Low patient engagement hinders at-home blood pressure management

Despite guideline recommendations and improved access to care, individuals with hypertension are unlikely to measure their blood pressure at home as often as recommended, according to data from researchers at Mass General Brigham. In a retrospective cohort study, investigators found that even with free blood pressure devices, education, and personalized support, patient engagement with at-home blood pressure monitoring remained low - highlighting the need for more convenient, less burdensome monitoring tools. The findings were published in JAMA Cardiology.

Previous research suggests that at-home blood pressure measurements are often more accurate than clinic readings. Current American Heart Association guidelines recommend that patients with hypertension take two readings, one minute apart, twice daily for up to seven days to obtain an accurate average before a clinical visit.

A single blood pressure reading in the doctor's office can be misleading. Stress, recent physical activity, or anxiety during a visit can artificially elevate readings. By collecting multiple measurements per day at home over several days we gain a far more accurate picture of a patient's true blood pressure and can tailor treatment more effectively."

Naomi Fisher, MD, senior author, endocrinologist, Division of Endocrinology, Diabetes and Hypertension, Mass General Brigham Department of Medicine

Investigators conducted a retrospective cohort study of 3,390 patients enrolled in a remote hypertension management program conducted between September 2018 and June 2022. The program aimed to evaluate whether at-home BP monitoring could effectively decrease BP. All participants received education and free at-home blood pressure monitors and were asked to complete 28 weekly readings, which were automatically transmitted to patient navigators. Notably, the primary analysis showed that participants who actively measured their home BP and reached maintenance achieved decreases in blood pressure associated with a 40 percent relative risk reduction in major cardiovascular events and all-cause mortality. 

This study focuses on a secondary analysis focused on patient engagement with at home monitoring. Here, investigators tracked the number of readings completed over seven-day periods to assess patient engagement. Engagement levels were categorized as no engagement (completed 0 measurements), low engagement (completed 1-11 measurements), intermediate engagement (completed 12-23 measurements), and high engagement (completed 24-28 measurements). Engagement with at-home blood pressure monitoring varied, with 32.7% showing no engagement, 14.3% low engagement, and 18.2% and 34.8% demonstrating intermediate and high engagement, respectively.

Authors note that these findings highlight a need for more innovative, easy-to-use wearable devices, much like continuous glucose monitoring devices used for diabetes management. The idea would be to passively collect blood pressure readings to reduce the burden on patients.

Investigators aim to focus future research on understanding the specific barriers patients face with at home blood pressure monitoring that contribute to low engagement. With several new devices in development or awaiting approval from the U.S. Food and Drug Administration, they are also assessing how hypertension treatment outcomes differ between patients using traditional monitors and those using new wearable continuous monitoring systems.

"Current guidelines require frequent, carefully timed blood pressure measurements for accuracy, but the reality of patients' lives often makes this unrealistic," said lead author Ozan Unlu, MD, a fellow in Interventional Cardiology with Mass General Brigham Heart and Vascular Institute. "This gap highlights the need for low-burden technologies that capture reliable blood pressure data without asking patients to rearrange their lives to manage their condition."

 In addition to Fisher and Unlu, Mass General Brigham authors include David Zelle, Christopher P. Cannon, Simin Lee, Marian McPartlin, Samantha Subramaniam, Michela Tucci, Michael Oates, Christian Figueroa, Hunter Nichols, Tabitha V. Rutkowski, Alexander J. Blood, and Benjamin M. Scirica.