Efficiency of remote monitoring and guidance in blood pressure management: a randomized controlled trial

Regular monitoring of blood pressure (BP) is essential for managing hypertension. The long-term effectiveness of remote monitoring in BP control requires further validation. Although self-monitoring has some benefits, its overall effectiveness remains inconclusive. In this study, we aimed to compare whether remote monitoring and self-monitoring differ from usual care in terms of their effects on BP reduction in patients with hypertension. This multicentre randomised controlled trial enrolled participants diagnosed with primary hypertension in Qingdao, China, from December 2020 to December 2021. Patients were randomly assigned to one of the following three groups: remote monitoring, self-monitoring, or usual care. All groups underwent scheduled outpatient follow-up visits every 3 months throughout the 24-month study period. The primary outcome was the adjusted mean difference in systolic BP, which was used to evaluate the effectiveness of remote monitoring and self-monitoring compared to usual care. A total of 1006 participants were analysed: 332 in the usual care group, 337 in the self-monitoring group, and 337 in the remote group. After 24 months, BP was significantly reduced in all the groups, particularly in the remote group with suboptimal baseline BP, where systolic and diastolic BP decreased by 17.7 mm Hg and 10.2 mm Hg, respectively. Compared to the usual care group, the adjusted mean difference in systolic BP for the remote group was -2.7 (-4.45, -0.96), p = 0.002, while the self-monitoring group showed no significant difference. No significant differences in diastolic BP were observed between either group and the usual care group. Attainment rates of target BP increased rapidly in the first 3 months, and continued to rise only in the remote group, reaching 69.65%. The remote group had a higher proportion of calcium channel blockers, diuretics, and combination therapy than the usual care and self-monitoring groups. Remote monitoring and guidance enhanced the efficiency of BP management, whereas self-monitoring alone proved to be ineffective. ClincialTrials.gov Identifier: NCT04690478.