Human heart showing surrounding veins and arteries to represent cardiovascular disease as predicted by polygenic risk scores

A study of more than 10,000 patients treated in the Mass General Brigham network shows that a remote cholesterol and blood pressure management program was successful at significantly lowering blood pressure (BP) and low-density lipoprotein (LDL) cholesterol in participants.

The researchers believe the success of this program shows it could be rolled out more widely and has the potential to particularly help those for whom in-person visits are difficult.

High BP, or hypertension, and increased levels of LDL cholesterol are common in the population and are known risk factors for the onset of cardiovascular disease and potentially life-threatening events such as heart attacks and strokes.

Lifestyle improvements, treatment and regular follow-ups are important for individuals with these risk factors, but applying this across the large number of people affected can be a challenge.

“Approximately 30 percent to 50 percent of eligible patients in the U.S. do not achieve optimal guideline directed treatment goals. Recent data suggest that rates of BP and lipid control have stagnated and even deteriorated,” write Alexander Blood, a clinician and researcher in the Division of Cardiovascular Medicine at the Brigham, and colleagues in JAMA Cardiology.

“The rate of risk factor control is even lower among certain racial and ethnic populations, those who live in rural geographic areas, and those with limited English proficiency.”

To assess if a remote monitoring program was feasible and beneficial in at-risk individuals, Blood and colleagues recruited 10,803 participants (3658 patients with hypertension, 8103 patients with cholesterol, and 958 patients with both) to take part in a study where most received education, home BP device integration, and medication titration and 1266 received education only.

The study participants were 65 years on average when recruited. Overall, 1321 identified as Black, 1190 as Hispanic, 7758 as White, and 1727 as another or multiple races. Around 11% had a preferred language that was not English.

In the BP remote monitoring group, reductions of 9.7/5.2 mmHg were seen at 12 months versus 1.5/0.7 mmHg in the education only group. In the lipids group, LDL cholesterol went down by 37.5 mg/dL at 12 months in the remote monitoring group versus 10.2 mg/dl in the education only group.

Notably, reductions in BP and LDL cholesterol did not appear to differ significantly between different racial/ethnic or primary language groups.

“Coming into a brick-and-mortar office can present a high burden for patients who have chronic conditions or for people who live far away,” said corresponding author Benjamin Scirica, of the Division of Cardiovascular Medicine at Brigham and Women’s Hospital, in a press statement.

“We began this remote care delivery program before the pandemic began. And when the pandemic started, we saw a significant increase in our enrollment and a greater interest in the advantages of remote care. Patients want innovative solutions to more easily engage with the health system. Our program provides strong evidence that remote care can work and can make a difference in patients’ lives.”

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