Home Blood Pressure Monitoring in Routine Care—Factors Associated with Enrollment and Blood Pressures Recorded in the Veterans Health Administration

BACKGROUND: Out-of-office blood pressure (BP) monitoring is recommended for hypertension management. Home BP monitoring (HBPM), which involves patients measuring their BP and transmitting readings to their provider, remains underutilized. We sought to understand how HBPM is utilized in routine clinical care and factors associated with enrollment in a national HBPM program. METHODS: We conducted a retrospective study of Veterans with uncontrolled BP (systolic BP > 140mmHg) in the Veterans Health Administration (VHA) from 2013 to 2019. We identified patient-, provider-, and systems-level factors associated with enrollment in the HBPM program and with duration of monitoring and number of BPs transmitted. RESULTS: Among 1,759,851 Veterans meeting eligibility criteria, 63,361 (3.6%) were enrolled in HBPM. Black race, Hispanic ethnicity, and higher systolic BP at the eligible primary care visit were associated with higher likelihood of enrollment. Older age and living in an area with lower socioeconomic status were associated with lower likelihood of enrollment. Non-physician providers, providers with higher percent of patients with controlled BP, and providers at VA medical center main campuses were more likely to enroll patients in the HBPM program. The average number of BPs transmitted in the first 4 weeks of monitoring was 25.0; the median duration of HBPM was 192 days. Older age was associated with transmission of more BP measurements and longer duration of HBPM. CONCLUSION: HBPM is underutilized in eligible VHA patients. Older age was associated with lower likelihood of enrollment but greater number of transmitted BPs. Interventions to improve HBPM utilization could focus on provider and facility factors.