Using Remote Patient Monitoring to Lower Hypertension Progression

As healthcare organizations develop remote patient monitoring (RPM) programs to help patients with chronic diseases, they will look to identify populations most likely to benefit from home monitoring and care management. One such group is patients living with hypertension. 

Hypertension, or high blood pressure, affects approximately 116 million people (47%) in the United States, according to the Centers for Disease Control and Prevention. Roughly one-quarter of those people have their blood pressure under control, and the rest live with a condition that puts them at a much higher risk of heart disease or stroke. In 2019 alone, high blood pressure was listed as a primary or contributing cause of death for almost 517,000 people, and treatment costs the US healthcare system more than $130 billion annually. 

To improve clinical outcomes and reduce costly treatments, a healthcare organization can launch an RPM program that focuses on patients with a history of hypertension or prehypertension. The latter is defined by blood pressure ranging from 120 to 139 mm Hg systolic and/or 80 to 89 mm Hg diastolic blood pressure (DBP). Identifying these patients and enrolling them in a program that allows for regular monitoring gives providers a chance to intervene more quickly before a manageable condition becomes a health emergency requiring hospitalization. 

Establishing a basic RPM program 

An effective care management plan typically involves daily blood pressure and pulse readings along with medication. An RPM program equips qualified patients with a wireless blood pressure monitor, enabling patients to take daily readings and send that information to their care team. The care team works with the patients to ensure that readings are taken at specific times (e.g., mornings, evenings, after exercise). Based on those readings, the care team can then adjust medication as needed. 

According to Withings Chief Medical Officer Shikha Anand, MD, MPH, a healthcare organization launching an RPM program for hypertension must ensure the devices used in the home are properly calibrated and that patients know how to take their blood pressure. A successful program takes an appropriate amount of time and effort to make sure patients are comfortable with the technology so that the act of gathering data is not a burden and that data is accurate and reliable. 

In addition, providers need to set a baseline for that data. Rather than telling the patient what those blood pressure readings should be, setting a baseline is about understanding what constitutes a “normal” reading for that patient. A few different readings taken during the day—when the patient is doing what she normally does — set the bar. A few more readings following exercise or stressful activities will show the provider how cardiac activity affects the patient. 

From there, a provider and patient will collaborate to set a routine, identifying those moments during daily life when a blood pressure reading should be taken. The idea is to map the trends in a patient’s blood pressure, enabling care providers to develop the best care management plan to keep that patient’s blood pressure under control. It will also allow them to spot trends and identify when care providers need to adjust treatment. 

The use of a reporting dashboard can assist providers by helping to simplify the task of patient monitoring. Access to such tools is instrumental to shifting the healthcare industry from episodic to longitudinal care, helping patients along their healthcare journey and giving providers the ability to identify trends and opportunities for timely interventions. 

Planning proactive care management 

An RPM program should be designed not only to manage care but also to improve health outcomes —that is, using the platform to identify why a patient’s blood pressure may be high and taking steps to address those issues.  

According to Anand, care providers can use the data coming into an RPM program to identify those times when a patient’s blood pressure rises and then talk to the patient to determine the causes of those surges. For example, increases in blood pressure may be due to exercise, stress, lack of hydration, or diet. By reviewing the data with patients, a provider can help them connect the dots between behavior and health and enforce the importance of medication adherence. 

A key component to ensuring success with an RPM program is patient engagement. Meaningful patient engagement involves presenting data to patients to show how lifestyle choices affect health and reinforcing the idea that patients can take more control over their lifestyles. If high blood pressure readings result from stressful events, a patient may need to learn how to manage stress. If those readings stem from a person’s food or drink choices, then education on a better diet is in order. 

As healthcare organizations become comfortable with their RPM platforms, they can also add devices and collect more data to improve care management. Adding a weight scale and activity tracker allows providers to track a patient’s weight and exercise, perhaps even heart rate and sleep quality. Doing so adds even more detail to a patient’s daily life, offering more opportunities for the patient and provider to identify the causes of hypertension and recommendations for managing the condition.  

An RPM program gives care providers more opportunities to connect and collaborate with patients and more chances to reinforce healthy choices and lifestyles. To facilitate those opportunities, an RPM program should include communication. While data collection and transmission are vital to care management, providers and patients need to be able to talk to each other when and where necessary. While a phone call or audio-visual telehealth connection might be ideal, an e-mail or text messaging channel can work just as well.  

How RPM can evolve into health management 

Because hypertension can affect the heart, kidneys, and other organs and cause a wide variety of health concerns, a proactive RPM program gives care providers many opportunities to improve patient health, thus reducing healthcare costs and boosting clinical outcomes.  

According to Anand, an RPM strategy can be integrated into almost any primary care service, offering many opportunities for care management and coordination. Through hypertension treatment, patients can be steered toward smoking cessation and weight management programs as well as services that address behavioral health and even sleep management. The strategy, once again, lies in giving patients access to resources and care when they need it most, not just when they visit a doctor or clinic.  

RPM programs will evolve with the technology. Devices, including wearables and sensor-embedded clothing, will become more sophisticated in capturing and transmitting reliable biometric data to providers. More importantly, as healthcare organizations become more comfortable with using RPM technology, they will develop their own strategies and best practices that will make this service a key component of not only healthcare but also health and wellness. 

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Withings brought the first consumer smart scale to market in 2008 and has since expanded its portfolio to include hybrid watches, connected blood pressure monitors, sleep trackers, and smart thermometers. This growth has led to Withings Health Solutions, a division for health care professionals to leverage patient-generated data using remote monitoring and Withings range of award-winning medical devices.