Abstract Body (Do not enter title and authors here): Background: Remote patient monitoring (RPM) is used to manage hypertension, but its long-term effects, especially after breaks in monitoring, are not well characterized. It remains unclear whether systolic blood pressure (SBP) improvements achieved during RPM persist following a leave of absence (LOA) and whether re-initiation can restore prior gains.

Hypothesis: Discontinuing RPM will cause SBP to regress toward pre-intervention levels while re-initiating RPM will reinstate SBP reductions like those seen during the initial engagement.

Methods: We identified 9,942 Medicare beneficiaries (baseline SBP ≥ 130 mm Hg or DBP ≥ 80 mm Hg) who participated in an initial RPM period (“Initiation”) and then re-enrolled after a ≥ 60 day LOA (“Reinitiation”). For each period, we calculated monthly mean SBP from the average of the first seven home readings up to 10 months.

Results: During the Initiation period, mean SBP fell markedly from 140.8 ± 14.9 mmHg in Month 1 to 134.6 ± 13.7 mm Hg by Month 10 (–6.2 mmHg; p<0.0001). Following a ≥ 60 day LOA, reinitiation participants experienced a significant SBP decline from 137.6 ± 17.5 mmHg to 133.1 ± 12.8 mmHg (–4.5 mmHg; p<0.01), demonstrating a monthly reduction slope (–0.50 mmHg/month) nearly identical to that observed during Initiation period (–0.69 mmHg/month). At the end of the Initiation period (Month 10), mean SBP was 134.6 ± 13.7 mmHg, whereas at the re-enrollment time point (Month 1 of Reinitiation), SBP was significantly higher at 137.6 ± 17.5 mmHg (p<0.0001), confirming regression toward baseline following RPM interruption. By Month 5 of Reinitiation period, mean SBP was 134.7 ± 14.1 mmHg, not significantly different from the 134.6 ± 13.7 mmHg observed at Month 10 of Initiation (p = 0.802), demonstrating that, within five months of re-engagement, patients regained their previous level of SBP.

Conclusions: Interrupting RPM leads to significant SBP regression, while re-initiating RPM restores comparable declines within five months. This regression-resumption profile eliminates regression to the mean as the sole explanation and suggests RPM’s mechanistic efficacy. Continuous RPM engagement sustains SBP reductions out to ten months and likely beyond. These data support RPM as a chronic care infrastructure, rather than an episodic tool, essential for long-term hypertension management. Policy makers should consider a framework that considers a long-term participation in RPM.