Aug 2026· JACC Case Reports· pp.
109672
· 0 citations· 8 references
Medicine
TL;DR
Patients with RH were enrolled in the 3-month RBPM program, which resulted in meaningful systolic BP changes, high medication adherence, and favorable patient satisfaction, and cellular-enabled BP monitors outperformed their Bluetooth-enabled counterparts in data transmission reliability.
Abstract
Background
Current American College of Cardiology/American Heart Association guidelines emphasize home blood pressure (BP) monitoring, shared decision-making, self-management interventions, and multidisciplinary care as key strategies for improving outcomes in patients with resistant hypertension (RH). However, evidence regarding optimal device selection for remote blood pressure monitoring (RBPM) is limited.
PROJECT
Rationale
We incorporated these strategies into our RBPM program at a specialized RH clinic to evaluate their impact on BP control, medication adherence, and patient satisfaction. In addition, we prospectively compared data transmission reliability between cellular-enabled and Bluetooth-enabled BP monitors.
PROJECT SUMMARY
Patients with RH were enrolled in our 3-month RBPM program, which resulted in meaningful systolic BP changes, high medication adherence, and favorable patient satisfaction. Furthermore, cellular-enabled BP monitors outperformed their Bluetooth-enabled counterparts in data transmission reliability.
TAKE-HOME MESSAGE
Multidisciplinary RBPM programs deploying cellular-enabled BP monitors effectively improve BP control, promote medication adherence, and contribute to high patient satisfaction.
Background Racial and ethnic minority populations face disproportionate rates of uncontrolled blood pressure (BP) and hypertension-related mortality. Remote hypertension monitoring (RHM) with active clinician-led medication titration has shown promise for improving BP control, but real-world evidence in majority-minority primary care settings remains limited. Methods This retrospective cohort study (January 2022-December 2024) enrolled adults with hypertension in a Bluetooth-integrated RHM program at a single urban academic primary care clinic. Of 550 patients enrolled, 503 with evaluable follow-up data were included. Patients transmitted daily home BP readings; clinicians reviewed readings monthly and titrated anti-hypertensive regimens per 2017 ACC/AHA guidelines. BP control was assessed at baseline and 3, 6, and 9 months. Factors associated with longitudinal BP control were examined using multivariable generalized estimating equations (GEE), with outcomes defined as strict control (<130/80 mmHg), at-least-moderate control (<140/90 mmHg), and uncontrolled (>140/90 mmHg). Results Among 503 participants (mean age 58.3 [SD 12.1] years; 63.6% African American; 52.9% male), BP control increased from 10.1% at baseline to 37.1% at 9 months. Each additional month of enrollment was associated with reduced odds of uncontrolled BP (adjusted odds ratio [aOR] 0.82; 95% CI, 0.80-0.85; P<.001). White race was associated with lower odds of uncontrolled BP versus African American race (aOR 0.57, at-least-moderate control; aOR 0.40, strict control; both P<.001). Male sex (aOR 1.46; P=.02) and congestive heart failure (aOR 2.09, strict control; aOR 2.05, at-least-moderate control; both P<.05) were associated with higher odds of uncontrolled BP. Conclusion Bluetooth-integrated RHM with active clinician-led medication titration was associated with a nearly 4-fold increase in BP control over 9 months in a majority-minority primary care population. Persistent within-program racial disparities underscore the need for equity-centered strategies beyond technology adoption alone. Prospective studies with concurrent usual-care comparators are needed to establish causal inference.
R. Mackey, R. Bharucha, A. Monte et al.· medRxiv· 0 citations
Practice Problem: Hypertension is a leading contributor to cardiovascular disease, and suboptimal adherence to remote patient monitoring (RPM) limits opportunities for timely intervention and effective blood pressure management in outpatient primary care.
PICOT: The PICOT question that guided this project was: Among outpatient clinic nursing staff responsible for remote patient monitoring (RPM) in adults with hypertension (P), how does implementation of a structured nurse-led education and reminder protocol (I), compared to standard RPM practices consisting of routine onboarding and passive reminder processes (C), influence patient adherence to RPM protocols (O) over a 10-week period (T)?
Evidence: Evidence supports nurse-led education, structured follow-up, and standardized clinical workflows as effective strategies for improving patient adherence to remote patient monitoring and hypertension management. The project was guided by the Johns Hopkins Evidence-Based Practice Model and Lewin's Change Theory.
Intervention: Fifteen adults enrolled in an outpatient RPM program received standardized onboarding education and weekly reminder contacts.
Outcome: RPM adherence improved from 33% at baseline to 67% by Week 10, exceeding the 60% benchmark. Blood pressure reading counts increased significantly (t(14) = −3.16, p = .007), with 100% onboarding completion, 93% reminder completion, 87% workflow compliance, and 100% participant retention.
Conclusion: The intervention improved RPM adherence and implementation outcomes, supporting standardized nurse-led education and structured follow-up as sustainable strategies to strengthen hypertension management in outpatient primary care.
Aims: Hypertension (HT) remains a major global health problem, and achieving optimal blood pressure (BP) control continues to be challenging in clinical practice. Patient-related factors such as disease awareness, medication adherence, and home blood pressure monitoring (HBPM) behaviors play a crucial role in HT management. This study aimed to evaluate the relationship between these factors and BP control.Methods: This prospective, single-center, cross-sectional study included 280 adult patients with HT. Disease awareness was assessed using the Hypertension Knowledge-Level Scale (HK-LS), and medication adherence was evaluated using the Adherence to Refills and Medications Scale (ARMS). HBPM habits were assessed using a structured questionnaire. Multivariable logistic regression analysis was performed to identify independent predictors of uncontrolled HT. Model performance was evaluated using receiver operating characteristic analysis, calibration plots, and decision curve analysis.Results: A total of 280 patients were analyzed, of whom 132 (47.1%) had uncontrolled HT. Patients with uncontrolled HT had significantly lower HK-LS scores and higher ARMS scores (p
M. Karamanlıoğlu· Journal of Health Sciences a...· 0 citations
BACKGROUND
Hypertension is the leading risk factor for cardiovascular disease (CVD) worldwide. Implementation-based blood pressure (BP) control programs improve BP control and reduce CVD risk, but whether their benefits persist after withdrawal of trial-supported intervention components remains uncertain, especially when intensive BP control is targeted. In CRHCP (China Rural Hypertension Control Project), a nonphysician community healthcare provider (NPCHP)-led program with the intensive target of <130/80 mm Hg reduced CVD risk during the 4-year active intervention period. We extended follow-up for an additional 3 years to assess BP control and CVD outcomes over the 7-year overall period and during the 3-year posttrial period.
METHODS
CRHCP was a cluster-randomized controlled trial conducted in rural China. Eligible participants were ≥40 years of age with BP ≥140/90 mm Hg or ≥130/80 mm Hg if at high CVD risk or receiving antihypertensive treatment. We randomly assigned 326 villages 1:1 to NPCHP-led intensive BP control or usual care. During the 4-year intervention, trained NPCHPs initiated and titrated antihypertensive medications using a standardized protocol under primary care physician supervision and provided coaching on home BP monitoring, lifestyle modification, and medication adherence. The program also provided discounted or free antihypertensive medications, additional training, and performance incentives. Participants in the usual care group received local standard BP management throughout. During the 3-year posttrial period from years 4 to 7, intervention participants continued care with their original NPCHPs, with physician and hypertension specialist consultation available; discounted or free medications, additional training, and performance incentives were discontinued. The primary outcome was a composite of myocardial infarction, stroke, hospitalization for heart failure, and CVD death. Treatment effects were evaluated separately over the 7-year overall and 3-year posttrial periods with prespecified subgroup analyses.
RESULTS
Between May 8 and November 28, 2018, 33 995 participants were enrolled; 31 334 entered the posttrial follow-up. At the end of the 7-year overall period, BP was 138.8/80.7 mm Hg in the intervention group versus 152.3/86.1 mm Hg in the usual care group (between-group difference, -13.5/-5.4 mm Hg; P<0.0001 for both systolic and diastolic BPs); percentage of the participants with BP <130/80 mm Hg was 33.9% versus 10.5% (P<0.0001). During the 7-year overall period, the rate of composite CVD events was 2.4% versus 3.0% per person-year in the intervention and usual care groups, respectively (hazard ratio, 0.76 [95% CI, 0.72-0.81]; P<0.0001). During the 3-year posttrial period, the corresponding rates were 3.4% versus 4.2% per person-year (hazard ratio, 0.79 [95% CI, 0.73-0.85]; P<0.0001). Posttrial effects in CVD risk reduction were generally consistent across subgroups defined by baseline age, sex, education, and antihypertensive medication use. Over the 7-year overall period, the intervention group had higher risks of hypotension (risk ratio, 1.58 [95% CI, 1.39-1.79]) and mild hypokalemia (risk ratio, 1.38 [95% CI, 1.23-1.56]; P<0.001 for both).
CONCLUSIONS
Multicomponent BP management strategy with a BP target <130/80 mm Hg led by NPCHPs achieved sustained BP control and reduced CVD risk during both the 7-year overall and 3-year posttrial periods.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03527719.
In this community-based cohort of older adults, HBPM provided stable BP estimates within three days (can be non-consecutive within an 8-day period) using morning and evening sessions with ≥2 readings each, supporting shorter, less burdensome HBPM protocols in clinical guidelines for hypertension management in older adults.
Frances M Wang, Hannah V Col, F. L. Kwapong et al.· American Journal of Hyperten...· 0 citations
BACKGROUND
Hypertension remains substantially underdiagnosed and undertreated globally, with ambulatory blood pressure monitoring (ABPM) - the gold standard for hypertension diagnosis - significantly underutilised in primary care. Nurse-led protocols offer a scalable approach to closing these gaps, yet evidence from rural Irish general practice is limited.
METHODS
This retrospective paired clinical audit reviewed electronic health records of 706 adults aged ≥ 25 years with clinic systolic blood pressure ≥ 150 mmHg or a coded ICPC-2 diagnosis of hypertension at a single rural Irish general practice. In November 2019, a nurse-led clinical practice pathway based on ESH and NICE guidelines was implemented in the practice, empowering practice nurses to independently initiate ABPM referrals, deliver lifestyle counselling, and coordinate follow-up. Data were then collected pre-protocol (November 2017 to 2019) and post-protocol (November 2019 to 2022) to assess changes in HTN diagnosis and management. Paired categorical outcomes were compared using McNemar's test with Bonferroni correction; continuous outcomes were compared using the Wilcoxon signed-rank test.
RESULTS
ABPM utilisation rose by more than 10% (57.1% to 69.0%), enabling more accurate diagnosis and treatment decisions. Coded hypertension diagnoses rose from 78.9% to 83.9%, and the proportion achieving guideline-recommended BP targets improved from 37.7% to 44.1%. Antihypertensive therapy was meaningfully intensified: ACEi/ARB and calcium channel blocker prescribing increased significantly, and the mean number of medication classes rose from 1.88 to 2.18. Post-protocol analysis identified a sequence of associations linking ABPM uptake to new hypertension diagnosis (OR 6.60) and new diagnosis to antihypertensive prescribing (OR 5.45).
CONCLUSIONS
A nurse-led protocol centred on ABPM as the diagnostic cornerstone was associated with significant improvements in hypertension diagnosis and treatment in a rural Irish primary care setting, sustained throughout the COVID-19 pandemic. These findings support wider evaluation of nurse-led, ABPM-integrated models as a practical approach to closing the hypertension treatment gap in primary care.
S. Bhat, W. Cullen, T. Heffernan et al.· BMC Primary Care· 0 citations
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