Opportunity

One in three Americans is diagnosed with high blood pressure (hypertension). If not well controlled, hypertension increases the risk of developing heart disease, stroke, kidney disease, and other serious health conditions.

Although safe, effective, and inexpensive treatments are available, hypertension is uncontrolled in about half of patients diagnosed with the condition.

The traditional care model for hypertension relies on patients receiving treatment for high blood pressure at a doctor's office, completing multiple visits to adjust medications, conducting repeated blood pressure readings, and participating in counseling. This process can require frequent visits and missed time from work to achieve blood pressure goals. Because of this intensive process, patients may struggle to remain engaged in treatment and ultimately don't gain control.

In 2023, an estimated 174,000 current Penn Medicine patients had a hypertension diagnosis. 

Intervention

BP Pal is a remote blood pressure monitoring program intended to improve the rate of controlled hypertension among Penn Medicine primary care patients. The program is based on the Employee Hypertension Program, which started at Penn in 2015.

Enrolled patients receive blood pressure checks and reminders via text message at their preferred time each week, though they can send in blood pressure readings at any time. Readings are automatically processed, and out-of-range values are escalated to the centralized BP Pal care team, consisting of one nurse and a physician assistant, for further management. Additionally, BP Pal uses natural language understanding to classify and triage inbound texts so that the care team can quickly identify high-priority patient needs and medication requests.

To investigate the effectiveness of the program, we conducted a randomized controlled trial of BP Pal in 2023, enrolling 300 primary care patients with uncontrolled hypertension. Patients in the intervention arm received a blood pressure monitor and six months of text-based blood pressure monitoring through BP Pal. Patients in the control arm received usual care.

Impact

Trial patients enrolled in BP Pal experienced a 14.7-point decrease in systolic blood pressure, comparable to the 10.9-point decrease seen in the control group. Although this was not a statistically significant change from baseline readings, the parity in results supports the intervention as an opportunity to streamline and automate remote blood pressure monitoring to optimize care delivery. Notably, BP Pal participants were highly engaged, submitting 73 percent of the weekly readings on average, which indicates the program is feasible and acceptable to patients.