Abstract P359: Achieving Normal Blood Pressure with Cloud-based Monitoring and Management

Abstract

Introduction: We assessed the feasibility and impact of remote monitoring and medication management on hypertension control in a nursing home. Hypothesis: Uncontrolled hypertension is a causal factor for cardiovascular disease. We hypothesized that increased sensitivity to elevated blood pressure (BP) readings via remote monitoring and targeted medication management alerts would lead to higher rates of controlled hypertension. Methods: We followed 48 long-term nursing home patients (average age=68.4) over a 10-week period, of whom 21 were identified as uncontrolled hypertension with a reading >140/90 mmHg. BP readings were taken 3 times a week as compared to a norm of 1 measurement per 3 weeks. Blood pressure data was stored in a cloud and analyzed via algorithms. The physician was given a summary of data identifying those patients who met criteria for elevated BP with averaged per week mean systolic and diastolic blood pressure. Furthermore, patients were further stratified via an algorithm where systolic BP over 140 mmHg was reported as a fraction of the week with uncontrolled hypertension. Together these 3 variables guided the physician in making a determination of a decision to escalate pharmacologic therapy. Results: After monitoring and interventions there were significant decreases in the patients’ average BP (130.6 mmHg vs. 135.6 mmHg, p=0.027). Neurological (headache, vision changes) and cardiac symptoms (chest pain) were resolved or improved in 83% of patients (5 of 6). By end of the pilot 4.2% (2 of 48) remained hypertensive as compared to the initial 43.8% (21 of 48) found to be hypertensive at start of pilot; 95.8% (46 of 48) remained controlled by end of study. Furthermore, when compared with a similar cohort of patients, hospital admissions were 80% (2 versus 10) fewer in the study population. Conclusions: In agreement with our hypothesis, more frequent BP measurements and medication adjustments led to increased rates of hypertension control. We believe that normotension is achievable using cloud-based monitoring, reporting, and treatment. In conclusion, this new method requires serious consideration versus the current standard of care and could help provide improvements in skilled nursing facilities and other care settings.