Remote Blood Pressure Monitoring for High Blood Pressure

(REACH Trial)

Overseen By Courtney Lyles, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of California, San Francisco

Disqualifiers: Under 18, Controlled hypertension

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 7

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to help people with high blood pressure manage their condition better from home. Participants will use home blood pressure monitors and digital communication tools to determine if these technologies improve blood pressure control over a year. The trial includes two groups: one will receive support from a pharmacist to adjust medications, while the other will use remote monitoring tools with minimal support. This study may suit those in the San Francisco Health Network who have been diagnosed with high blood pressure that is not well controlled, can speak English or Spanish, and have seen a primary care provider in the last two years. As an unphased trial, this study offers a unique opportunity to explore innovative ways to manage high blood pressure from home.

Do I have to stop taking my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that remote blood pressure monitoring is safe for hypertension management?

Research shows that monitoring blood pressure from home is generally safe. Several studies have found this method effectively manages high blood pressure. For example, one study found that patients using remote monitoring experienced a significant drop in blood pressure over time. Another study noted that this method can detect changes in blood pressure that might predict heart problems.

Most people handle remote blood pressure monitoring well, with no major reports of harmful effects. The process uses technology to track blood pressure from home, which is less invasive than other treatments. This makes it a safe option for many people managing high blood pressure.

Overall, for those considering a trial involving remote blood pressure monitoring, current evidence suggests it is a safe and well-tolerated way to manage high blood pressure. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores innovative ways to manage high blood pressure through remote and home-based monitoring. Unlike traditional treatments that rely heavily on frequent in-person visits, this approach uses technology to keep track of blood pressure from home. One standout feature is the involvement of pharmacists who can adjust medications based on home readings, potentially making treatment more personalized and timely. Additionally, another arm of the trial offers minimal support but provides a comprehensive summary of home readings to primary care providers, aiming to streamline and enhance the communication of patient data. This trial could lead to more efficient, patient-centered care in managing hypertension.

What evidence suggests that remote blood pressure monitoring is effective for high blood pressure?

Research has shown that checking blood pressure at home, combined with remote support, effectively manages high blood pressure. In this trial, one arm involves cellular home blood pressure monitoring with pharmacist support for treatment intensification, which studies have shown improves blood pressure control more than regular care. Another arm involves cellular home blood pressure monitoring with minimal support, where patients log their blood pressures and receive summaries sent to their primary care provider. This approach can also detect changes in blood pressure that might signal heart problems. Overall, home monitors and remote support help people manage their blood pressure more effectively. ^{1 2 4 5 6}

Who Is on the Research Team?

Courtney Lyles, PhD

Principal Investigator

University of California, San Francisco

Are You a Good Fit for This Trial?

This trial is for adults over 18 within the San Francisco Health Network who have uncontrolled high blood pressure and are listed in the hypertension registry. Participants must be able to speak English or Spanish, have seen their primary care provider in the last two years, and either completed Aim 1 training or be willing to do so.

Inclusion Criteria

Patient within the San Francisco Health Network (SFHN)

Complete Aim 1 training, in addition to patients who have not completed Aim 1 training

I am over 18 years old.

Exclusion Criteria

I am under 18 years old.

My high blood pressure is under control.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Technology Training

Participants receive training on using home blood pressure monitors, online portals, and digital messaging applications

2-4 weeks

1-2 visits (in-person)

Intervention

Participants use home blood pressure monitors and engage in digital communication with healthcare providers to manage hypertension

12 months

Regular virtual check-ins and data monitoring

Follow-up

Participants are monitored for safety and effectiveness after treatment

6 months

Follow-up survey at 6 months

What Are the Treatments Tested in This Trial?

Interventions

• Home Blood Pressure Monitoring
• Remote Monitoring

Trial Overview The study tests if using home blood pressure monitors along with digital tools like texting, mobile apps, and online medical records can help patients manage their high blood pressure better over a period of one year.

How Is the Trial Designed?

Group I: Cellular Home blood pressure (BP) monitoring with minimal support Experimental Treatment 1 Intervention

Patients will be instructed to write down their blood pressures (BP) in a BP log that will be provided to them at the time of enrollment. Study staff will access the patient's home BP measurements on the BP device dashboard and send a summary of the home BP measurements (mean, median, % of BP measurements at goal) to the primary care provider in a telephone encounter (TE) 3 to 5 days prior to the next scheduled visit.

Group II: Cellular Home blood pressure (BP) monitoring with pharmacist support for treatment intensification Active Control 1 Intervention

For patients randomized to this intervention arm, a pharmacist will review the home blood pressure (BP) measurements and use an evidence-based algorithm to make recommendations for medication intensification. If the patient has a primary care provider (PCP) appointment within 2 weeks, the pharmacist will send a telephone encounter (TE) with BP measurements and medication recommendations to the PCP 3 -5 days prior to the scheduled appointment. If the patients has no appointment scheduled within two weeks, the pharmacist will call the patient and prescribe medication intensification if the patient is amenable.

Group III: Non-randomized usual care Active Control 1 Intervention

To compare the two intervention arms with usual care, investigators will extract electronic health record (EHR) data on active San Francisco Health Network (SFHN) adult patients (age 18+) with diagnosis of hypertension who made at least one primary care visit during the study period.

Who Is Running the Clinical Trial?

University of California, San Francisco

Lead Sponsor

Trials

2,636

Recruited

19,080,000+

National Heart, Lung, and Blood Institute (NHLBI)

Collaborator

Trials

3,987

Recruited

47,860,000+

Published Research Related to This Trial

In a study of 374 hypertensive patients, remote patient monitoring, with or without physician care, was found to be as effective as traditional office care in reducing blood pressure over 24 weeks.

Patients over 55 years old showed significant improvements in blood pressure with remote monitoring, indicating that this approach can be beneficial for older adults managing hypertension.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized clinical trial to assess the effectiveness of remote patient monitoring and physician care in reducing office blood pressure. Kim, YN., Shin, DG., Park, S., et al.[2018]

In a pilot trial involving 132 participants with hypertension, a remote blood pressure monitoring system led to a significant reduction in mean blood pressure from 137/85 to 132/78 mmHg over an average follow-up of 487 days.

The percentage of subjects achieving controlled blood pressure (<140/90 mmHg) increased from 47% to 66%, indicating the potential effectiveness of this monitoring system in managing hypertension.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A pilot test of a new tool for remote blood pressure monitoring. Boman, K., Brenander, A., Gustavsson, M., et al.[2019]

Remote monitoring of blood pressure using telemedicine technology can significantly improve the management of arterial hypertension, leading to better control of blood pressure levels in patients.

Implementing remote monitoring in Russia has shown promising results in achieving target blood pressure levels, which could ultimately reduce emergency care visits and lower the risk of serious cardiovascular events like strokes and heart attacks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Realities and prospects of remote blood pressure monitoring in hypertensive patients. Boytsov, SA.[2019]

Remote blood pressure monitoring (RBPM) significantly reduces both systolic and diastolic blood pressure in urban patients with hypertension, with a decrease of approximately 4.5 mmHg in systolic and 2.1 mmHg in diastolic pressure compared to usual care.

Patients using RBPM also had a higher rate of blood pressure control, with a relative risk increase of 22.6%, indicating that RBPM is an effective strategy for managing hypertension in urban settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Updated Meta-Analysis of Remote Blood Pressure Monitoring in Urban-Dwelling Patients with Hypertension. Park, SH., Shin, JH., Park, J., et al.[2021]

Remote ambulatory blood pressure monitoring (ABPM) can be safely and effectively conducted without face-to-face contact, as demonstrated by a study involving 65 participants, where 88% successfully completed the monitoring.

The study found no significant difference in measurement success rates between remote (88%) and face-to-face (89%) ABPM, indicating that remote methods can provide comparable results in hypertension management during the COVID-19 pandemic.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ambulatory blood pressure monitoring using telemedicine: proof-of-concept cohort and failure modes and effects analyses. Armitage, LC., Lawson, BK., Roman, C., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11353537/

Remote Patient Monitoring Is Associated with Improved ... RPM is associated with improved HTN control and provides further evidence supporting telehealth programs which can aid in chronic disease management.

2. nature.com nature.com/articles/s41371-023-00850-w

Blood pressure outcomes at 12 months in primary care ... Effectiveness of home blood pressure monitoring, web communication, and pharmacist care on hypertension control: a randomized controlled trial.

3. bmcmedicine.biomedcentral.com bmcmedicine.biomedcentral.com/articles/10.1186/s12916-025-04278-6

Efficiency of remote monitoring and guidance in blood ... In this study, we aimed to compare whether remote monitoring and self-monitoring differ from usual care in terms of their effects on BP ...

4. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2819402

Remote Blood Pressure Monitoring With Social Support for ... This 3-arm randomized clinical trial compared the effectiveness of 3 different approaches to improving BP control outside of office visits.

5. academic.oup.com academic.oup.com/ajh/advance-article/doi/10.1093/ajh/hpaf097/8154826

Remote Blood Pressure Monitoring: A Comprehensive Review This technology at home allows for the detection of instantaneous fluctuations in BP that could be predictive of cardiovascular disease events.

6. healthsnap.io healthsnap.io/remote-patient-monitoring-patient-outcomes-data-in-2023/

Remote Patient Monitoring: Patient Outcomes Data in 2023 HealthSnap's Remote Patient Monitoring program continues to deliver impactful results, reaffirming its pivotal role in chronic disease management.