Ozan Unlu, MD, is a fellow in interventional cardiology at Brigham and Women’s Hospital and Harvard University.

Ozan Unlu, MD

Home Blood Pressure Monitoring Engagement Suboptimal Among Most Patients, With Ozan Unlu, MD

Patient engagement with home blood pressure monitoring (HBPM) is suboptimal despite widespread awareness of 

 risk, presenting a barrier to effective treatment and demanding innovative approaches to the HBPM process.

A recent cohort study, conducted within a remote hypertension management program at Mass General Brigham, collected and analyzed data on adults with uncontrolled hypertension between 2018 and 2022. The investigators sought to determine the degree of patient engagement with HBPM, given the 12-measurements-per-week guidelines for reliable assessment. Ultimately, they found a significant proportion of the study population exhibited no engagement whatsoever.

“The implications of this are important. It doesn’t mean that the guidelines really need to change, to recommend fewer blood pressure measurements, because the guideline recommendations are well grounded in research,” Ozan Unlu, MD, a fellow in interventional cardiology at Brigham and Women’s Hospital and lead investigator on the study, told 

 in an exclusive interview. “However, I think we need to come up with ways to understand why patients are not measuring their blood pressures and then mitigate this.”

During the program, patients received a free, validated HBPM device that automatically transmitted readings to the clinic. Additionally, education and support from health care navigators was provided. Patients were identified via Mass General Brigham’s electronic health record based on hypertensive office blood pressure, which was defined as the most recent office systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg on ≥2 occasions.

After enrollment, patients were entered into a 7-day baseline measurement period. Patients took blood pressure measurements at home twice each morning and evening before medications on ≥6 days per week; investigators were aiming for 24-28 weekly readings. A minimum of 12 readings over 3 days was required to ensure a reliable baseline measurement. Confirmed hypertension led to a series of 14-day medication titration cycles, each of which included a 7-day waiting period post-medication initiation or dose change. This model was continued until maintenance, defined as reaching target BP average (<130/80 mmHg) was achieved over 7 days.

This cohort analysis included a total of 3390 patients, with a median age of 61 (interquartile range [IQR], 52-69) years. A high proportion of patients had comorbidities, such as 

 (n = 996). At baseline, 1107 patients had no engagement with HBPM, 484 had low engagement, 618 had medium engagement, and 1181 had high engagement. This translates to 1591 patients with insufficient measurements. The median number of blood pressure measurements per patient per week was 16 (IQR, 0-26) for baseline assessment.

These findings indicate that, even with the support of automatic data transmission, frequent reminders, and clinical education via a large-scale program at an integrated academic medical center, engagement with HBPM was suboptimal. Almost half of the included patients recorded <12 measurements, which were required to continue into the program’s active titration phase. Only about 1 in 3 patients achieved the 24-28 measurements per week recommended by the program.

“In general, whenever we recommend some lifestyle changes to our patients, it requires a behavior change,” Unlu told 

. “And that’s not always easier to do. I think blood pressure measurements are just a few minutes in a day, but for patients, it requires some kind of behavior change to have that habit into their daily routine. That’s not always possible, if their daily routine doesn’t allow them to do that.”

Editor’s Note: Unlu reports no relevant disclosures.

Unlu O, Zelle D, Cannon CP, et al. Patient Engagement With Home Blood Pressure Monitoring. 

Blood AJ, Cannon CP, Gordon WJ, et al. Results of a Remotely Delivered Hypertension and Lipid Program in More Than 10 000 Patients Across a Diverse Health Care Network. JAMA Cardiol. 2023;8(1):12-21. 

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Despite being considered superior to in-clinic measurements, a substantial number of patients do not follow the HBPM guideline recommendations of 12 readings per week.

Ozan Unlu, MD

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