Despite guideline recommendations and improved access to care, individuals with hypertension are unlikely to measure their blood pressure at home as often as recommended. This is according to a study conducted by researchers at Mass General Brigham, published in JAMA Cardiology. The study highlights that even with free blood pressure devices, education, and personalized support, patient engagement with at-home blood pressure monitoring remains low, underscoring the need for more convenient, less burdensome monitoring tools.
Previous research suggests that at-home blood pressure measurements are often more accurate than clinic readings. Current American Heart Association guidelines recommend that patients with hypertension take two readings, one minute apart, twice daily for up to seven days to obtain an accurate average before a clinical visit.
The Study’s Findings and Implications
In a retrospective cohort study of 3,390 patients enrolled in a remote hypertension management program between September 2018 and June 2022, investigators aimed to evaluate whether at-home blood pressure (BP) monitoring could effectively decrease BP. All participants received education and free at-home blood pressure monitors and were asked to complete 28 weekly readings, which were automatically transmitted to patient navigators.
Notably, the primary analysis showed that participants who actively measured their home BP and reached maintenance achieved decreases in blood pressure associated with a 40 percent relative risk reduction in major cardiovascular events and all-cause mortality. However, the study’s secondary analysis focused on patient engagement with at-home monitoring revealed varying levels of engagement.
“A single blood pressure reading in the doctor’s office can be misleading,” said senior author Naomi Fisher, MD, an endocrinologist at Mass General Brigham. “Stress, recent physical activity, or anxiety during a visit can artificially elevate readings. By collecting multiple measurements per day at home over several days, we gain a far more accurate picture of a patient’s true blood pressure and can tailor treatment more effectively.”
Engagement Levels and Challenges
The study categorized engagement levels as no engagement (completed 0 measurements), low engagement (completed 1-11 measurements), intermediate engagement (completed 12-23 measurements), and high engagement (completed 24-28 measurements). The results showed that 32.7% of patients exhibited no engagement, 14.3% showed low engagement, while 18.2% and 34.8% demonstrated intermediate and high engagement, respectively.
These findings highlight a need for more innovative, easy-to-use wearable devices, similar to continuous glucose monitoring devices used for diabetes management. Such devices could passively collect blood pressure readings, reducing the burden on patients.
Future Directions and Technological Innovations
Investigators aim to focus future research on understanding the specific barriers patients face with at-home blood pressure monitoring that contribute to low engagement. With several new devices in development or awaiting approval from the U.S. Food and Drug Administration, researchers are also assessing how hypertension treatment outcomes differ between patients using traditional monitors and those using new wearable continuous monitoring systems.
“Current guidelines require frequent, carefully timed blood pressure measurements for accuracy, but the reality of patients’ lives often makes this unrealistic,” said lead author Ozan Unlu, MD, a fellow in Interventional Cardiology at Mass General Brigham Heart and Vascular Institute. “This gap highlights the need for low-burden technologies that capture reliable blood pressure data without asking patients to rearrange their lives to manage their condition.”
In addition to Fisher and Unlu, the study’s authors include David Zelle, Christopher P. Cannon, Simin Lee, Marian McPartlin, Samantha Subramaniam, Michela Tucci, Michael Oates, Christian Figueroa, Hunter Nichols, Tabitha V. Rutkowski, Alexander J. Blood, and Benjamin M. Scirica.
Funding and Disclosures
The work was sponsored by the Mass General Brigham Health System, AllWays Health Partners, and the US National Institutes of Health. Disclosures include grants from Aktiia Healthcare and Recor Medical, and personal fees from Alnylam, AstraZeneca, Boston Scientific, and Recor Medical outside the submitted work. Additional author disclosures can be found in the published paper.
The study, titled “Patient Engagement With Home Blood Pressure Monitoring,” is available in JAMA Cardiology with DOI: 10.1001/jamacardio.2025.5196.
