Remote Monitoring, Telehealth Use Linked to Tighter Blood Pressure Control

Telehealth services, combined with remote patient monitoring, helped boost engagement and blood pressure control among stroke survivors living in under-resourced communities, according to new research.

The research, which will be presented at the American Stroke Association's International Stroke Conference 2022, to be held Feb. 8 to 11, examined the impact of a new strategy, called Telehealth After Stroke Care, to manage stroke patients after they are discharged from a healthcare facility.

For the study, researchers from New York City-based Columbia University examined data from people who received post-stroke care after being discharged from NewYork-Presbyterian/Columbia University Irving Medical Center.

Study participants included 50 stroke survivors, of which 44 percent were Hispanic, 32 percent were Black, and 20 percent were white, with an average age of 64. Further, 54 percent of the participants had a high-school or lower level of education, and only 30 percent had private health insurance.

The participants were randomly divided into two groups: one group received the usual post-stroke care, and the other was treated using the new Telehealth After Stroke Care strategy. Researchers followed both groups for 90 days post-discharge, which is the period when the chance of another stroke is highest.

Usual care involved a video visit with a primary care provider one to two weeks after hospital discharge and video visits with a stroke specialist at six and 12 weeks after discharge. Meanwhile, the enhanced telehealth strategy group received mobile tablets and blood pressure monitors, which remotely sent their readings to their EHR, in addition to video visits with a team that included pharmacy support.

Further, the enhanced telehealth strategy group got a blood pressure infographic in English or Spanish, tailored individually, to help educate them about healthy blood pressure levels, goals, and ways to improve control.

The group that received care through the Telehealth After Stroke Care strategy had higher patient engagement rates, with 91 percent of patients in that group completing the video visit with primary care providers and specialists, compared with 75 percent of patients in the usual care group.

Notably, the telehealth intervention group had better blood pressure control, with 76 percent of participants having their blood pressure under control at the end of the study, compared to 25 percent in the usual care group.

"Hypertension is the most important modifiable risk factor for a second or recurrent stroke," said Imama A. Naqvi, MD, lead study author and neurologist with New York-Presbyterian/Columbia University Irving Medical Center, in the news release. "We know that a small change to lower systolic blood pressure [the top number in a blood pressure reading] reduces recurrent stroke risk by more than 20 percent. Yet, blood pressure is poorly controlled among more than half of stroke survivors."

The Telehealth After Stroke Care strategy not only improved blood pressure control rates overall but also for Black participants within the two groups. Black adults have a higher prevalence of uncontrolled blood pressure than White adults.

Blood pressure control improved among Black participants in the enhanced telehealth group — from 40 percent of participants having their blood pressure under control at enrollment to 100 percent by the end of the study. In the usual care group, blood pressure control improved from 14 percent to 29 percent among Black participants.

"COVID-19 has highlighted numerous health inequities that make post-stroke care more difficult and created a gap in health outcomes for people from diverse racial and ethnic groups," said Naqvi. "We need to devise ways to bridge this divide."

This study builds on research published in 2020 showing that people enrolled in a telemonitoring program to control high blood pressure were about half as likely to have a heart attack or stroke compared to those who received routine care.