Remote BP, cholesterol management program can optimize guideline-directed therapy

November 16, 2022

2 minute read

Scirica reports receiving institutional research grants at Brigham and Women’s Hospital and Mass General Brigham from Aktiia, AstraZeneca, Better Therapeutics, Eisai, Merck, Novartis, Pfizer, and Recor; and receive consultant fees, personal fees or program support from AbbVie, Always Health Partners, Boehringer Ingelheim, GlaxoSmithKline, Hanmi, Lexicon, Manmi, Merck, Novo Nordisk and Sanofi; and owns shares in Health[at]Scale and Doxity. Please see the study for relevant financial information from all other authors.

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A remote management program for hypertension and hypercholesterolemia with more than 10,000 participants has been associated with significant decreases in BP and LDL at 6 and 12 months compared to education alone, the researchers reported.

“The current healthcare system is broken and for decades has failed to provide effective and chronic cardiovascular care,” Benjamin M. Scirica, MD, MPH, associate professor of medicine at Harvard Medical School and director of quality initiatives in the cardiovascular division at Brigham and Women’s Hospital, Healio told Healio. “We have developed a methodology to create and implement scalable care programs that improve access to care and optimize CV treatments. It’s a delivered remotely, pharmacist-led, blood pressure and cholesterol management program. The study showed that the program can provide high quality care with clinically meaningful outcomes that reduce CVD risk in a large and diverse patient population.

Graphical representation of the data presented in the article

A remote management program for hypertension and hypercholesterolemia was associated with significant decreases in BP and LDL at 6 and 12 months compared to education alone.
Source: Adobe Stock

Scirica and colleagues analyzed data from 10,803 adults aged 26 to 80 with high blood pressure and/or LDL who were enrolled in a comprehensive remote hypertension and/or cholesterol program between January 2018 and July 2021. The average age of participants was 65; 56% were women; 12% were black, 11% were Hispanic, and 11% reported a preferred language other than English. Of the participants, 3,658 were enrolled in the hypertension program and 8,103 were enrolled in the lipid program.

Enrolled patients received education, integration of a home blood pressure device, and medication titration; however, 1,266 participants who declined the program’s home BP monitoring and medication titration were enrolled in an education-only group and provided with diet, lifestyle, and medication counseling.

Benjamin M. Scirica

“Since the education-only cohort had no home blood pressure readings, only office blood pressure readings retrieved from the electronic health record closest to the appropriate times were used for this comparison. for both groups,” the researchers wrote.

Non-licensed navigators and pharmacists, supported by CV clinicians, coordinated care using standardized algorithms, task management software, and automation. Researchers monitored blood pressure and lab test results. The primary endpoint was the change in BP and LDL.

The researchers evaluated 424,482 PA readings and 139,263 lab reports.

In the hypertension program, mean office BP before enrollment was 150/83 mm Hg; mean home BP was 145/83 mm Hg.

For participants engaged in remote medication management, mean clinic BP at 6 months and 12 months after enrollment decreased by -8.7/-3.8 mm Hg and -9.7/- 5.2 mm Hg, respectively. In the school-only cohort, BP changed on average by –1.5/–0.7 mm Hg at 6 months and by +0.2/1.9 mm Hg at 12 months (P for the difference between cohorts,

In the lipid management program, remote medication management participants experienced a mean LDL reduction of -35.4 mg/dL and -37.5 mg/dL at 6 and 12 months, respectively, while that the education-only cohort experienced a mean LDL reduction of -9.3 mg/dL and –10.2 mg/dL at 6 and 12 months, respectively (P .001).

Findings persisted in analyzes stratified by race and primary language spoken.

“We need to continue testing different engagement and retention strategies to include more patients in these programs,” Scirica told Healio. “Furthermore, there are a variety of potential business models that need to be tested to determine the best ways to sustain these programs within the current healthcare system.”

For more information:

Benjamin M. Scirica, MD, MPH, can be contacted at [email protected]

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