Chervonski Ethan, Pelegri Elan, Calle Franzenith De La, Mandal Soumik, Graves Claire A, Colella Doreen, Elmaleh-Sachs Arielle, Nay Jacalyn, Dapkins Isaac, Schoenthaler Antoinette
New York University Grossman School of Medicine, New York, NY.
Family Health Centers, New York University Langone Health, New York, NY.
Am J Prev Med. 2025 Aug 3:108031. doi: 10.1016/j.amepre.2025.108031.
The impact of remote patient monitoring (RPM) for hypertension (HTN) on cardiovascular health (CVH) remains ill-defined. This study characterized the association between a RPM, team-based HTN intervention and CVH markers.
This retrospective, single-arm cohort study included patients with uncontrolled HTN enrolled February 2022-July 2024 in the ALTA trial (clinicaltrials.gov NCT03713515) at five safety-net practices. The ALTA intervention involves RPM supported by a virtual clinic including a nurse practitioner (NP), registered nurse, and community health worker. Demographics, ALTA utilization, and CVH markers (blood pressure [BP], lipids, glycemic indicators, body mass index [BMI], and smoking) at baseline and 12 months were collected. Five markers were scored (0=poor, 1=intermediate, 2=ideal) and summed into a CVH score. The primary endpoint was the 12-month CVH score change in patients with baseline score ≤7. Secondary endpoints included individual non-BP marker changes in patients with baseline derangements.
Among 568 patients (mean age: 56 years), most were female, non-Hispanic Black, and English-speaking. NP visits were more common among females (p=0.04); no other demographics predicted ALTA utilization. The CVH score improved from 4.5 to 5.2 (n=196, p<0.001), independent of ALTA utilization. Total cholesterol (n=86, p<0.001), LDL (n=128, p<0.001), and triglycerides (n=51, p=0.004) improved. Hemoglobin A1c (n=195) dropped among patients with ≥1 NP visit (p=0.02). Fasting glucose (n=135) and BMI (n=289) decreased in the highest tertile of NP visits (p=0.03) and RPM (p=0.02), respectively. 4 of 27 patients quit smoking.
RPM with team-based support was associated with CVH improvements. Benefits may depend on intervention utilization.
远程患者监测（RPM）对高血压（HTN）患者心血管健康（CVH）的影响仍不明确。本研究旨在明确RPM、基于团队的高血压干预措施与CVH标志物之间的关联。
这项回顾性单臂队列研究纳入了2022年2月至2024年7月在五项安全网实践中参加ALTA试验（clinicaltrials.gov NCT03713515）的血压控制不佳的高血压患者。ALTA干预措施包括由虚拟诊所提供支持的RPM，该虚拟诊所配备一名执业护士（NP）、一名注册护士和一名社区卫生工作者。收集了患者的人口统计学信息、ALTA干预措施的使用情况以及基线和12个月时的CVH标志物（血压[BP]、血脂、血糖指标、体重指数[BMI]和吸烟情况）。对五项标志物进行评分（0=差，1=中等，2=理想），并汇总成一个CVH评分。主要终点是基线评分≤7的患者12个月时CVH评分的变化。次要终点包括基线指标异常的患者个体非血压标志物的变化。
在568名患者（平均年龄：56岁）中，大多数为女性、非西班牙裔黑人且说英语。NP问诊在女性中更为常见（p=0.04）；没有其他人口统计学特征能够预测ALTA干预措施的使用情况。CVH评分从4.5提高到了5.2（n=196，p<0.001），与ALTA干预措施的使用情况无关。总胆固醇（n=86，p<0.001）、低密度脂蛋白（n=128，p<0.001）和甘油三酯（n=51，p=0.004）有所改善。在接受≥1次NP问诊的患者中，糖化血红蛋白（n=195）有所下降（p=0.0
