Hypertension, a leading risk factor for cardiovascular disease, remains poorly controlled globally, particularly within underserved communities where access to regular medical care, consistent monitoring, and health education are often limited. These disparities contribute to poorer health outcomes and exacerbate health inequalities. Remote Patient Monitoring (RPM), employing easily accessible digital tools like connected blood pressure cuffs, has the potential to overcome these geographical and socioeconomic barriers, providing continuous data, empowering patients, and enabling timely clinical intervention, thus significantly impacting public health.
The aim of the study.
This study aimed to evaluate the effectiveness of a 6-month RPM program, incorporating connected blood pressure monitors and nurse-led feedback, in achieving blood pressure control and reducing systolic blood pressure in hypertensive patients residing in underserved urban areas.
Material and methods.
A cluster-randomized controlled trial was conducted across 10 primary care clinics serving underserved populations in three different regions (Casablanca, Boston, and Oslo). A total of 400 adult hypertensive patients (BP ≥140/90 mmHg or on anti-hypertensive medication) were enrolled and assigned based on clinic clusters. Five clinics (n=200 patients) implemented the RPM intervention, providing patients with a Bluetooth-enabled blood pressure cuff that transmitted readings daily to a secure platform. Nurses provided weekly telemedicine consultations and personalized feedback based on these readings. The other five clinics (n=200 patients) served as the control group, receiving standard in-person care. Primary outcomes included the change in mean systolic blood pressure (SBP) from baseline at 6 months and the proportion of patients achieving BP control (SBP <140 mmHg and DBP <90 mmHg). Statistical analysis involved mixed-effects models to account for clustering, with significance set at p < 0.05.
At 6 months, patients in the RPM group demonstrated a significantly greater reduction in mean SBP (mean reduction of 9.5 ± 2.8 mmHg) compared to the control group (mean reduction of 4.2 ± 1.9 mmHg) (p < 0.001). The proportion of patients achieving blood pressure control was also significantly higher in the RPM group (60.5%) compared to the control group (37.5%) (p < 0.001). Furthermore, adherence to medication as self-reported was higher in the RPM group (88% vs. 72%, p = 0.002). No significant differences were observed in adverse event rates between the two groups. Patient feedback indicated high satisfaction with the convenience and personalized attention provided by the RPM program.
This study definitively demonstrates that remote patient monitoring, incorporating connected devices and integrated nurse support, is a highly effective intervention for improving blood pressure control and reducing SBP among hypertensive patients in underserved communities. By overcoming traditional barriers to care, RPM holds significant promise for promoting health equity and enhancing chronic disease management. These findings support the widespread adoption and funding of RPM programs within primary care for at-risk populations.
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