Remote BP Monitoring Dips a Toe Into Post-Acute Care

Remote physiologic monitoring (RPM) of blood pressure (BP) showed promise for post-acute patients transitioning to outpatient care, a small pilot study found.

Twenty hypertension patients were discharged from Tennessee post-acute care facilities (e.g., long-term care hospitals, inpatient rehabilitation facilities, and skilled nursing facilities) and given a Bluetooth- or cellular-connected BP monitor and trained to use it in tandem with the Alertive mobile app, which delivered results to physicians at post-acute care facilities and ambulatory care centers each month.

From a total of 758 such BP readings taken from March to May 2021, investigators identified 12 hypertensive crises in six unique patients and nine hypotensive crises in five patients. All events led to intervention, reported Jorge Sanchez, MD, of Alertive Healthcare in Mercer Island, Washington, during this year’s virtual Hypertension Scientific Sessions hosted by the American Heart Association.

One patient was hospitalized, and another referred to the emergency department for abdominal pain.

Mean systolic BP dropped from 144.7 mmHg at the start of RPM to 135.2 mmHg at the end of the program (P=0.018), Sanchez noted.

“We need to continue applying RPM to reduce hypertension; we definitely need to do more work,” because there’s “lots of interest in this area,” he said, suggesting that the benefits of RPM are better established in high-risk patients.

He added that researchers need to recruit larger numbers of patients for future studies and analyze the impact of COVID-19 on facilities and patients engaged in RPM.

The question of what RPM contributes to post-acute hypertension care was posed by session co-moderator Boran Katunaric, MD, of Medical College of Wisconsin in Milwaukee.

In response, Sanchez cited a prior study showing that an RPM cohort had benefits over age-matched controls. Those patients underwent frequent medication changes and experienced “very few” hypotensive events, he said.

“I think because RPM puts the BP monitoring in the face of the physician, the physician is sort of forced to make a decision because it’s there and it’s safe,” Sanchez said. He acknowledged, however, that his group did not study what healthcare providers actually do with the information provided on RPM.

The 20 people in the current study averaged 78.3 years old and were enrolled in Medicare’s RPM program.

Patients were telephoned once a month by the nursing team, who coached them on their BP data, adherence to medications, and upcoming medical visits.

RPM protocol called for immediate alerts to physicians when a person’s BP went out of bounds, going too high or too low.

Post-acute care hypotension in particular needs to be evaluated further in cardiovascular and renal patients, Sanchez and colleagues wrote in their study.

Session co-moderator Fernando Elijovich, MD, of Vanderbilt University Medical Center in Nashville, questioned whether the researcher had data on these specific groups.

Sanchez clarified that this remains theoretical, as there were no patients with end-stage renal disease in the study.

Remaining questions include how dippers versus non-dippers fare on RPM, and what the effect is on medication changes.

“The interesting thing is the patients will take their BP. If they’re engaged and they see the benefit of this, they will take BP one, two times a day without a problem,” Sanchez said.

  • Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

Disclosures

Sanchez disclosed equity ownership in Alertive Health.

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