高血圧治療薬の変更における遠隔モニタリング処方患者

Remote Patient Monitoring (RPM) includes home blood pressure (BP) measurement with readings sent directly to the electronic health record (EHR). We hypothesize that RPM facilitates quicker, more frequent, more appropriate antihypertensive medication changes.

Patients with hypertension in six primary care clinics were prescribed RPM between November 2020 and August 2021 (N = 288) and matched to four control patients (N = 1152). Office and RPM BP readings and medication data over 18 months were extracted from the EHR. RPM patients were classified as baseline controlled (office and RPM <130/<80 mmHg), sustained (office and RPM ≥130 and/or ≥80), white-coat (office ≥130 and/or ≥80, RPM <130/<80) or masked hypertension (office <130/<80, RPM ≥130 and/or ≥80).

RPM patients had earlier first antihypertensive medication changes, with half of RPM patients having ≥1 change by 228 days versus 530 days for controls. RPM patients had more total medication changes, with 25% of RPM patients having ≥4 (median 1; 25th-75th percentiles 0-4) changes versus ≥2 (median 1; 0-2) changes in controls. Compared to baseline sustained hypertension RPM users, white-coat hypertension users were less likely to have ≥1 medication increase (24% [N = 11] versus 53% [N = 74], p = 0.001) within 12 months. Compared to baseline-controlled RPM users, masked hypertension users were less likely to have ≥1 medication decrease (0% [N = 0] versus 44% [N = 8]; p = 0.003) within 12 months.

Even without additional staff dedicated to medication adjustment, RPM facilitated quicker medication changes, more total changes and differential prescribing decisions for white-coat and masked hypertension patients supporting RPM use in primary care.