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Blood Pressure Outcomes Following a Home Blood Pressure Monitoring Program in a Large Integrated US Health System
Teresa N Harrison1, Rachelle A Juan1, Jaejin An1,2
1Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA.
Insights
Home blood pressure telemonitoring (HBPT) helps patients manage hypertension. A study found that 75% of patients sustained blood pressure control for 12 months after completing the HBPT program.
Area of Science:
- Cardiovascular Medicine
- Health Informatics
- Digital Health
Background:
- Home blood pressure telemonitoring (HBPT) empowers patients in self-care and can reduce in-office blood pressure (BP) measurements.
- Limited evidence exists on the long-term sustainability of BP control achieved through HBPT programs.
- This study investigated the sustained impact of an HBPT program on patient BP outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a home blood pressure telemonitoring program in achieving and sustaining blood pressure control.
- To identify factors associated with sustained blood pressure control after program completion.
Main Methods:
- Patients with uncontrolled hypertension were enrolled in an HBPT program utilizing a BP device and mobile application.
- Clinic BP was assessed before and after HBPT enrollment.
- Sustained clinic BP control was defined as <140/90 mmHg within 12 months post-program graduation (home BP <135/85 mmHg).
- Multivariable robust Poisson regression analyzed factors linked to sustained BP control.
Main Results:
- Out of 3574 enrolled patients, 59% consented. Of those who graduated (met home BP control), 75% (396/527) sustained clinic BP control for 12 months.
- Mean clinic systolic BP and diastolic BP decreased significantly by 16.3 mmHg and 10.0 mmHg, respectively (p<.0001).
- The program demonstrated potential, though enrollment and scaling require further strategies.
Conclusions:
- The HBPT program showed promise in improving and sustaining blood pressure control.
- Effective strategies are needed to enhance patient enrollment, consent, and program scalability.
- Sustained BP control was achieved by a significant majority of patients who completed the program.
Background:
Home blood pressure telemonitoring (HBPT) can empower patients to participate in their healthcare and reduce office BP. Evidence that BP control can be sustained following HBPT is scarce. We examined the effects of an HBPT program on BP outcomes.
Methods:
We included patients with uncontrolled hypertension enrolled in an HBPT program at an integrated healthcare system between November 2019 and June 2022. Clinicians enrolled patients and provided them with a BP device and a mobile application. We examined clinic BP before and after enrollment in HBPT, and sustained clinic BP control (last clinic BP < 140/90 mmHg) within 12 months following graduation from the program (home BP < 135/85 mmHg). Multivariable robust Poisson regression was used to identify factors associated with sustained clinic BP control.
Results:
Overall, 3574 patients were enrolled and 59% consented to participation. Among those who consented, 3% did not submit >1 home BP, 37% were actively enrolled, 30% disenrolled without meeting home BP control and 30% graduated by meeting home BP control. Among 527 patients who graduated and had ≥1 follow-up clinic BP, 396 (75%) sustained clinic BP control within 12 months while mean clinic SBP and DBP was reduced by 16.3 (95% CI: -18.3, -14.4) mmHg and 10.0 (95% CI: -11.1, -8.9) mmHg, respectively (P < 0.0001 for both) compared with the last clinic BP prior to HBPT enrollment.
Conclusions:
The HBPT program in this healthcare system demonstrates potential; however, effective strategies are needed to facilitate enrollment and consent of patients and to scale the program.
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