JMIR Publications

ABSTRACT

Background:

Hypertension affects one in five Canadians and is the leading cause of morbidity and mortality globally. The control of hypertension is declining for the first time in 10 years 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 presenting to the ED, to prepare for conducting a randomized controlled trial.

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. A monitoring clinician received this data and monitored the patient’s condition. 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 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:

Results from our pilot feasibility study suggest that HBPT intervention is feasible post-discharge management strategy and can be beneficial in supporting patients with asymptomatic elevated BP from the ED. A randomized trial is needed to evaluate the efficacy of this intervention on BP control.