Abstract Body: Background
Remote patient monitoring (RPM) enables clinicians to combine validated home blood pressure (BP) devices, wireless data transmission, and a centralized care team to follow trends in BP and intervene as needed. While RPM has been correlated with reductions in BP, the contribution of patient engagement to systolic (SBP), diastolic (DBP), and mean arterial pressure (MAP) reductions remains unclear over prolonged follow-up. Our objective was to relate RPM engagement, measured by the Transmission Index (TI), to SBP, DBP, and MAP change in adults with Stage-2 hypertension.
Hypothesis
We hypothesize that, among adults with Stage-2 hypertension enrolled in an RPM program, greater patient engagement will be associated with larger SBP reductions. We hypothesize a similar dose-response effect will be observed for DBP and MAP.
Methods
We conducted a retrospective analysis of adults with baseline Stage-2 HTN (SBP ≥140 mmHg or DBP ≥90 mmHg), enrolled ≥90 days in an RPM program, and transmitting ≥14 days of data total. The Stage-2 cohort comprised 20,353 patients (mean program duration 414 ± 161 days; baseline SBP 150.9 ± 11.2 mmHg; baseline DBP 88.0 ± 10.0 mmHg). Patients were stratified into ten equal TI deciles (0–10 % to 90–100 %). To account for variability in BP readings, BP reported is the average of the first seven or last seven readings for an individual. Primary outcomes were ΔSBP, ΔDBP, and ΔMAP (most recent – baseline). Linear trends (β, mmHg per 10 % TI) were estimated via ANCOVA.
Results
Patients with TI ≥ 50 % achieved mean ΔSBP of –12.3 mmHg, ΔDBP of –8.9 mmHg, and ΔMAP of –10.9 mmHg—approximately 35–45 % greater reductions than those with TI < 50 %. In addition, engagement slopes were determined for SBP: β = –1.15 mmHg per 10 % TI (p < 0.001), DBP: β = –0.56 mmHg per 10 % TI (p < 0.001), and MAP: β = –0.76 mmHg per 10 % TI (p < 0.001).
Conclusions
In >20,000 Stage-2 hypertensive adults monitored for a mean of 414 days, higher RPM engagement showed a robust, graded association with greater BP reductions: every 10 % increase in daily transmissions yielded ~1.2 mmHg SBP, 0.6 mmHg DBP, and 0.8 mmHg MAP additional lowering. These findings underscore the importance of sustained patient participation in RPM to maximize BP control and guide clinical and payer strategies to incentivize engagement.