm Hg)
Before intervention After intervention Before intervention After intervention
Observation group 75 155.62 ± 8.74 119.13 ± 4.15 95.48 ± 8.62 76.41 ± 8.03
Control group 75 147.27 ± 7.63 134.63 ± 6.48 96.51 ± 8.64 86.98 ± 7.62
t / 1.298 8.435 0.932 6.538
P / .124 .023 .293 .015
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3.3. Comparison of self-management ability between the 2 groups

After intervention, the scores of self-management ability in diet control, self-care skills, rehabilitation exercise, and self-monitoring in the observation group were higher than those in the control group (P < .05), as shown in Table 3 (Fig. 2).

Table 3.

Comparison of self-management ability between the 2 groups (x¯±s).

Groups n Diet control score Self-care skill score Rehabilitation exercise score Self-monitoring score
Observation group 75 8.17 ± 1.33 7.34 ± 1.26 8.05 ± 1.03 8.01 ± 1.26
Control group 75 3.37 ± 1.42 4.07 ± 1.83 4.24 ± 1.82 4.22 ± 1.45
t / 5.812 6.975 6.823 6.436
P / .000 .000 .000 .000
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Figure 2.

Figure 2.

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Comparison of self-management ability (***P < .05).

3.4. Comparison of prognosis between the 2 groups

After intervention, the total incidence of chest tightness, dyspnea, arrhythmia, edema, and nausea in the observation group was 5 (6.67%), which was significantly lower than that in the control group 12 (16.00%) (P < .05), as shown in Table 4 (Fig. 3).

Table 4.

Comparison of prognosis between the 2 groups (n (%)).

Groups n Chest tightness Dyspnea Arrhythmia Edema Nausea Total incidence
Observation group 75 1 (1.33) 0 (0.00) 1 (1.33) 1 (1.33) 2 (2.67) 5 (6.67)
Control group 75 3 (4.00) 1 (1.33) 2 (2.67) 2 (2.67) 4 (5.33) 12 (16.00)
X 2 / / / / / / 6.675
P / / / / / / .024
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Figure 3.

Figure 3.

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The total incidence of prognosis.

3.5. Intelligent management mode based on Internet of Things significantly improved satisfaction of elderly patients with hypertensive heart disease

After intervention, the total nursing satisfaction was 94.67% (71/75), which was significantly higher than that in the control group 73.33% (55/75) (P < .05) (Fig. 4).

Figure 4.

Figure 4.

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The nursing satisfaction.

4. Discussion

Hypertensive heart disease is a common clinical disease, which is caused by many factors, such as obesity, nutrition, and genetic factors. The most important is poor control of hypertension. According to the survey, genetic factors account for 20%, and more than 60% of the population is caused by hypertension.[28] Long-term hypertension leads to changes in the heart structure and function of patients, leading to the main cause of heart failure, thus forming hypertensive heart disease.[29,30] With the decline of physical function, the anti-interference ability and perception ability of elderly patients are declining. Hypertensive heart disease in the elderly has a long course, and the disease is repeated and difficult to recover.[31] It was easy to cause the elderly patients to have bad psychological feelings of anxiety, lack of self-management, and affect the quality of life of patients. The Internet of Things is a network technology based on the Internet, which extends the user end to the object and realizes information exchange. The wireless transmission and directional transmission of monitoring data are realized by connecting the ECG and blood pressure monitors to the network.[32,33] Use relevant APP software to complete patient self-management under the guidance of professional doctors. Doctors can complete monitoring, medical decision-making and other work in real time through APP. It can solve patients’ doubts and perplexities in real time, urge patients to change their bad habits, enable patients to get medical assistance at the first time, improve patients’ self-management ability, and restore patients’ confidence in overcoming diseases.[34–36]

The low rate of blood pressure reaching the standard has become a worldwide health problem, and is one of the important factors leading to the high mortality of hypertension patients. Effectively improving the rate of blood pressure reaching the standard has important clinical significance for reducing the mortality and disability rate of hypertension. Meta-analysis on the impact of family self-rated blood pressure on the prognosis of hypertensive patients shows that family self-rated blood pressure can improve the blood pressure control rate, medication compliance, and self-management awareness of patients, while mobile medical software with data recording function can help hypertensive patients improve blood pressure measurement and medication compliance. The study used the new mode of Internet plus + Hypertension Management for 184 patients with hypertension. The patients used intelligent sphygmomanometers to measure blood pressure and realize automatic data transmission, and pushed blood pressure measurement reminders at 7 am every day. The compliance of patients with self-measured blood pressure increased from 18.5% to 82.7%, and the rate of blood pressure reaching the standard increased from 38.6% to 68.2%, superior to the traditional hypertension self-management mode. American scholars use mobile medical software with medication reminder function to improve the medication compliance and blood pressure control rate of hypertensive patients. This may be related to the following factors: Hypertension is a chronic disease requiring lifelong management, healthy living habits are conducive to the control of patients’ blood pressure, and the biggest “bottleneck” was how to stimulate and maintain patients’ enthusiasm and enthusiasm for self-management and achieve the sustainability of self-management. However, the traditional self-management model requires patients to have a high degree of subjective initiative, and it is difficult to achieve the effect for patients with lower education and older age. The friendly reminding function of the new model platform of “Internet plus + Hypertension Management” can urge and promote hypertension patients to develop the habit of self-management, and ultimately achieve effective blood pressure standards. The community general practice team in the new model platform of Internet plus + Hypertension Management would follow up patients in a timely manner every week through WeChat groups, telephone calls and on-site activities to understand their health-related behaviors and assess their blood pressure control, give personalized comprehensive health evaluation and recommend scientifically understandable hypertension prevention and control information and online real-time communication methods. The new model platform of Internet plus + Hypertension Management used the Internet as a medium. With the intelligent electronic sphygmomanometer as the monitoring tool, scientific and easy to understand hypertension prevention and control information, and convenient online health communication and consultation functions, patients’ questions can be solved in a timely manner and their treatment compliance can be improved. With the rapid development of information technology, the new model of Internet plus + hypertension management can effectively improve the physical exercise habits of hypertension patients, improve the treatment compliance of hypertension patients and the rate of blood pressure reaching the standard, which is the only way to improve the level of hypertension management. However, at present, the prevention and control of Internet plus chronic diseases is still in its infancy. There was still no standardized implementation process and management specification at home and abroad. The core content of health guidance and education, and the industry standard of body index collection equipment are being improved. In addition, the implementation of the new model of Internet plus + Hypertension Management required certain equipment and personnel investment, and the service providers and recipients need to learn new methods, which will bring some difficulties to its promotion. Each region can gradually promote the development of the new model of “Internet plus” management of chronic diseases such as hypertension according to its own actual situation, and ultimately improve the management level and effect of chronic diseases such as hypertension.

In this study, the systolic blood pressure and diastolic blood pressure of patients in the observation group were lower than those in the control group after the intervention of intelligent management mode based on the Internet of Things (P < .05). After intervention, the scores of self-management ability in diet control, self-care skills, rehabilitation exercise, and self-monitoring of patients in the observation group were higher than those in the control group (P < .05). It can be seen that the application of intelligent management mode based on the Internet of Things in elderly patients with hypertensive heart disease can effectively improve the blood pressure level of patients and improve their self-management ability.[37,38] Compared with the traditional intervention, it can increase the participation rate of patients by 20%, improve the drug compliance of patients, and improve the prognosis of patients. In this study, after intervention, the total incidence of chest tightness, dyspnea, arrhythmia, edema, and nausea in the observation group was 5 (6.67%), which was significantly lower than that in the control group (12 (16.00%) (P < .05), indicating that the application of intelligent management mode based on the Internet of Things could significantly improve the prognosis and patient compliance.

5. Conclusions

In conclusion, the application of intelligent management mode based on the Internet of Things in elderly patients with hypertensive heart disease can effectively improve the blood pressure level of patients, improve their self-management ability, and significantly improve the prognosis, which is worthy of promotion and application.

Author contributions

Conceptualization: Yaning Xu, Wenxin Zai, Lei Zhu, Ting Dai.

Data curation: Yaning Xu, Wenxin Zai, Ming Yang, Lei Zhu, Ting Dai.

Formal analysis: Yaning Xu, Wenxin Zai, Ming Yang, Lei Zhu, Xin Fu, Ting Dai.

Investigation: Yaning Xu, Ming Yang, Yun Zhang.

Writing – original draft: Yaning Xu, Wenxin Zai, Ming Yang, Yun Zhang, Xin Fu, Ting Dai.

Writing – review & editing: Yaning Xu, Lei Zhu, Xin Fu, Ting Dai.

Methodology: Ming Yang, Yun Zhang.

Visualization: Yun Zhang, Xin Fu, Ting Dai.

Validation: Xin Fu, Ting Dai.

Abbreviations:

6MWD
6-minute walking distance
BNP
brain natriuretic peptide
LVEF
left ventricular ejection fraction.

The authors have no funding to disclose.

The authors have no conflicts of interest to disclose.

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

How to cite this article: Xu Y, Zai W, Yang M, Zhu L, Zhang Y, Fu X, Dai T. Influence of intelligent management mode based on Internet of Things on self-management ability and prognosis of elderly patients with hypertensive heart disease: An observational study. Medicine 2024;103:22(e38179).

YX and WZ contributed equally to this work.

Contributor Information

Yaning Xu, Email: xyn970911@163.com.

Wenxin Zai, Email: 306013965@qq.com.

Ming Yang, Email: 376219789@qq.com.

Lei Zhu, Email: 13109945@qq.com.

Yun Zhang, Email: 461206094@qq.com.

Xin Fu, Email: 26215669@qq.com.

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