Objectives Since 2019, the Centers for Medicare and Medicaid Services covers remote physiologic monitoring (RPM) for blood pressure (BP) per hypertension diagnosis and treatment guidelines. Here, we integrated Omron VitalSight RPM into the health system’s electronic health record to transmit BP and pulse without manual entry, assessed feasibility, and used pragmatic prospective matched cohort studies to assess initial effects in (1) uncontrolled (last two office BP ≥140/90 mmHg) and (2) general (diagnosed hypertension or last office BP ≥140/90 mmHg) hypertension patient populations. Materials and Methods Seventeen clinicians at two internal medicine practices were oriented. Eligible patients were aged 65–85 years had Medicare insurance with ≥1 office visit in the previous year. We prospectively identified matched controls (age, sex, BP, and number of office visits in previous year) from other primary care practices within the health system and estimated the association between RPM availability (clinic-level) and patient BP outcomes after 6 months. ClinicalTrials.gov: NCT04604925. Results Feasibility. Uptake was low at pilot clinics: 10 physicians prescribed RPM to 118 patients during the 6-month pilot. This included 7% (14/207) of the prespecified uncontrolled hypertension cohort and 3.3% (78/2356) of the general hypertension cohort. Surveyed clinicians (n = 4) reported changing their patients’ medical treatment in response to RPM BPs, although they recommended having a dedicated RN or LPN to review BP readings. Effectiveness. At 6 months, BP control was greater at pilot practices than among matched controls (uncontrolled: 31.4% vs 22.8%; P = .007; general: 64.0% vs 59.7%; P < .001). Systolic BP at last office visit did not differ (mean [SD] 146.0 [15.7] vs 147.1 [15.6]; P = .48) in the uncontrolled population, and was lower in the general population (131.8 [15.7] vs 132.8 [15.9]; P = .04).The frequency of antihypertensive medication changes was similar in both groups (uncontrolled P = .986; general P = .218). Discussion and Conclusions Uptake notwithstanding, RPM may have improved BP control. A potential mechanism is increased physician awareness of and attention to uncontrolled hypertension. Barriers to RPM use among physicians require further study.

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.

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Design and method: In this cross-sectional study, we analyzed 1,737 predialysis CKD patients enrolled in the prospective Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD). Apparent treatment-resistant hypertension was defined as systolic blood pressure > = 140 mm Hg or diastolic blood pressure > = 90 mm Hg with concurrent use of three antihypertensive medication classes or use of four or more antihypertensive medication classes regardless of blood pressure level. Serum klotho levels were measured using an enzymelinked immunosorbent assay. Participants were divided into quartiles.Results: Among study subjects, 303 patients (17.4%) had ATRH. Prevalence of ATRH were 21.9%, 18.9%, 18.2% and 10.8% for the 1st to 4th quartiles of soluble klotho, respectively (p for trend < 0.001). The adjusted OR [95% CI] of 1st to 3th quartile of soluble klotho in reference to 4th quartile were 2.01 (1.32-3.06), 1.59 (1.04-2.42) and 1.69 (1.11-2.57).Conclusions: Soluble klotho level was inversely associated with the presence of ATRH in Korean predialysis CKD patients. This relationship was independent of various cardiovascular risk factors.

Introduction: Remote patient monitoring (RPM) for blood pressure (BP) in primary care may support hypertension control. Hypothesis: Among Medicare patients enrolled from six pilot primary care clinics, those prescribed RPM would have better BP control (BP <140/90 mm Hg), and lower office SBP at 3, 6 and 9 months compared with matched controls. Methods: This was a pragmatic observational study. Patients were included if they belonged to any of six primary care practices that were in pilot studies of the Omron VitalSight TM RPM system which enabled transmission of BP and pulse from a BP monitor into the electronic health record without manual entry. We used 1:4 propensity score matching to identify contemporary matches for 288 RPM-prescribed patients from the same clinics, based on age, sex, systolic BP (SBP), marital status, and several other clinical and healthcare use characteristics. Outcomes included controlling high blood pressure (most recent primary care office or RPM BP <140/90 mm Hg), most recent primary care office SBP, and most recent primary care or RPM SBP, and were assessed after 3, 6, and 9 months. Results: Baseline characteristics of the 288 RPM patients and 1152 controls were similar. The mean ages (SD) were 73.6 (7.4) and 73.8 (7.9) years, respectively. Corresponding mean (SD) SBPs were 142.7 (19.5) and 141.2 (18.7) mm Hg. Controlling high blood pressure was greater in the RPM-prescribed cohort than in matched controls at 3, 6 and 9 months (Table). Mean of last office SBPs did not differ. Means of most recent SBP that included remote values were lower for the RPM-prescribed cohort at 3, 6 and 9 months. Conclusions: BP control and mean of last office or remote SBP diverged quickly and were partially sustained at 9 months. As mean office SBPs did not differ, additional evaluation is needed to assess the degree to which observed differences were due to greater declines in BP overall among RPM patients vs. differences between measured home and office blood pressures.