Home Blood Pressure Telemonitoring Technology for Patients with Asymptomatic Elevated Blood Pressure Discharged from the Emergency Department: A Pilot Study.

BACKGROUND: Hypertension affects one in five Canadians and is the leading cause of morbidity and mortality globally. The control of hypertension is declining due to multiple factors including a lack of access to primary care. Consequently, patients with hypertension frequently need to visit the emergency department (ED) due to high blood pressure (BP). Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring Blood Pressure (TEC4Home-BP) is a pilot project that implements and evaluates a comprehensive home blood pressure telemonitoring (HBPT) and physician case management protocol designed as a post-discharge management strategy to support patients with asymptomatic elevated BP as they transition from the ED to home.

OBJECTIVE: Our objective was to conduct a feasibility study of a HBPT program for patients with asymptomatic elevated BP discharged from the ED.

METHODS: Patients discharged from an urban, tertiary care hospital ED with asymptomatic elevated BP were recruited in Vancouver, Canada and provided with HBPT technology for 3-months of monitoring post-discharged and referred to specialist Hypertension Clinics. Participants were asked to monitor their BP twice in the morning and evenings and tele-transmit readings via Bluetooth Sensor each day using an App. A monitoring clinician received this data and monitored the patient's condition daily and to adjust anti-hypertensive medications. Feasibility outcomes included eligibility, recruitment, adherence to monitoring, and retention rates. Secondary outcomes included: proportion of those who were defined as having hypertension post-ED visits, changes in mean BP, overall BP control, medication adherence (as measured by the Hill-Bone Medication Adherence Scale), changes to anti-hypertensive medications, quality of life (as measured by the 5-level EuroQoL-5D-5L questionnaire), and end-user experience at 3-months.

RESULTS: Forty-six multi-ethnic patients (age 63 ± 17 years, 69% women) found to have severe hypertension (191±23/100±14 mmHg) in the ED were recruited, initiated on HBPT with hypertension specialist physician referral and followed up for 3-months. Eligibility and recruitment rate were 40% and 88%, respectively. The proportion of participants that completed ≥ 80% of home BP measurement at 1- and 3-months was 76% and 57%, respectively. The proportion of individuals who achieved home systolic BP and diastolic BP control at 3-months was 71.4% and 85.7%, respectively. Mean home SBP and DBP improved by -13/-5 mm Hg after initiation of HBPT to the end of the study. Patients were prescribed one additional anti-hypertensive medication. No differences in medication adherence from enrolment to 3 months were noted. Most patients (75%) were highly satisfied with the HBPT program and 80% found digital health tools easy to use.

CONCLUSIONS: HBPT intervention is a feasible post-discharge management strategy and can be beneficial in supporting patients with asymptomatic elevated BP from the ED. A randomized trial is underway to evaluate the efficacy of this intervention on BP control.