Improving Blood Pressure in High-Risk Patients With CKD Using an Interdisciplinary Remote Hypertension Program
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Published on: May 26, 2022
Molly C Fisher1, Sharon Rikin2, Sonali Gupta1
1Division of Nephrology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, New York, USA.
Insights
This study shows that remote patient monitoring (RPM) effectively improves blood pressure (BP) control in Black and Hispanic patients with chronic kidney disease (CKD). The program demonstrated high feasibility and significant BP reductions, offering a promising approach to reduce health disparities.
Area of Science:
- Nephrology
- Cardiology
- Health Equity
Background:
- Racial and ethnic disparities persist in achieving blood pressure (BP) control among patients with chronic kidney disease (CKD).
- Interventions are needed to address these disparities and improve hypertension management in vulnerable populations.
- Remote patient monitoring (RPM) offers a potential solution for enhanced BP management in CKD patients.
Purpose of the Study:
- To determine the feasibility and effectiveness of an interdisciplinary RPM hypertension program.
- To evaluate the program's impact on BP control in predominantly Black and Hispanic patients with CKD.
- To assess the potential of RPM in reducing racial and ethnic disparities in hypertension management.
Main Methods:
- An RPM hypertension program was evaluated in a New York City health system (July 2021-October 2022).
- Patients used cellular-enabled BP devices for real-time data transmission, receiving lifestyle education and telemedicine-based medication adjustments by a nurse practitioner.
- Feasibility was assessed by enrollment, participation, and retention rates; BP control was measured by mean BP change at 3 months and the proportion achieving BP < 130/80 mmHg at 6 months.
Main Results:
- The program demonstrated high feasibility, with 91.9% enrollment and 78.4% retention at 3 months among invited patients.
- Significant mean reductions in systolic BP (-15.0 mmHg) and diastolic BP (-6.7 mmHg) were observed at 3 months (P < 0.0001 and P = 0.0007, respectively).
- By 6 months, 49.4% of participants achieved the target BP of < 130/80 mmHg.
Conclusions:
- The interdisciplinary RPM hypertension program was feasible and effective in improving BP control in CKD patients.
- This approach shows promise for increasing equity in hypertension management, particularly for racial and ethnic minority groups.
- Further research is needed to evaluate the long-term maintenance of BP control with RPM compared to usual care.
Introduction:
Interventions are needed to reduce racial and ethnic disparities in achieving blood pressure (BP) control among patients with chronic kidney disease (CKD). We determined the feasibility and effectiveness of an interdisciplinary remote patient monitoring (RPM) hypertension program in predominantly Black and Hispanic patients with CKD.
Methods:
We evaluated an RPM hypertension program for patients with CKD in a New York City health system between July 2021 and October 2022. BP data were transmitted in real-time using a cellular-enabled BP device. Education on lifestyle and adherence was provided, and medications were adjusted by a nurse practitioner (NP) via telemedicine. Feasibility was quantitatively assessed as enrollment, participation, and retention at 3 months. Effect on BP was estimated as mean change in BP at 3 months and proportion with BP < 130/80 mmHg at 6 months.
Results:
Among 111 patients invited, 102 (91.9%) enrolled and 87 (78.4%) were retained in the program for 3 months. Median age was 61 years, 50% were female, 55.9% were Black, 35.3% were Hispanic, and median estimated glomerular filtration rate was 47.5 ml/min per 1.73 m2. The median days per month that BP was measured ranged from 16 to 23. Mean change in systolic and diastolic BP from enrollment to 3 months was -15.0 ± 20.8 (P < 0.0001) and -6.7 ± 17.7 (P = 0.0007), respectively. By 6 months, 49.4% achieved BP < 130/80 mm Hg.
Conclusion:
This RPM hypertension program in patients with CKD was feasible and effective in improving BP, which is promising for increasing equity in hypertension control. Future studies evaluating long-term maintenance of BP control using this approach compared with usual care are needed.
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