Hypertension is known as the “silent killer” because there are typically no symptoms. Elevated blood pressure during an office visit is often dismissed as an incidental finding, or the patient is told, “we’ll recheck your BP again next time.” It can also be easily mis-diagnosed in the clinic setting due to technique errors or “white coat” readings that are artificially elevated. Until a major event like a heart attack occurs, it’s difficult to get patients to adhere to care plans and make necessary lifestyle changes to improve the condition.

According to the CDC website, nearly half a million deaths in the United States included hypertension as a primary or contributing cause in 2018 and high blood pressure costs the United States about $131 billion each year. It’s hard to deny that hypertension is a public health crisis in the U.S.

It doesn’t just impact patients. Hypertension is a quality improvement measure in an array of value-based payment models including MIPS, HEDIS, Star, and Accountable Care Organizations. So almost all healthcare providers face a financial impact related to unmanaged hypertension.

Even with these high stakes, only 1 in 4 patients with hypertension are at goal. That is clear evidence that the status quo for treatment isn’t working. We must shift our strategy and begin to tackle this problem head on with at-home monitoring and ongoing support. This care beyond the clinic will help you accomplish several things that can’t be done in one office visit every three to six months.

The Importance of In-Home Monitoring

Confirm the diagnosis with out-of-office BP measurements. A one-time measurement during an office visit is not sufficient for a diagnosis like hypertension. Prompting patients to use an at-home device to measure their blood pressure regularly will help you differentiate between true hypertension and “white coat” elevation. At-home measurements – whether they are manually entered or collected via a bluetooth or cellular enabled device – are also a good reminder for the patient to see how they are doing and stay motivated to change.

Monitor and titrate BP-lowering medications. Medication adherence is one of the most effective tools for managing hypertension and yet only 51% of patients follow their doctor’s recommendation for treatment. Monitoring potential barriers to adherence between visits gives you the opportunity to adjust doses, switch therapies, offer education to foster compliance and help patients adhere to their treatment plan and see better outcomes.

Deliver coaching and encouragement to support lifestyle changes. It’s not easy to start an exercise routine or make significant changes to one’s diet, but those are excellent tools to address high blood pressure. Providing gentle nudges on a regular basis can help patients change their habits at their own pace. Reminding patients of what’s at stake and making resources available in multiple formats (online resources, in person groups, one on one consultations) are effective ways to maintain engagement and sustained change.

A technology solution can help you automate and monitor all of these patient interactions. The communication can all be done asynchronously, which is more convenient and efficient for everyone. If a patient does report something that requires immediate intervention, a digital platform can alert your team to take action. In a Twistle pilot program using the “Controlling Blood Pressure” care pathway, early data is extremely promising. After just one 28-day cycle with Twistle’s Controlling Blood Pressure Pathway, 80% of hypertensive patients achieved a mean SBP/DBP < 140/90 and 50% reached a BP of < 130/80.

If we’re going to meaningfully move the needle on unmanaged hypertension, there isn’t a one size fits all approach. That’s why a flexible technology solution is so critical. If you can meet patients where they are, and provide tools and resources that are meaningful and accessible for them, it’s possible to improve the health of a large patient population and give them a much better chance of avoiding long term health issues.

Factsheet: Hypertension Management

Home BP monitoring is an inexpensive, widely available, yet underutilized
tool to assist with the diagnosis of hypertension, evaluation of suspected white-coat hypertension, and long-term BP management. Learn more:

Twistle offers flexible, configurable care pathways to help patients meet their goals, eliminate manual busy work for your care team, and help patients experience the best outcomes possible. If you need help optimizing and personalizing patient care pathways, contact Twistle at info@twistle.com.

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