Standardized, remote blood pressure (BP) and cholesterol management programs have favorable outcomes and may help improve access to guideline-directed therapy at scale. These findings were published in JAMA Cardiology.
Patients (N=18,444) who had BP and/or low-density lipoprotein cholesterol (LDL-C) levels higher than guideline recommendation limits and had at least 1 visit in the Mass General Brigham health network between 2018 and 2021 were invited to participate in this study. A subset of patients (n=10,803) received education about BP and cholesterol goals, a home BP device, and medication titration. Outcomes of this remote monitoring program were evaluated through 12 months.
The included patients had a mean age of 65 (SD, 11.4) years, 56% were women, and 72% were White. Overall, 3658 patients had hypertension, 8103 had high cholesterol, and 958 had both. Among the groups with high BP or LDL-C, 301 and 965 patients opted out of pharmacological management and only received education, respectively.
Overall, the hypertension program received 424,482 BP measurements and 59,867 laboratory results, distributed 15,047 new prescriptions, and each patient received 2.5 medication changes on average. The cholesterol program received 79,396 laboratory results, distributed 12,838 new prescriptions, and each patient received 1.7 medication changes on average.
Compared with patients who only received education, patients who received remote BP monitoring with pharmacologic management had greater changes to systolic BP from baseline at 6 months (mean change, -8.7 vs -1.5 mm Hg; P <.001) and 12 months (mean change, -9.7 vs 0.2 mm Hg; P <.001) and to diastolic BP at 6 months (mean change, -3.8 vs -0.7 mm Hg; P <.001) and 12 months (mean change, -5.2 vs -1.9 mm Hg; P <.001). Similarly, remote cholesterol monitoring with pharmacologic management better improved LDL-C levels at 6 months (mean change, -35.4 vs -9.3 mg/dL; P <.001) and 12 months (mean change, -37.5 vs -10.2 mg/dL; P <.001) compared with education alone.
At exit from the BP program, the average decrease in systolic BP was -15.6 mm Hg and diastolic BP was -5.8 mm Hg (P <.001). For the subset of patients who left the program prematurely (n=1697), the average decreases in systolic and diastolic BP from baseline were -7.4 mm Hg and -4.0 mm Hg, respectively. In the cholesterol program, the proportion of patients who achieved LDL-C targets was 94% among the subset of patients who entered the maintenance phase of the program.
The major limitation of this study is the nonrandomized design.
“The findings in this study indicated an association between remote health delivery at scale and improvements in chronic disease metrics in a large urban and suburban outpatient cohort and across racial, ethnic, and language populations historically underserved by health care,” the study authors wrote. “We believe that this program may serve as a model for health care professionals and systems aiming to enhance access, patient engagement, and health outcomes.”
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Blood AJ, Cannon CP, Gordon WJ, et al. Results of a remotely delivered hypertension and lipid program in more than 10 000 patients across a diverse health care network. JAMA Cardiol. Published online November 9, 2022. doi:10.1001/jamacardio.2022.4018