Summary of Clinical Research on Remote Patient Monitoring & Hypertension

Clinical Research Demonstrates RPM Improves Hypertension Outcomes

Clinical studies have long supported that improving control of blood pressure drastically improves cardiovascular risk:

  • 20-25% for heart attack
  • 35-40% for stroke
  • 50% for heart failure

With the rapid growth of telehealth and Remote Patient Monitoring (RPM), many studies are now investigating whether remote monitoring can play an effective role in improving blood pressure control. Below is a summary of the clinical research on the role of RPM in controlling hypertension.

Overall, most studies indicate a powerful and promising role for RPM in managing hypertension. Furthermore, these studies support that the best results are achieved not just from patients taking readings at home, but the combination of at-home readings with timely remote interventions based on the additional data.

Optimize Health’s own experience using Remote Patient Monitoring to manage blood pressure has produced results consistent with the clinical research. Hypertensive patients using Optimize Health’s managed RPM service have seen a 5-point decrease in systolic BP within the first 3 months of monitoring and 7-point decrease in 6 months.

 

How to Use this Research

Whether you have an existing RPM program or are considering launching one, we understand that you need to direct your limited resources to programs that have been clinically proven to positively impact patient outcomes. Physicians and ordering providers rely on the results of clinical research studies every day to make patient care decisions. The below studies can be used for a variety of purposes including:

  • Educating physicians on the clinical benefits of RPM
  • Justifying the investment of staff time and practice resources into launching or maintaining an RPM program
  • Improving RPM patient identification and onboarding based on patient populations that can benefit from RPM

Included Studies & Resources

Using Remote Patient Monitoring Technologies For Better Cardiovascular Disease Outcomes Guidance
Source: American Heart Association

Monitoring At Home Yields Better Blood Pressure Control
Source: Science Daily

Cardiovascular Events And Costs With Home Blood Pressure Telemonitoring And Pharmacist Management For Uncontrolled Hypertension
Source: American Heart Association Hypertension Journal

Current Science On Consumer Use Of Mobile Health For Cardiovascular Disease Prevention
A Scientific Statement From The American Heart Association
Source: American Heart Association Circulation Journal

Role Of Home Blood Pressure Monitoring In Overcoming Therapeutic Inertia And Improving Hypertension Control: A Systematic Review And Meta-Analysis
Source: American Heart Association Hypertension Journal

Remote Health Monitoring Platform Reduces Blood Pressure And Crisis Hypertension
Source: American Heart Association Hypertension Journal

Effect Of Home Blood Pressure Telemonitoring With Self-Care Support On Uncontrolled Systolic Hypertension In Diabetics
Source: American Heart Association Hypertension Journal

Effect Of Home Blood Pressure Telemonitoring And Pharmacist Management On Blood Pressure Control: A Cluster-Randomized Clinical Trial
Source: JAMA

Home Blood Pressure Telemonitoring Improves Hypertension Control In General Practice: The TeleBPCare Study
Source: Journal Of Hypertension

Clinical Usefulness And Cost-Effectiveness Of Home Blood Pressure Telemonitoring: Meta-Analysis Of Randomized Controlled Studies
Source: Journal Of Hypertension

Development Of An Entirely Remote, Non-Physician Led Hypertension Management Program
Source: Clinical Cardiology Open Access Journal

Reducing Blood Pressure With Internet-Based Interventions: A Meta-Analysis
Source: Canadian Cardiovascular Society

The Role Of Home Blood Pressure Telemonitoring For Blood Pressure Control
Source: Severance Cardiovascular Hospital And Cardiovascular Research Institute
• Yonsei University College Of Medicine (Seoul, South Korea)

Cellular Phone And Internet-Based Individual Intervention On Blood Pressure And Obesity In Obese Patients With Hypertension
Source: International Journal Of Medical Informatics

Telecare Is A Valuable Tool For Hypertension Management: A Systematic Review And Meta-Analysis
Source: Blood Pressure Monitoring

Self-Monitoring Of Blood Pressure In Hypertension: A Systematic Review And Individual Patient Data Meta-Analysis
Source: PLoS Medicine


Using Remote Patient Monitoring Technologies For Better Cardiovascular Disease Outcomes Guidance

Source: American Heart Association

Summary: Research has shown RPM can reduce systolic blood pressure (SBP) and diastolic blood pressure (DBP) significantly compared to usual care and self-monitoring alone. When compared directly to usual care, RPM on the average reduced SBP and DBP. In three-way comparisons, though self-monitoring alone may have a positive impact on blood pressure control compared to usual care, the inclusion of RPM can have a more substantive impact on SBP and DBP than does self-monitoring. Additional studies have shown that RPM’s positive impact on SBP can increase if the intervention is long-term, and if the intervention includes multiple behavior change techniques.

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Monitoring At Home Yields Better Blood Pressure Control

Source: American Heart Association

Summary: Research has shown RPM can reduce systolic blood pressure (SBP) and diastolic blood pressure (DBP) significantly compared to usual care and self-monitoring alone. When compared directly to usual care, RPM on the average reduced SBP and DBP. In three-way comparisons, though self-monitoring alone may have a positive impact on blood pressure control compared to usual care, the inclusion of RPM can have a more substantive impact on SBP and DBP than does self-monitoring. Additional studies have shown that RPM’s positive impact on SBP can increase if the intervention is long-term, and if the intervention includes multiple behavior change techniques.

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Cardiovascular Events And Costs With Home Blood Pressure Telemonitoring And Pharmacist Management For Uncontrolled Hypertension

Source: American Heart Association Hypertension Journal

Summary: People taking part in a pharmacist-led telemonitoring program to control high blood pressure had about half as many cardiovascular events as those monitored through routine office visits, according to a new study. The research used data from 450 people with uncontrolled high blood pressure across 16 clinics in Minnesota. Participants were randomly split into two groups. After six months of using at-home monitors and being guided over the phone by pharmacists, participants had lower blood pressure for two years compared to the group who received routine care through their primary care doctor. After five years, 5.3% of the remote care group had heart attacks, strokes, stent placements or heart failure hospitalizations compared to 10.4% for the routine care group.

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Current Science On Consumer Use Of Mobile Health For Cardiovascular Disease Prevention

A Scientific Statement from the American Heart Association

Source: American Heart Association Circulation Journal

Summary: The aims of this scientific statement are to review the literature on mHealth tools available to the consumer in the prevention of CVD (eg, dietary self-monitoring apps, physical activity monitors, and BP monitors); to provide the current evidence on the use of the vast array of mobile devices such as use of mobile phones for communication and feedback, smartphone apps, wearable sensors, or physiological monitors that are readily available and promoted to the public for monitoring their health; and to provide recommendations for future research directions.

The goal is to provide the clinician and researcher a review of the current evidence on using mHealth tools and devices when targeting behavior change, cardiovascular risk reduction, and improved cardiovascular health.

This statement is divided into sections by the behaviors or health indicators included in the AHA’s Life’s Simple 7 program: achieving a healthful weight, improving physical activity, quitting smoking, achieving blood glucose control, and managing BP and lipids to achieve target levels. Within each section, the recent evidence for studies using mHealth approaches is reviewed, gaps are identified, and directions for future research are provided.

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Role Of Home Blood Pressure Monitoring In Overcoming Therapeutic Inertia And Improving Hypertension Control: A Systematic Review And Meta-Analysis

Source: American Heart Association Hypertension Journal

Abstract: Hypertension remains the most common modifiable cardiovascular risk factor, yet hypertension control rates remain dismal. Home blood pressure (BP) monitoring has the potential to improve hypertension control. The purpose of this review was to quantify both the magnitude and mechanisms of benefit of home BP monitoring on BP reduction. Using a structured review, studies were selected if they reported either changes in BP or percentage of participants achieving a pre-established BP goal between randomized groups using home-based and office-based BP measurements. A random-effects model was used to estimate the magnitude of benefit and relative risk. The search yielded 37 randomized controlled trials with 9446 participants that contributed data for this meta-analysis.

Compared with clinic-based measurements (control group), systolic BP improved with home-based BP monitoring (-2.63 mm Hg; 95% CI, -4.24, -1.02); diastolic BP also showed improvement (-1.68 mm Hg; 95% CI, -2.58, -0.79). Reductions in home BP monitoring-based therapy were greater when telemonitoring was used. Home BP monitoring led to more frequent antihypertensive medication reductions (relative risk, 2.02 [95% CI, 1.32 to 3.11]) and was associated with less therapeutic inertia defined as unchanged medication despite elevated BP (relative risk for unchanged medication, 0.82 [95% CI, 0.68 to 0.99]).

Compared with clinic BP monitoring alone, home BP monitoring has the potential to overcome therapeutic inertia and lead to a small but significant reduction in systolic and diastolic BP.

Hypertension control with home BP monitoring can be enhanced further when accompanied by plans to monitor and treat elevated BP such as through telemonitoring.

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Remote Health Monitoring Platform Reduces Blood Pressure And Crisis Hypertension

Source: American Heart Association Hypertension Journal

Results: 337 patients who provided >20 BP readings from October 2018 to April 2019 were included in the study. A total of 51,125 blood pressure readings were included in this analysis. Patient readings were stratified by epoch chronologically. The first epoch (E1), represented the first 25% of readings in the remote monitoring system, and the fourth epoch (E4) represented the final 25% of readings. From E1 to E4, patients saw an average decrease of 4.7 mmHg in systolic blood pressure (133.0 vs. 128.3; p<0.001). The proportion of readings in crisis hypertension range decreased from 3.3% to 1.9% (p<0.001), while the amount of hypotensive readings did not substantially change (1.4 vs. 1.6%; p=0.14).

Conclusions: Patients in a Medicare cohort achieved a significant reduction in blood pressure via remote monitoring as well as a significant reduction in crisis blood pressure readings.

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Effect Of Home Blood Pressure Telemonitoring With Self-Care Support On Uncontrolled Systolic Hypertension In Diabetics

Source: American Heart Association Hypertension Journal

Abstract: Lowering blood pressure reduces cardiovascular risk, yet hypertension is poorly controlled in diabetic patients. In a pilot study we demonstrated that a home blood pressure telemonitoring system, which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading, improved blood pressure control. Messages were based on care paths defined by running averages of transmitted readings.

The present study tests the system's effectiveness in a randomized, controlled trial in diabetic patients with uncontrolled systolic hypertension. Of 244 subjects screened for eligibility, 110 (45%) were randomly allocated to the intervention (n = 55) or control (n = 55) group, and 105 (95.5%) completed the 1-year outcome visit. In the intention-to-treat analysis, mean daytime ambulatory systolic blood pressure, the primary end point, decreased significantly only in the intervention group by 9.1 ± 15.6 mmHg (SD; P < 0.0001), and the mean between-group difference was 7.1 ± 2.3 mmHg (SE; P < 0.005). Furthermore, 51% of intervention subjects achieved the guideline recommended target of <130/80 mmHg compared with 31% of control subjects (P < 0.05). These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians. Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale (baseline, 4.1 ± 3.76; exit, 5.2 ± 4.30; P = 0.014).

This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension and improved hypertension control. Home blood pressure monitoring alone had no effect on blood pressure. Promoting patient self-care may have negative psychological effects.

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Effect Of Home Blood Pressure Telemonitoring And Pharmacist Management On Blood Pressure Control: A Cluster-Randomized Clinical Trial

Source: JAMA

Results: At baseline, enrollees were 45% women, 82% white, mean (SD) age was 61.1 (12.0) years, and mean systolic BP was 148 mm Hg and diastolic BP was 85 mm Hg. Blood pressure was controlled at both 6 and 12 months in 57.2% (95% CI, 44.8% to 68.7%) of patients in the telemonitoring intervention group vs 30.0% (95% CI, 23.2% to 37.8%) of patients in the usual care group (P = .001). At 18 months (6 months of postintervention follow-up), BP was controlled in 71.8% (95% CI, 65.0% to 77.8%) of patients in the telemonitoring intervention group vs 57.1% (95% CI, 51.5% to 62.6%) of patients in the usual care group (P = .003).

Compared with the usual care group, systolic BP decreased more from baseline among patients in the telemonitoring intervention group at 6 months (-10.7 mm Hg [95% CI, -14.3 to -7.3 mm Hg]; P<.001), at 12 months (-9.7 mm Hg [95% CI, -13.4 to -6.0 mm Hg]; P<.001), and at 18 months (-6.6 mm Hg [95% CI, -10.7 to -2.5 mm Hg]; P = .004).

Compared with the usual care group, diastolic BP decreased more from baseline among patients in the telemonitoring intervention group at 6 months (-6.0 mm Hg [95% CI, -8.6 to -3.4 mm Hg]; P<.001), at 12 months (-5.1 mm Hg [95% CI, -7.4 to -2.8 mm Hg]; P<.001), and at 18 months (-3.0 mm Hg [95% CI, -6.3 to 0.3 mm Hg]; P = .07).

Conclusions and relevance: Home BP telemonitoring and pharmacist case management achieved better BP control compared with usual care during 12 months of intervention that persisted during 6 months of postintervention follow-up.

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Home Blood Pressure Telemonitoring Improves Hypertension Control In General Practice: The TeleBPCare Study

Source: Journal Of Hypertension

Results: Baseline office blood pressures were 149 ± 12/89 ± 9 and 148 ± 13/89 ± 7 mmHg in groups A (n = 111) and B (n = 187) respectively, the corresponding daytime values being 140 ± 11/84 ± 8 and 139 ± 11/84 ± 8 mmHg. The percentage of daytime blood pressure normalization was higher in group B (62%) than in group A (50%) (P < 0.05). There were less frequent treatment changes in group B than in group A (9 vs. 14%, P < 0.05). Quality of life tended to be higher and costs lower in group B.

Conclusion: Patients' management based on home blood pressure teletransmission led to better control of ambulatory blood pressure than with usual care, with a more regular treatment regimen.

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Clinical Usefulness And Cost-Effectiveness Of Home Blood Pressure Telemonitoring: Meta-Analysis Of Randomized Controlled Studies

Source: Journal Of Hypertension

Results: Twenty-three randomized controlled trials with a high level of heterogeneity were selected (7037 patients). Compared to usual care, HBPT improved office SBP by 4.71 mmHg [95% confidence interval (CI): 6.18, 3.24; P < 0.001] and DBP by 2.45 mmHg (3.33, 1.57; P < 0.001). A larger proportion of patients achieved office BP normalization (<140/90 mmHg nondiabetic patients and <130/80 mmHg diabetic patients) in the intervention group [RR: 1.16 (1.04, 1.29); P < 0.001]. HBPT led to a significantly larger prescription of antihypertensive medications [+0.40 (+0.17,+0.62), P < 0.001], but to therapeutic adherence and rate of office consultations similar to usual care. Healthcare costs were significantly (P < 0.001) larger in the HBPT group [+662.92 (+540.81, +785.04) euros per patient], but were similar to those of the usual care when only medical costs were considered [−12.4 (−930.52, +906.23) euros; P = 0.767]. Use of HBPT helped improving the physical component of quality of life [SF-12 or SF-36 questionnaire: +2.78 (+1.15, +4.41) P < 0.001]. No difference was observed in the risk of adverse events [RR: 1.22 (0.86, 1.71); P = 0.111].

Conclusion: HBPT may represent a useful tool to improve hypertension control and associated healthcare outcomes, although it is still more costly compared with usual care.

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Development Of An Entirely Remote, Non-Physician Led Hypertension Management Program

Source: Clinical Cardiology Open Access Journal

Results: Eighty-one percent of all enrolled, and 91% of those patients who regularly measured home BP achieved goal, in an average of 7 weeks. Control was reached similarly across races, genders, and ages.

Conclusions: A home-based BP control program run by non-physicians can provide efficient, effective and rapid control, suggesting an innovative paradigm for hypertension management. This program is effective, sustainable, adaptable, and scalable to fit current and emerging national systems of healthcare.

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Reducing Blood Pressure With Internet-Based Interventions: A Meta-Analysis

Source: Canadian Cardiovascular Society

Results: The search strategy identified 13 trials, and the mean reduction of systolic and diastolic blood pressure was -3.8 mm Hg (95% confidence interval [Cl], -5.63 to -2.06 mm Hg; P < 0.01) and -2.1 mm Hg (95% CI, -3.51 to -0.65 mm Hg; P < 0.05), respectively. The greatest magnitude of blood pressure reduction was found for interventions that lasted 6 months or longer, used 5 or more behavior change techniques, or delivered health messages proactively.

Conclusion: Research on preventive e-counseling for blood pressure reduction is at an early stage of development. This review provides preliminary evidence of blood pressure reduction with Internet-based interventions. Future studies need to evaluate the contribution of specific intervention components in order to establish a best practice e-counseling protocol that is efficacious in reducing blood pressure.

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The Role Of Home Blood Pressure Telemonitoring For Blood Pressure Control

Source: Severance Cardiovascular Hospital And Cardiovascular Research Institute
• Yonsei University College Of Medicine (Seoul, South Korea)

Conclusion: The treatment of hypertension based on measurement of office BP once every few months may be a thing of the past. Home BP monitoring is a cost-effective way to assess for white coat hypertension, masked hypertension, and 24-hour BP control while increasing patient awareness and treatment adherence. Therefore, home BP should be the ideal out-of-office BP measurement for routine management of hypertension patients [19]. At present, when considering the evidence and the cost-effectiveness, co-intervention, including teletransmission or health care professional co-management, should be limited to selected cases. However, technological advances are allowing for accurate measurement and telemonitoring of day-to-day home BP. Also, active intervention of medical personnel through the use of BP telemonitoring is helpful for improving drug compliance and achieving target BP. Although nothing can replace the tried and tested doctor-patient relationship in the office, telemonitoring of home BP will be an important tool for treating hypertension in the future.

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Cellular Phone And Internet-Based Individual Intervention On Blood Pressure And Obesity In Obese Patients With Hypertension

Source: International Journal Of Medical Informatics

Results: Systolic (SBP) and diastolic blood pressures (DBP) significantly decreased by 9.1 and 7.2 mmHg respectively at 8 weeks from the baseline in the intervention group (p<0.05). However, after 8 weeks from the baseline both SBP and DBP in the control group had not changed significantly. Yet, there were significant mean decreases in body weight and waist circumference by 1.6 kg (p<0.05) and 2.8 cm (p<0.05) in the intervention group, respectively. In the control group increases in body weight and waist circumference (p<0.05) mean changes were also significant. High density lipoprotein cholesterol (HDL-C) significantly increased, with a mean change of 3.7 mg/dl at 8 weeks from baseline in the intervention group (p<0.05). The mean change of HDL-C in the control group was, however, not significant.

Conclusion: During 8 weeks using this web-based intervention by way of cellular phone and Internet SMS improved blood pressure, body weight, waist circumference, and HDL-C in patients with obese hypertension.

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Telecare Is A Valuable Tool For Hypertension Management: A Systematic Review And Meta-Analysis

Source: Blood Pressure Monitoring

Abstract: There is an increasing interest for using telecare (TC) in the management of hypertension. A systematic review to the use of blood pressure (BP) measurement in TC has been performed (Medline/PubMed, Embase, and Cochrane Library), selecting randomized clinical trials that compared TC with usual care (UC) for hypertension management (treatment and/or coaching). Nine randomized clinical trials were selected (n=2501, 61.4±0.6 years, 42±2.7% males). Overall there was a significant larger decrease in the TC group than in the UC group for systolic (5.2±1.5 mmHg; P<0.001) and diastolic BP (2.1±0.8 mmHg; P<0.01).

When studies were separated for antihypertensive treatment modification during the study (yes or no), systolic BP decrease difference between the TC and UC groups (ΔTC-ΔUC) tended to be significantly lower (5.1±2.9 mmHg lower) with treatment modification compared with nontreatment modification in which the ΔTC-ΔUC was 8.6±2.4 mmHg, P=0.07. TC led to a greater decrease in systolic and diastolic BP than UC. The differences between TC and UC for systolic BP tend to become larger when no treatment modification is applied. TC seems a valuable tool for hypertension management.

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Self-Monitoring Of Blood Pressure In Hypertension: A Systematic Review And Individual Patient Data Meta-Analysis

Source: PLoS Medicine

Conclusions: Self-monitoring alone is not associated with lower BP or better control, but in conjunction with co-interventions (including systematic medication titration by doctors, pharmacists, or patients; education; or lifestyle counseling) leads to clinically significant BP reduction which persists for at least 12 months. The implementation of self-monitoring in hypertension should be accompanied by such co-interventions.

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Conclusion

While the potential for RPM to positively impact our patient’s life is significant, it does require strong leadership, dedicated staff, and careful planning to implement successfully. Whether you are brand new to RPM or trying to re-energize an existing program, we hope this playbook has provided a foundation for understanding everything that is required for a successful launch or re-launch.

At Optimize Health, we believe strongly in the power of RPM to be a critical component in improving patient outcomes while lowering costs. We are always happy to talk to healthcare groups about our services or just answer questions about RPM in general.

For more information about RPM, please visit www.optimize.health or schedule a free consultation with one of our RPM experts.

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