Cardiovascular Health Markers With Remote Team-Based Hypertension Management in a Safety-Net Population.

Abstract

The impact of remote patient monitoring for hypertension on cardiovascular health remains ill defined. This study characterized the association between a remote patient monitoring, team-based hypertension intervention and cardiovascular health markers. This retrospective, single-arm cohort study included patients with uncontrolled hypertension enrolled from February 2022 to July 2024 in the ALTA trial (clinicaltrials.gov NCT03713515) at 5 safety-net practices. The ALTA intervention involves remote patient monitoring supported by a virtual clinic managed by a nurse practitioner, a registered nurse, and a community health worker. Demographics, ALTA utilization, and cardiovascular health markers (blood pressure, lipids, glycemic indicators, BMI, and smoking history) at baseline and 12 months were collected. The 5 cardiovascular health markers were scored (0=poor, 1=intermediate, 2=ideal) and summed into a cardiovascular health score. The primary endpoint was a change in the 12-month cardiovascular health score among patients with a baseline score of ≤7. Secondary endpoints included changes in individual non-blood pressure markers among patients with baseline derangements. Among the 568 included patients (mean age: 56 years), most were female, non-Hispanic Black, and English-speaking individuals. Nurse practitioner visits were more common among females (p=0.04), with no other demographics predicting ALTA utilization. The cardiovascular health score improved from 4.5 to 5.2 (n=196, p<0.001), independent of ALTA utilization. Total cholesterol (n=86, p<0.001), low-density lipoprotein (n=128, p<0.001), and triglyceride levels (n=51, p=0.004) also improved. Hemoglobin A_1c (n=195) dropped among patients with ≥1 nurse practitioner visit (p=0.02). Fasting glucose (n=135) and BMI (n=289) decreased in the highest tertile of nurse practitioner visits (p=0.03) and remote patient monitoring (p=0.02), respectively. Finally, 4 of 27 patients quit smoking. Remote patient monitoring with team-based support was associated with cardiovascular health improvements. However, benefits may depend on the intervention's utilization.