Introduction:
While remote patient monitoring (RPM) for hypertension (HTN) continues to grow in the United States, most systems are third party, employer-directed, or do not directly lead to changes in medication management. Systems that address these issues may reduce therapeutic inertia and lead to more rapid control of blood pressure (BP). We developed a clinician-facing HTN RPM system with evidence-based customizable medication titration protocols that integrate with a patient mobile app and Bluetooth®-connected BP cuff. We report interim results from the pilot implementation of this system.
Hypothesis:
In a pilot study, an RPM system with patient and clinician-facing platforms and a semi-automated protocol will achieve high engagement with actionable user feedback.
Methods:
We performed a single arm, single center study with five clinicians from primary care (3) and cardiology (2). Eligible patients had essential hypertension (BP >130/80 mmHg) and a smartphone (iPhone, Android). Patients used a Bluetooth®-connected cuff that sent readings to a patient app and a clinician dashboard. Based on BP and comorbidities, a protocol provided medication titration recommendations for clinicians. In this 12-week study, we assessed feasibility through user feedback, user engagement (defined as the number of BP measurements), and changes in systolic (SBP, mmHg) and diastolic BP (DBP, mmHg).
Results:
We enrolled 18 patients (age 51
+
11y; 94% male; 29% White). Baseline SBP was 133
+
7.8 and DBP was 87
+
7.1. At a mean follow-up of 4.7 weeks, there were 15
+
11 weekly BP measurements per patient. Mean per-patient decreases in SBP and DBP were 12 (95% CI 5.8-18, p<0.001) and 7.1 (95% CI 3.1-11, p = 0.002), respectively. A total of 77.8% (14/18) patients continued BP measurements without attrition. Key feedback included improved cuff-mobile app connectivity (patients) and increased medication choices in protocols (clinicians).
Conclusions:
In interim results of a pilot study, an RPM HTN system was implemented with high engagement, evidence of BP reduction, and actionable feedback. Complete results including medication and BP changes are anticipated by September 2020 and will guide a planned, funded, large, multicenter cluster randomized trial.
An open trial pilot study examining a remote patient monitoring system for pediatric obesity: Design and Methods (Preprint)