Improving Blood Pressure in High-Risk Patients With CKD Using an Interdisciplinary Remote Hypertension Program

Abstract

Introduction

Interventions are needed to reduce racial and ethnic disparities in achieving blood pressure (BP) control among patients with chronic kidney disease (CKD). We determined the feasibility and effectiveness of an interdisciplinary remote patient monitoring (RPM) hypertension program in predominantly Black and Hispanic patients with CKD.

Methods

We evaluated an RPM hypertension program for patients with CKD in a New York City health system between July 2021 and October 2022. BP data were transmitted in real-time using a cellular-enabled BP device. Education on lifestyle and adherence was provided, and medications were adjusted by a nurse practitioner (NP) via telemedicine. Feasibility was quantitatively assessed as enrollment, participation, and retention at 3 months. Effect on BP was estimated as mean change in BP at 3 months and proportion with BP < 130/80 mmHg at 6 months.

Results

Among 111 patients invited, 102 (91.9%) enrolled and 87 (78.4%) were retained in the program for 3 months. Median age was 61 years, 50% were female, 55.9% were Black, 35.3% were Hispanic, and median estimated glomerular filtration rate was 47.5 ml/min per 1.73 m². The median days per month that BP was measured ranged from 16 to 23. Mean change in systolic and diastolic BP from enrollment to 3 months was −15.0 ± 20.8 (P < 0.0001) and −6.7 ± 17.7 (P = 0.0007), respectively. By 6 months, 49.4% achieved BP < 130/80 mm Hg.

Conclusion

This RPM hypertension program in patients with CKD was feasible and effective in improving BP, which is promising for increasing equity in hypertension control. Future studies evaluating long-term maintenance of BP control using this approach compared with usual care are needed.