Remote healthcare programme improves hypertension and lipid control

A remote, algorithm-driven programme with over 10,000 enrolled participants was able to reduce hypertension and LDL cholesterol in patients with a high risk for cardiovascular events. The programme may reduce the need for in-person visitations and has the potential to provide equitable care across underserved populations.

Dr Alexander Blood (Brigham and Women’s Hospital, MA, USA) explained that undertreatment of hypertension and hypercholesterolaemia is a serious problem, with 30–50% of patients not receiving the optimal medical treatment [1]. A remote programme was developed to improve hypertension and lipid control, with an emphasis on equal healthcare distribution across subgroups. Patient navigators, pharmacists, and digital technology were integrated into the programme’s model using a remote care delivery platform. In total, 6,887 patients were included in the lipid programme and 3,367 patients entered the hypertension programme. Approximately 40% of participants in either group completed the programme. The main reasons for study discontinuation were withdrawal, referral to an MD, and not being able to reach the participant.

In all patients enrolled in the hypertension programme, systolic blood pressure (BP) was reduced at the last measurement of the study (mean 135 mmHg) compared with baseline (mean 145 mmHg; P<0.0001). This effect was more pronounced in patients who completed the programme (mean 125 mmHg vs 137 mmHg; P<0.0001). Similarly, diastolic BP was significantly decreased at the latest BP measurement of the study compared with baseline. Dr Blood added that “92% of the patients who completed the programme reached their guideline-recommended BP goals. Subgroup analysis demonstrated that the effect was consistent across ethnic groups, with equal proportions of subgroup populations achieving study completion. This result suggests that traditionally underserved subgroups benefit equally from the current programme.”

The lipid programme showed a reduction of LDL cholesterol at the latest performed measurement (mean 100 mg/dL) compared with baseline (mean 145 mg/dL; P<0.0001). Again, this effect was more pronounced in patients who completed the programme (mean 70 mg/dL vs 140 mg/dL; P<0.0001). Reductions in LDL cholesterol were also similar across subgroups. The effects of the lipid-lowering programme could be explained by the significantly higher prescription rates of high-intensity statins (baseline 40% vs exit 55%), ezetimibe (baseline 9% vs exit 20%), and PCSK9i (baseline 1% vs exit 5%). In addition, the proportion of participants who did not receive any lipid-lowering therapy decreased (baseline 19% vs exit 3%). According to Dr Blood, this programme should be replicable in healthcare systems across the world, reducing the barrier of individuals to interact with the healthcare system. However, the low percentage (40%) of study completers with the majority not completing the study impacts the generalisability of the findings and reaffirms the difficulty of maintaining patients in longitudinal remote care management.

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   1. Blood AJ, et al. Digital Care Transformation: Report from the First 10,000 Patients Enrolled in a Remote Algorithm-based Cardiovascular Risk Management Program to Improve Lipid and Hypertension Control. LBS02, AHA Scientific Sessions 2021, 13–15 November.

Want to read more? Medicom has a featured interview with Dr Alexander Blood (Brigham and Women’s Hospital, MA, USA) about the scope of remote healthcare in hypertension and hyperlipidaemia

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Posted on 14 January 202213 June 2024