Integrating Scalability and Equity into Hypertension Remote Patient Monitoring Program Design

Remote patient monitoring (RPM) for hypertension combines home blood pressure (BP) monitoring with electronic transmission of BP readings and clinical support. RPM has the potential to improve BP control and reduce hypertension disparities, but because it depends on devices, connectivity, digital literacy, and sustained engagement, it may also worsen inequities if not intentionally designed. This review examines barriers to equitable RPM implementation and strategies to address them. RPM can improve hypertension control and extend care beyond traditional clinical settings, but its effect on health equity depends on program design. Equity should be treated as a core design principle. Future research should evaluate differential reach, engagement, effectiveness, and sustainability across populations and identify payment models that support equitable implementation at scale. Barriers to equitable RPM implementation occur at patient, clinician, health system, and policy levels. Key challenges include limited access to technology, language barriers, out-of-pocket costs, inadequate cuff sizing, unmet social needs, clinician workload, referral bias, infrastructure limitations, reimbursement variability, and the digital divide. Emerging evidence suggests that equity-focused strategies can improve reach and engagement, including provision of cellular-enabled devices, reduced patient costs, culturally and linguistically tailored support, team-based care, registry-based outreach, and routine monitoring of enrollment and outcomes across demographic groups. High-resource, low-resource, and hybrid RPM models each offer distinct advantages and tradeoffs in balancing scalability, sustainability, and equity.