Abstract 4368504: Concordance Between In-Office versus At-Home Systolic Blood Pressure Reductions in RPM-Engaged Patients with Uncontrolled Hypertension

Abstract

Background: Remote patient monitoring (RPM) devices aim to improve hypertension management by providing frequent readings outside clinic, but validation comparing home versus in-office blood pressure (BP) reductions is needed to ensure clinical utility. We compared systolic BP (SBP) changes measured in-office versus at home among RPM-engaged patients with uncontrolled hypertension to validate device accuracy and assess durability of BP improvements via a retrospective, propensity-score matched cohort ensuring comparable baseline SBP and monitoring duration. Hypothesis: We hypothesize that mean SBP reductions will be nonsignificant between settings in the uncontrolled cohort. Methods: Medicare beneficiaries with uncontrolled hypertension enrolled in RPM from January to October 2024 were matched by baseline SBP and total monitoring duration: in-office readings (n=3,399) versus at-home readings (n=3,399). The primary cohort included patients with baseline SBP ≥130 mm Hg (in-office n=2,313; at-home n=2,271). In-office SBP change was defined as the difference between the last pre-RPM clinic measurement and the first in-office reading ≥90 days after RPM initiation. Home SBP change was defined as the difference between the mean of the first seven and last seven home readings during the RPM period. Independent t-tests compared mean changes, and chi-square tests compared proportions achieving a ≥10 mm Hg reduction. Results: In the uncontrolled cohort, mean in-office SBP decreased from 143.2 ± 14.7 mm Hg to 133.0 ± 17.6 mm Hg (−10.2 ± 20.4 mm Hg; n=2,313), while home SBP decreased from 143.5 ± 14.4 mm Hg to 133.6 ± 16.3 mm Hg (−9.8 ± 15.9 mm Hg; n=2,271). The between-group difference in mean SBP change was 0.4 mm Hg (95% CI: −0.6 to 1.4; p = 0.44). A ≥10 mm Hg reduction occurred in 49.3% of in-office patients versus 47.3% of home-measured patients (p = 0.19). The between-group difference was 4.1 mm Hg, favoring in-office measurements (p < 0.0001), with 70.5% of in-office versus 61.6% of home-measured patients achieving ≥10 mm Hg reduction (p < 0.0001). Conclusions: RPM-based SBP improvements at home demonstrate concordance with in-office readings among patients with uncontrolled hypertension, validating device accuracy and demonstrating durable BP improvements. These findings support clinical integration and payer reimbursement for RPM in hypertension management.