Continual Versus Occasional Blood Pressure (COOL-BP) in Remote Hypertension Management

Remote hypertension management programs have emerged as potential solutions to improve poor rates of blood pressure (BP) control. The Continual Versus Occasional Blood Pressure (COOL-BP) Study investigated the feasibility and efficacy of using a cuffless wrist BP monitor in a remote hypertension (HTN) program.

COOL-BP was a prospective single-arm study within a larger HTN management program at Mass General Brigham (MGB). Participants had uncontrolled HTN, were already engaged in the MGB Remote Hypertension Program, and used a smartphone. The study involved patients wearing the Aktiia cuffless wrist BP monitor and performing traditional home BP monitoring (HBPM). The primary endpoint was the correlation of BP measurements between devices. Secondary endpoints included concordance between HBPM and cuffless pressures following a medication titration, and patient satisfaction with the cuffless device.

We enrolled 38 patients, of whom 25 provided BP data on overlapping dates with both devices. There was moderate correlation between average nonsimultaneous daytime BPs within the same time periods (r = 0.57, 95% CI: 0.39-0.71 for systolic BP [P < 0.001]; r = 0.64, 95% CI: 0.48-0.76, for diastolic BP [P < 0.001]). The concordance of systolic BP changes detected by the two devices post medication titration was 87.5%. Most patients (91%) preferred the cuffless device, citing ease of use and convenience.

Cuffless BP devices demonstrate promise in enhancing patient compliance and effectiveness in HTN management. Their integration into clinical practice could offer a more patient-friendly and reliable approach to BP monitoring, though more research is needed to establish their utility in large populations.