Clinician-Led Remote Hypertension Monitoring and Blood Pressure Control in a Majority-Minority Primary Care Cohort: Racial Disparities and Equity Implications

Background

Racial and ethnic minority populations face disproportionate rates of uncontrolled blood pressure (BP) and hypertension-related mortality. Remote hypertension monitoring (RHM) with active clinician-led medication titration has shown promise for improving BP control, but real-world evidence in majority-minority primary care settings remains limited.

Methods

This retrospective cohort study (January 2022–December 2024) enrolled adults with hypertension in a Bluetooth-integrated RHM program at a single urban academic primary care clinic. Of 550 patients enrolled, 503 with evaluable follow-up data were included. Patients transmitted daily home BP readings; clinicians reviewed readings monthly and titrated anti-hypertensive regimens per 2017 ACC/AHA guidelines. BP control was assessed at baseline and 3, 6, and 9 months. Factors associated with longitudinal BP control were examined using multivariable generalized estimating equations (GEE), with outcomes defined as strict control (<130/80 mmHg), at-least-moderate control (<140/90 mmHg), and uncontrolled (>140/90 mmHg).

Results

Among 503 participants (mean age 58.3 [SD 12.1] years; 63.6% African American; 52.9% male), BP control increased from 10.1% at baseline to 37.1% at 9 months. Each additional month of enrollment was associated with reduced odds of uncontrolled BP (adjusted odds ratio [aOR] 0.82; 95% CI, 0.80–0.85; P<.001). White race was associated with lower odds of uncontrolled BP versus African American race (aOR 0.57, at-least-moderate control; aOR 0.40, strict control; both P<.001). Male sex (aOR 1.46; P=.02) and congestive heart failure (aOR 2.09, strict control; aOR 2.05, at-least-moderate control; both P<.05) were associated with higher odds of uncontrolled BP.

Conclusion

Bluetooth-integrated RHM with active clinician-led medication titration was associated with a nearly 4-fold increase in BP control over 9 months in a majority-minority primary care population. Persistent within-program racial disparities underscore the need for equity-centered strategies beyond technology adoption alone. Prospective studies with concurrent usual-care comparators are needed to establish causal inference.

What is Known

• Remote hypertension monitoring combined with active pharmacist- or clinician-led medication titration reduces blood pressure more effectively than passive monitoring or usual care alone, as demonstrated in randomized trials conducted predominantly in White, non-minority populations.

• Black Americans bear a disproportionate burden of hypertension, with earlier onset, greater severity, and higher rates of hypertensive end-organ damage compared with other racial and ethnic groups, and persistent disparities in BP control remain despite similar awareness and treatment rates.

What the Study Adds

• In one of the largest single-center cohort studies of physician-led remote hypertension monitoring in a majority-African American urban primary care population, BP control rates increased nearly 4-fold (10.1% to 37.1%) over 9 months, with each month of enrollment independently associated with an 18% reduction in the odds of uncontrolled BP.

• Despite overall program efficacy, significant within-program racial disparities persisted — White patients had 43%–60% lower odds of uncontrolled BP compared with African American patients — and male sex and congestive heart failure were independently associated with failure to achieve BP control targets, identifying high-priority subgroups for augmented intervention strategies.