Key result
Home blood pressure monitoring is linked to ~8% lower all-cause mortality without reducing major cardiovascular events.
Why the study?
Home blood pressure monitoring has been shown to lower BP in randomized trials, but its real-world effect on clinical outcomes including cardiovascular events and mortality was not known.
Does home blood pressure monitoring reduce all-cause mortality and major adverse cardiovascular events in Veterans with uncontrolled hypertension?
Cohort (n=60,299)
Yes
Does home blood pressure monitoring reduce all-cause mortality and major adverse cardiovascular events in Veterans with uncontrolled hypertension?
In a large national cohort of Veterans with uncontrolled hypertension, real-world home blood pressure monitoring was associated with an 8.3% reduction in all-cause mortality over 6.4 years of follow-up.
Answers are grounded in this paper and cite their sources.
Home BP monitoring was associated with lower mortality in Veterans; leaves open causal benefit and requires randomized confirmation.
Importance: Home blood pressure monitoring (HBPM) has been shown to lower blood pressure (BP) in randomized trials, however its real-world effect on clinical outcomes is not known. Objective: To determine the association between HBPM and clinical outcomes including cardiovascular events and mortality. Design: Target trial emulation employing matched cohorts with index-date follow-up. Setting: Veterans Health Administration (VHA) telehealth program. Participants: Eligible Veterans had uncontrolled BP (defined as a systolic BP >140 mmHg) at a primary care visit within VHA, with a systolic BP >140 mmHg at the prior primary care visit or average systolic BP >140 mmHg over the year prior. The HBPM (intervention) group included eligible Veterans who were enrolled in a HBPM program for hypertension between January 1, 2013 and December 31, 2019. Individuals in the control group (usual care) were selected from eligible Veterans who were not enrolled in HBPM. Controls were matched with those in the intervention, in part, on demographics, baseline blood pressure and antihypertensive medication use, baseline frailty, mortality risk, and selected comorbidities. Exposure: HBPM in the VHA telehealth program Main Outcomes: All-cause mortality and major adverse cardiovascular events (MACE), defined as the first occurrence during follow-up of acute myocardial infarction, stroke, acute heart failure, or unstable angina. Results: Among 30,203 Veterans enrolled in HBPM and 30,096 non-enrolled controls, with a median duration of 202 days of HBPM and 6.4 years of follow-up, HBPM was associated with 8.3% lower risk of mortality (hazard ratio 0.92; 95% confidence interval 0.89, 0.95) and a 4.1% higher risk of MACE (HR 1.04; 95% CI 1.01, 1.08). In analyses calibrated for negative control outcomes, there was no longer a statistically significant association between HBPM and MACE. Conclusions and Relevance: HBPM as utilized in routine clinical care among a large national cohort of adults with uncontrolled hypertension was associated with reduced risk of mortality. The association between HBPM with increased risk of MACE may have been due to ascertainment differences between those enrolled and not enrolled in HBPM.
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Birkelo et al. (2026) conducted a cohort in Uncontrolled hypertension (n=60,299). Home blood pressure monitoring (HBPM) in the VHA telehealth program vs. Usual care (eligible Veterans not enrolled in HBPM, matched on demographics, baseline BP, antihypertensive medication use, baseline frailty, mortality risk, and selected comorbidities) was evaluated on All-cause mortality and major adverse cardiovascular events (MACE: first occurrence of acute myocardial infarction, stroke, acute heart failure, or unstable angina) (HR 0.92, 95% CI 0.89-0.95). Home blood pressure monitoring was associated with lower all-cause mortality and higher major cardiovascular events, though major cardiovascular events was non-significant after calibration.
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