Remote Patient Monitoring (RPM)
Research Supports Remote Patient Monitoring for Hypertension Control
Despite increasing blood pressure awareness and control, more than 30% of adults with hypertension are unaware, and nearly 50% of diagnosed hypertension is uncontrolled. With the cost of diagnosed hypertension exceeding $50 billion annually, traditional office-based hypertension treatment hasn’t proven effective or efficient enough. High blood pressure (HBP) also remains poorly controlled at the population level.
Remote patient monitoring (RPM) for hypertension is a proven methodology that physicians can use to predict and prevent cardiac incidents related to HBP. Through clinical trials, RPM has realized improved outcomes by enabling accurate, early BP detection and decreasing all-cause mortality rates and hospitalizations. And as part of Medicare reimbursement for RPM, primary care physicians and cardiologists can more effectively assess, treat, and monitor existing hypertension.
Worldwide hypertension guidelines recommend out-of-office blood pressure monitoring. The accelerated adoption of e-health, telemonitoring, and RPM technologies during the COVID-19 pandemic demonstrates better hypertension control.
Hypertension control is central to avoiding serious cardiac events
Clinicians know the effect hypertension has on health and cardiovascular risk. Improving blood pressure control can drastically reduce the risk of heart attack, stroke, and heart failure, particularly when considering the prevalence of hypertension with other cardiac events:
- 7:10 patients experiencing their first heart attack have high blood pressure
- 7:10 patients with chronic heart failure also have high blood pressure
- 8:10 patients having their first stroke have high blood pressure
Controlling hypertension through an RPM program offers more opportunities for providers to avoid new or exacerbated effects on a patient’s heart and kidneys, as well as chronic illnesses like diabetes.
RPM benefits hypertension management
According to the American Medical Association, the following five barriers stand in the way of appropriate blood pressure management:
- Poor or inconsistent blood-pressure measurement techniques
- Masked hypertension where patients appear to have a normal BP in the office with high readings at home
- Clinical inertia occurs when a patient’s care team does not initiate or intensify treatment when BP readings reach target levels
- Care teams aren’t relying on evidence-based treatment protocols
- Patients aren’t actively engaged in self-management
Remote patient monitoring has the potential to address all of these obstacles. By offering a reliable measurement methodology, user-friendly blood pressure devices that can be easily worn or operated, and timely follow-ups or interventions to adjust the treatment plan, patients can gain greater insight into their readings and become more receptive to modifying their behavior based on the data.
Benefits of RPM for Hypertension
RPM for hypertension, aka blood pressure telemonitoring (BPT), is one of the most widely used telemedicine or eHealth technologies. RPM is useful because it can actively or passively take readings over time and provides visibility into the various influences on blood pressure outside of the clinic. Data collected over time facilitates discussions, interventions, and treatment changes based on a more holistic view.
As the research in the next section indicates, RPM-collected data can lead to improvements in systolic and diastolic blood pressure, better monitoring and medication adherence, as well as engaging patients more deeply in hypertension management for the long term.
RPM Research Roundup: Evidence supporting RPM for hypertension management
Various research studies have been conducted, demonstrating why RPM is a powerful tool in managing hypertension.
RPM is an effective treatment modality for hypertension
Achieving BP control for 81% of patients: Research conducted by Brigham and Women’s Hospital found that blood pressure home monitoring is an effective way to manage hypertension. The pilot used Bluetooth-enabled blood pressure devices to measure BP twice daily. Clinical staff received real-time readings on a dashboard where they could provide follow-up if needed.
Other studies achieved similar outcomes: An RPM Healthcare study found remote monitoring helped 74% of patients reduce their systolic and diastolic readings after three months. According to a research study featured in the Journal of the American College of Cardiology, the utilization of RPM resulted in the achievement of controlled hypertension in 41% of patients in the first month, with the percentage increasing to 51% over the course of the program. Furthermore, there was a significant improvement in the percentage of patients with diabetes who attained blood pressure control, which rose from 37% to 55%.
Length of RPM program didn’t improve outcomes: In an uncontrolled observational study that enrolled more than 1,000 patients, RPM was utilized to reduce the average mean arterial pressure (MAP) by four points, which was sustained for six months following the program. Notably, 50% of patients achieved normotension. Although more frequent measurements led to the greatest reduction in MAP, hypertensive patients showed a significant decrease in blood pressure regardless of whether they measured more or less than 16 days per month. The study also highlighted that there was no minimum number of monitoring days required to attain sufficient control.
RPM can provide more accurate and timely blood pressure readings
The following two examples highlight the value of RPM for improving the accuracy and timeliness of BP readings, enabling better hypertension control and patient engagement.
An Atlanta-based house-call medical practice struggled with incomplete and inconsistent patient BP reports during home visits. Often, the readings resulted in unnecessary outreach and inefficient use of staff time. After implementing RPM for patients with uncontrolled hypertension, they were able to create a much more reliable picture of the patient's health. Over the course of one year, approximately 300 patients were enrolled and monitored for 17 days each month as part of a program. The program yielded significant improvements in both systolic blood pressure and diastolic blood pressure. Furthermore, the program was associated with enhancements in patient satisfaction, self-efficacy, security, and health literacy.
A Kentucky-based cardiology practice used RPM to monitor 172 patients, growing to nearly 300. Combining remote patient monitoring with 20 minutes of follow-up increased patient engagement by 86% and enabled the clinic to receive consistent, reliable blood pressure readings.
Hypertension control outcomes: RPM alone vs. RPM plus care coordinator support
A Northwestern-led study demonstrated the impact of using RPM alone versus complemented by a care coordinator. Presented at the American College of Cardiology’s 71st Annual Scientific Sessions, this pilot showed RPM uptake was greater with nurse care coordinators than without. Blood pressure control was achieved among 28.8% of patients without an assigned care coordinator and 33.6% with a designated care coordinator.
Fully remote RPM for HTN during COVID proves the efficacy
A retrospective observational analysis evaluated fully remote RPM before and during the pandemic. A team of pharmacists, nurse practitioners, physicians, and non-licensed navigators used an evidence‐based clinical algorithm to optimize hypertensive treatment. Of the 1,256 patients enrolled, 51.1% reached their BP goals, with 94.6% of patients reaching their goal during the pandemic when the fully remote program was in place. That compares to 75.8% who achieved their BP goal pre-pandemic. Surprisingly, controlled BP maintenance was achieved earlier during the pandemic.
Sustainable blood pressure control
Another remote, navigator-led hypertension innovation program used RPM, an algorithmic care pathway, and patient coaching. Developed by a multidisciplinary group of clinical experts from subspecialties and primary care, the algorithm was automated and administered by non-licensed patient navigators. Eighty-one percent of patients reached HBP control, and 91% of those who consistently engaged in the program gained control in an average of seven weeks. Even follow-up at seven months showed significant, sustained reductions in blood pressure.
Types of RPM care models to improve hypertension management
Healthcare providers are leveraging RPM to manage hypertension in different models, for specific populations, and as a means of handling high-risk or increasing-risk patients. If considering implementing an RPM for a hypertension management program, it is crucial to be clear about clinical objectives and identify the patient groups that are most likely to benefit. These steps are key to ensuring the success of the program.
The American Heart Association published “Using Remote Patient Monitoring Technologies for Better Cardiovascular Disease Outcomes Guidance” to guide providers in launching remote patient monitoring programs. It cites that RPM can “empower patients to better manage their health and participate in healthcare. When used by clinicians, RPM can provide a more holistic view of a patient’s health over time, increase visibility into a patient’s adherence to treatment, and enable timely intervention before a costly care episode.”
RPM based on intervention type
Techniques for creating an RPM program include a combination of devices, collection methods, and clinician or staff engagement.
- Devices: RPM for hypertension could rely on Bluetooth biometric monitoring devices – like upper-arm automated cuffs, smartphone apps paired with wireless devices, or wearable monitors -- to provide blood pressure readings throughout the day.
- Data analysis: Machine learning and AI algorithms can pre-analyze data for patterns and concerning trends that may require intervention.
- Patient surveys: These can be used to understand patients' activities before their latest BP reading, providing valuable insight into their symptoms.
- Medication reminders: Assist patients with medication adherence through automated alerts or reminders
- Nurse or care coordinator engagement: Follow-up communication via phone, email, or text to check in with patients, provide feedback, discuss treatment changes, and offer educational resources.
- Telemedicine appointments: For homebound patients or for periodic in-clinic BP checks, these appointments provide an opportunity to discuss trends, delve deeper into self-care strategies, and personalize the support and guidance offered.
While an RPM program may deploy remote devices only with engagement solely during office appointments, others may use a combination of techniques. No matter the model, self-monitored blood pressure (SMBP) is recommended by organizations like the AHA, the Agency for Healthcare Research and Quality (AHRQ), the American Society of Hypertension (ASH), and the Preventive Cardiovascular Nurses Association (PCNA). They view SMBP “as a way to increase patients’ engagement and ability to self-manage their condition, enabling the care team to assist in timely achievement and maintenance of control and preventing heart attacks and strokes.”
Digital-connected care, such as RPM, promotes blood pressure self-reporting, a highly-structured protocol that involves collecting multiple blood pressure readings over 3-7 days and sharing the results with healthcare providers.
When SMBP is combined with RPM and a well-designed analytics platform, it enables healthcare providers to track clinical trends and monitor patient progress toward blood pressure and other health goals. This approach can lead to improved patient outcomes and help providers make more informed treatment decisions.
The American Medical Association has published a playbook to help clinicians develop an RPM program. For hypertension, the guide highlights the value of RPM, stating, “In addition to providing care teams with better, more actionable information earlier, RPM has been praised for engaging patients in their care by providing them access to their data so they can better understand the impact of their treatment and advocate for their medical needs.”
RPM for a postpartum hypertension assessment and treatment
In some practices, RPM may be best suited for specific patient populations who are generally more at risk or during a phase of life when HBP is prevalent.
Improved HBP control pre- and postpartum: The American College of Obstetricians and Gynecologists suggests telemedicine or RPM interventions during a woman’s fourth trimester. They cite success in non-obstetric populations to improve HBP, reduce inpatient and outpatient visits, and improve patient satisfaction. Hypertensive disorders during pregnancy are risk factors for later-life cardiovascular disease, and studies have shown postpartum care after a hypertensive disorder during pregnancy is often fragmented.
The University of Pittsburgh Medical Center (UPMC) created a postpartum RPM program to ensure mothers with current hypertension or at risk received appropriate hypertension treatment after delivery. More than 400 women were enrolled, including 41% with gestational hypertension, 44% with preeclampsia with no history of chronic hypertension, 12% with chronic hypertension with superimposed preeclampsia, and 3% with postpartum preeclampsia. Of the total population that completed the program, 94% reported high satisfaction. Their program demonstrates high compliance, retention, and patient satisfaction with the program, facilitating care handoffs from the obstetrician to the PCP for further blood pressure monitoring and treatment.
The ACOG recommends that blood pressure assessment be conducted within the first 3–10 days postpartum to identify women who may experience unrecognized blood pressure elevations. The UPMC study found that 16.5% of women required additional treatment, 26% of patients were discharged on antihypertensive medication, and 42% saw BP medication changes through the program.
RPM can be tailored to risk-level
Hypertension assessment and treatment work across a spectrum of risks. Data gathered and analyzed from RPM can support a comprehensive hypertension management program, including prevention, diagnosis, and rising risk, as well as for patients previously diagnosed. An RPM program can focus on any or all of these patient subsegments.
RPM can be used as part of SMBP to diagnose or reassess HBP, confirm a hypertension diagnosis, or monitor treatment changes over time. Gathering multiple readings over time can also provide a more holistic and representative view of possible HBP causes like sustained, white coat, or masked hypertension.
For possible rising-risk patients, an RPM program can act as anticipation medicine to identify increasing risk and predict the onset of cardiovascular events. These cardiac risks can be reduced or eliminated with proactive and timely intervention.
Lastly, patients with comorbidities like diabetes or kidney disease, low treatment adherence, or treatment-resistant hypertension may benefit from more intensive or extended RPM monitoring. One study used a smart home health monitoring system to predict type 2 diabetes with hypertension. A combination of conditional decision-making and machine-learning approaches was used to predict hypertension and diabetes status utilizing the patient’s glucose and blood pressure readings.
RPM for hypertension is the gateway to better prevention, diagnosis, and treatment across cardiac diseases
Research has demonstrated that RPM can reduce systolic and diastolic blood pressure compared to in-office or self-monitoring alone. Beyond hypertension management, RPM can provide monitoring and data analysis to support heart failure and atrial fibrillation detection. When combined with other interventions—like a clinician or care coordinator engagement—RPM can provide reliable, accurate data to support timely intervention, blood pressure control, and potentially avoid future cardiac events.
Software platforms can support the necessary digital infrastructure to deliver RPM services, as well as capture, share, and interpret patient data. ThoroughCare is a comprehensive solution to streamline and scale RPM across patient populations, enabling proactive monitoring related to specific conditions. Paired with personalized care planning and goal setting, ThoroughCare connects RPM with holistic care coordination and patient engagement.