Abstract P382: Blood Pressure Outcomes After 12 Months in Primary Care: A Prospective Cohort Study in Electronic Health Records Using Propensity Score Matching for Remote Patient Monitoring for Hypertension

Abstract

Introduction: In primary care (PC) settings, more hands-on hypertension management may be enabled by remote patient monitoring (RPM) for blood pressure (BP), leading to greater BP control over time Hypothesis: Individuals prescribed RPM will have better BP control (BP <140/90 mmHg) and lower office SBP after 12 months, compared with temporally-matched controls. Methods: We conducted a pragmatic matched cohort study in Medicare-enrolled patients with Hypertension at six PC practices, 288 of whom participated in pilot studies of a Omron VitalSight TM RPM system that enabled automatic transmission of BP and pulse into the electronic health record (EHR). We used 1:4 propensity score matching to identify 1152 contemporary matches for these patients from the same PC practices, based on age, sex, systolic BP (SBP), marital status, and several other clinical and healthcare visit characteristics. Outcomes after 12 months included controlling high blood pressure (most recent BP <140/90 mm Hg), and most recent systolic BP and diastolic BP, assessed 1) using PC office measurements only and 2) incorporating RPM measurements. Results: The matched cohort of 1152 patients was, on average, 74 (SD 8) years old, 71% female, and 71% non-Hispanic white. Average baseline systolic BP (SD) was similar between groups: 142.7 (19.5) and 141.2 (18.7) mm Hg in RPM-prescribed patients and controls, respectively (Table). Compared with matched controls, after 12 months the RPM-prescribed cohort had greater BP control (72.6% versus 65.6%) and lower systolic BP (132.3 versus 136.6 mm Hg) when including RPM measurements. However, these metrics were similar when using PC office measurements only. Conclusions: Greater BP control and lower SBP were observed after 12 months in RPM-prescribed patients when considering RPM measurements. Further studies will assess the contributions of adherence to RPM use to observed declines in BP. The EHR can be used to prospectively construct and conduct cohort studies.