Abstract
Background: Hypertension (HTN) is highly prevalent among older adults. Despite evidence that home blood pressure monitoring (HBPM) improves HTN awareness, treatment, and control, engagement with HBPM remains understudied in older adults with ischemic heart disease. This study sought to explain trends associated with HBPM engagement. Methods: We performed an interim analysis of the ongoing RESILIENT randomized mobile health cardiac rehabilitation (mHealth-CR) trial of patients age ≥65 years with ischemic heart disease. Participants in the RESILIENT mHealth-CR group were instructed to perform at least weekly home BP measurements over 12 weeks as part of the study intervention. Three engagement groups (high engagement, gradual decline, baseline engagement) were determined by latent class analysis. ANOVA or Chi-Squared tests were used to determine trends in HBPM engagement and changes in blood pressure (BP) overall and between engagement groups over the 12-week study. Results: Of the 111 participants, the mean (SD) HBPM engagement was 2.3 (2.3) days of HBPM/week and 31.6 (33.1) measures over 12 weeks ( Table ). Weekly HBPM declined from 74.8% to 50.5% from week 1 to week 12. Frequency of HBPM declined over time in both the gradual decline and baseline engagement groups, though remained consistent in the high engagement group. There were no significant differences in mean BP levels at week 1 and week 12 overall or between groups. However, there was a non-significant trend toward a lower systolic BP in the gradual decline group (106 (SD 20.5) mmHg) compared to the high engagement and baseline engagement groups (130 (SD 11.5) and 126 (SD 15.5) mmHg, respectively, p = 0.14). Conclusion: The majority of RESILIENT trial participants measured BP weekly as instructed. There was an overall downward trend in HBPM engagement over time. Once enrollment of the full RESILIENT sample is complete (target N=300 intervention participants), our next steps will be to investigate patient-level factors associated with differential HBPM engagement.
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