Hassan Shahzad, Blood Alexander J, Zelle David, Kumar Sanjay, Wagholikar Kavishwar, Gabovitch Daniel, Cannon Christopher P, Fisher Naomi, Scirica Benjamin M
Accelerator for Clinical Transformation (S.H., A.J.B., D.Z., S.K., K.W., D.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA.
Division of Cardiovascular Medicine (S.H., A.J.B., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA.
Hypertension. 2025 Apr;82(4):733-742. doi: 10.1161/HYPERTENSIONAHA.124.24475. Epub 2025 Jan 31.
Hypertension is a major cardiovascular risk factor, yet traditional care often results in suboptimal blood pressure (BP) control at the population level. We implemented a remote hypertension management program that monitored home BP and titrated medications per algorithm. This study assessed the program's long-term effects by examining participants' office BP up to 42 months post-enrollment.
Participants of the remote hypertension program were categorized into 4 groups: (1) enrolled-maintenance (achieved goal home BP of ≤130/80 mm Hg), (2) enrolled-early exit (left before achieving goal BP), (3) education-only (lifestyle modifications and medications compliance), and (4) white coat hypertension group (high office BP but normal home BP). Office BP readings of participants were collected up to 42 months post-enrollment. A linear mixed-effects regression model estimated mean BP levels and studied factors associated with above-goal systolic BP in the maintenance group.
Office BP readings from 3601 participants (mean age, 61±11 years; 57% female; 60% white; 52% atherosclerotic cardiovascular disease) were extracted from electronic health records and analyzed. All groups sustained office BP below their qualifying values (<0.001) over 42 months. In the maintenance group, 89.7% of participants maintained systolic BP at goal, compared with 63.5% in the early exit group, 69.4% in the education-only group, and 90.7% in the white coat hypertension group. Age >50 years was associated with above-goal systolic BP in the maintenance group.
Participants who achieved BP control through the remote hypertension program maintained goal systolic BP in 90% of cases up to 42 months post-enrollment. These findings highlight the long-term benefits of remote, intensive management programs for effective hypertension control.
高血压是主要的心血管危险因素，但传统护理在人群层面往往导致血压控制不理想。我们实施了一项远程高血压管理项目，该项目通过算法监测家庭血压并调整药物剂量。本研究通过检查参与者入组后长达42个月的诊室血压来评估该项目的长期效果。
远程高血压项目的参与者分为4组：（1）入组并维持（家庭血压达到目标值≤130/80 mmHg），（2）入组但提前退出（未达到目标血压前退出），（3）仅接受教育（生活方式调整和药物依从性），以及（4）白大衣高血压组（诊室血压高但家庭血压正常）。收集参与者入组后长达42个月的诊室血压读数。采用线性混合效应回归模型估计平均血压水平，并研究维持组中与高于目标收缩压相关的因素。
从电子健康记录中提取并分析了3601名参与者（平均年龄61±11岁；57%为女性；60%为白人；52%患有动脉粥样硬化性心血管疾病）的诊室血压读数。所有组在42个月内诊室血压均维持在其合格值以下（<0.001）。在维持组中，89.7%的参与者收缩压维持在目标水平，相比之下，提前退出组为63.5%，仅接受教育组为69.4%，白大衣高血压组为90.7%。维持组中年龄>50岁与高于目标收缩压相关。
通过远程高血压项目实现血压控制的参与者在入组后长达42个月的时间里，90%的病例收缩压维持在目标水平。这些发现凸显了远程强化管理项目对有效控制高血压的长期益处。
