Evaluating the use of a Telehome Hypertension Management Program for Patients Receiving Virtual Care: A Pilot Randomized Controlled Trial
New Technology, Therapies, eHealth & mHealth
Hypertension (HTN) is a leading cause of death and disability in the world. There are cheap, safe, and effective treatments. Despite this, blood pressure (BP) control remains suboptimal and has worsened during the COVID-19 pandemic. Factors contributing to suboptimal BP control include poor medication prescription, tolerance, and compliance, lack of patient engagement in HTN care, and infrequent BP checks.
This study aims to test a novel remote monitoring and management HTN program to create efficiencies in care while improving BP control and health outcomes. An innovative BP monitoring system collects BP readings and clinical symptoms, which are stored on a secure cloud. This is accessible to a research nurse, who uses a care algorithm to regularly titrate medications.
The results of this innovative study and tool can transform the care of patients with hypertension in Ontario and beyond. It can also be modified to enable self-care and empower patients.
Hypertension (HTN) is a leading cause of death and disability in the world. There are cheap, safe, and effective treatments available to manage blood pressure (BP). Despite this, BP control remains suboptimal and has worsened during the COVID-19 pandemic. Factors contributing to suboptimal control include poor medication prescription, tolerance, and compliance, lack of patient engagement in HTN care, and infrequent BP checks.
When considering solutions for HTN management during the pandemic and beyond, Blood Pressure Telemonitoring (BPT) has shown to improve self-management, BP control, and medication adherence. In a small observational study by Fisher and colleagues, there was a reduction of approximately 30mmHg and 20mmHg in the systolic and diastolic BP respectively with the use of a remote, non-physician led HTN management program.
This project has two main objectives: (1) Document how HTN management is occurring in the post-pandemic virtual care era; (2) test a new, innovative HTN management program to create efficiencies in care while improving BP control and health outcomes.
We are performing a single-center, prospective, open-label, concealed allocation, blinded endpoint, randomized controlled pilot study. We are ion the process of recruiting 100 patients (50 male, 50 female) with a diagnosis of HTN. Participants are being randomized 1:1 to either receive an interactive BP monitor and enrollment in the Telehome Monitoring Program or to usual care by their clinician.
Patients randomized to the intervention group will receive a voice-enabled, disease specific home monitoring device to take home for 3 months. This device performs and uploads BP readings and clinical questionnaires to a secure cloud, accessible to the research nurse for medication titration using a medical directive.
The primary outcome is change in systolic blood pressure on a 24-hour ambulatory blood pressure monitor, which is performed at baseline, 3-month follow up (primary outcome), and 6-month follow up (maintenance outcome).
If successful, this study would improve patient outcomes in a cost-effective manner and revolutionize HTN care across Canada. The results of this study are also supporting the development of a novel, evidence-based, easy-to-scale, self-care smartphone application that will empower patients to better manage their BP.