Fisher Molly C, Rikin Sharon, Gupta Sonali, Awori Jeremy, Terzibachi Michel, Sebastian Gracy, Stark Allison, Johns Tanya S
Division of Nephrology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, New York, USA.
Division of Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, New York, USA.
Kidney Int Rep. 2025 Jan 27;10(4):1101-1110. doi: 10.1016/j.ekir.2025.01.028. eCollection 2025 Apr.
Interventions are needed to reduce racial and ethnic disparities in achieving blood pressure (BP) control among patients with chronic kidney disease (CKD). We determined the feasibility and effectiveness of an interdisciplinary remote patient monitoring (RPM) hypertension program in predominantly Black and Hispanic patients with CKD.
We evaluated an RPM hypertension program for patients with CKD in a New York City health system between July 2021 and October 2022. BP data were transmitted in real-time using a cellular-enabled BP device. Education on lifestyle and adherence was provided, and medications were adjusted by a nurse practitioner (NP) via telemedicine. Feasibility was quantitatively assessed as enrollment, participation, and retention at 3 months. Effect on BP was estimated as mean change in BP at 3 months and proportion with BP < 130/80 mmHg at 6 months.
Among 111 patients invited, 102 (91.9%) enrolled and 87 (78.4%) were retained in the program for 3 months. Median age was 61 years, 50% were female, 55.9% were Black, 35.3% were Hispanic, and median estimated glomerular filtration rate was 47.5 ml/min per 1.73 m. The median days per month that BP was measured ranged from 16 to 23. Mean change in systolic and diastolic BP from enrollment to 3 months was -15.0 ± 20.8 ( < 0.0001) and -6.7 ± 17.7 ( = 0.0007), respectively. By 6 months, 49.4% achieved BP < 130/80 mm Hg.
This RPM hypertension program in patients with CKD was feasible and effective in improving BP, which is promising for increasing equity in hypertension control. Future studies evaluating long-term maintenance of BP control using this approach compared with usual care are needed.
需要采取干预措施来减少慢性肾脏病（CKD）患者在实现血压（BP）控制方面的种族和族裔差异。我们确定了一项跨学科远程患者监测（RPM）高血压项目在以黑人和西班牙裔为主的CKD患者中的可行性和有效性。
我们在2021年7月至2022年10月期间，对纽约市卫生系统中的CKD患者的RPM高血压项目进行了评估。血压数据通过具备蜂窝功能的血压设备实时传输。提供了生活方式和依从性方面的教育，执业护士（NP）通过远程医疗调整药物。可行性通过3个月时的入组、参与和留存情况进行定量评估。对血压的影响通过3个月时血压的平均变化以及6个月时血压<130/80 mmHg的比例来估计。
在111名受邀患者中，102名（91.9%）入组，87名（78.4%）在项目中留存3个月。中位年龄为61岁，50%为女性，55.9%为黑人，35.3%为西班牙裔，中位估计肾小球滤过率为47.5 ml/min/1.73 m²。每月测量血压的中位天数为16至23天。从入组到3个月，收缩压和舒张压的平均变化分别为-15.0±20.8（P<0.0001）和-6.7±17.7（P=0.0007）。到6个月时，49.4%的患者血压<130/80 mmHg。
该针对CKD患者的RPM高血压项目在改善血压方面是可行且有效的，这对于提高高血压控制的公平性很有前景。未来需要开展研究，将使用这种方法与常规护理相比的血压控制长期维持情况进行评估。
