Blood pressure outcomes following the telemonitoring program HartWacht for hypertension management: insights from real-world clinical practice

Hypertension remains one of the most important risk factors for cardiovascular disease, such as coronary heart disease and stroke. Despite the availability of effective medications and lifestyle modifications, many patients fail to achieve adequate blood pressure (BP) control. Telemonitoring provides a scalable, cost-effective solution to improve hypertension management. Evaluating its impact in real-world settings is crucial for optimizing hypertension management and healthcare delivery.

This study assessed the effectiveness of the Dutch telemonitoring program HartWacht on BP outcomes in patients with hypertension. A secondary objective was to identify predictors of treatment response at 3- and 6-months follow-up.

A retrospective cohort study was conducted including hypertensive patients enrolled in HartWacht from August 2016 to December 2024. Patients were instructed to measure their BP twice daily for one week, followed by once-weekly readings. A structured alarm system identified home-measured BP (HMBP) elevations based on pre-defined thresholds: an orange alarm if systolic or diastolic HMBP exceeded 140 mmHg or 90 mmHg, respectively, and a red alarm if systolic or diastolic HMBP exceeded 180 mmHg or 110 mmHg, respectively. In the case of one red or two consecutive orange alarms, the eHealth team contacted the patient by phone to discuss lifestyle and therapy adherence. If necessary, a consultation with a cardiologist was arranged for protocol-based medication adjustment. BP control was defined as a monthly mean HMBP <140/90 mmHg.

A total of 592 patients were included (mean age 61.8 ± 11.3 years; 44.3% female). At baseline, mean in-office systolic and diastolic BP was 161.3 ± 20.5 and 92.4 ± 12.4 mmHg, respectively, and patients used an average of 2.9 ± 1.3 antihypertensive drugs. After 1 month, the mean HMBP was 143/87 mmHg, with 37.8% (n=224) reaching BP control. The mean HMBP decreased to 134/82 mmHg at 12 months, with 61.9% (n=174) achieving BP control. At 2-year follow-up, 137 patients remained in the program of whom 66.4% had controlled BP with a mean HMBP of 132/82 mmHg. Linear mixed model analysis demonstrated significant reductions in systolic HMBP between month 1 and 12 (-9.1 [95% CI -6.3 to -11.9] mmHg) and between month 1 and 24 (-9.9 [95% CI -6.3 to -13.6] mmHg, p<0.001 for both). Higher baseline body weight and in-office BP were associated with lower odds of achieving BP control at 3- and 6-months follow-up.

Participating in HartWacht was associated with markedly and sustained reductions in HMBP over a 2-year period in a real-life clinical setting. Structured remote monitoring with timely intervention may improve long-term outcomes and reduce healthcare costs. These findings support the potential of telemonitoring for long-term hypertension management.