Matchmaking and the Future of Hypertension Management

ypertension is a leading cause of morbidity worldwide.It affects ≈100 million US adults, most of whom have uncontrolled hypertension.1 This propels our high incidence of heart failure, stroke, renal failure, and dementia.Persistently uncontrolled hypertension, even when recognized and diagnosed, is thought to have 2 primary causes: lack of treatment intensification by providers, labeled therapeutic inertia, and poor self-management by patients (including nonadherence to antihypertensive medications and other health behaviors).Most blood pressure (BP) monitoring takes place at the medical center or office.For providers, these office-based BP readings often are not actionable given concerns related to uncertainty about their patient's true BP. 2 For patients, office-based BP readings do not provide timely feedback to assist motivation for sustained engagement in medication-taking, dietary restrictions, and daily exercise.In contrast, home BP monitoring (HBPM) can be invaluable to providers while providing key feedback for patients.3 However, it is not routinely prescribed by providers and is conducted in a haphazard fashion by patients.Here, we reflect upon developments in HBPM and their potential utility to redress poor hypertension control and, hopefully, the associated morbidity and mortality. TRADITIONAL TELEMONITORING OF PATIENTS WITH HYPERTENSIONSince the 1990s, BP has been among the key physiological variables transmitted through telemonitoring platforms to providers (eg, home telehealth).The service requires placement of a communication device in the patient's home that receives readings from one or several monitors, such as an automated BP device, and routes this information to a home health nurse case-manager.The overall design and function of this provider-centric program has not significantly evolved despite incorporating newer communication technologies.It still generally requires technical staff to install the equipment, establish connectivity, and field technical questions.Home health nurses review BP data, monitoring for adherence and extreme values, then communicate directly with patients.At set intervals, the patient's BP reports can be sent to their physician, advanced practice provider, or nurse, at whose discretion action can be taken (Figure ; left).Despite seeing an individual reading on the cuff at the time of measurement, the patient is not informed of averages or trends, nor encouraged to take meaning from the data to guide or reinforce health behaviors.Patients lacking an understanding of their disease, its consequences, and its treatments, may not attend provider visits, fill and take prescriptions daily, engage in self-monitoring, or practice behavioral interventions to lower BP.Providers also may be unaware of the larger trends of a patient's BP, given the opt-in nature of the reports for many traditional home BP programs.Thus,