Effects of manually recorded or automatically transmitted home blood pressures with or without automated patient feedback on hypertension care

Federal Grant Award Summary

The National Heart, Lung, and Blood Institute (NHLBI) awarded Northwestern University a Project Grant of $793,184 on August 1, 2025, under the Cardiovascular Diseases Research program (CFDA 93.837) to conduct the AUTO2 Trial, a 2×2 factorial, patient-randomized controlled trial examining digitally-enabled home blood pressure monitoring strategies for patients with uncontrolled hypertension. The research will evaluate the comparative effectiveness of automated transmission versus manual transmission of remotely-obtained blood pressure values and automatically-generated medical advice delivered via patient portal messages versus no automated feedback. The trial's primary outcome will assess systolic blood pressure reduction at one year, with persistence of effects evaluated through 18 months, and will examine potential interactions between the two intervention components. This research addresses a significant clinical challenge: despite strong evidence that hypertension control reduces cardiovascular risk, hypertension remains poorly controlled and has worsened over the past decade, with office-based blood pressure measurements presenting inherent limitations for diagnosis and optimal treatment management.

The five-year project (completion date July 31, 2030) will be conducted at a large, diverse health system in Illinois and aims to develop practical, lighter-touch digital strategies for hypertension management that can be integrated into existing electronic health records and routine clinical care. By demonstrating the effectiveness of digitally-enabled home blood pressure monitoring approaches, the research seeks to identify implementable strategies that may overcome existing barriers to adoption of team-based care and home monitoring in clinical practice, ultimately contributing to improved hypertension control and reduced cardiovascular disease burden across diverse patient populations.

Abstract

Despite a strong evidence base demonstrating that controlling hypertension greatly reduces cardiovascular health risk, hypertension control remains poor, and has worsened in the past decade. Accurate and regular blood pressure measurement is essential to safely achieving blood pressure targets. Office blood pressure measurements have many known limitations, so achieving proper diagnosis, optimal control, and avoiding overtreatment requires repeated out-of-office measurement. Care strategies incorporating home blood pressure monitoring and proactive team-based care have been some of the most effective ways to improve hypertension control but face numerous barriers to implementation in routine practice and are not widely used. Lighter-touch, digitally-enabled strategies are practical and can be delivered via patients' existing electronic health records and tied to their usual source of care. If effective, these strategies may ultimately prove easier to implement in practice than more labor intensive strategies. The first aim is to conduct, in patients with uncontrolled hypertension at a large diverse health system, a 2X2 factorial patient-randomized controlled trial (the AUTO2 trial) to evaluate the effects of 1) automated transmission of remotely-obtained blood pressure values versus manual transmission, and 2) automatically-generated medical advice to patients related to their home blood pressure monitoring results sent via patient portal messages versus no automated feedback. The primary outcome will be systolic blood pressure at 1-year. Persistence of effects through 18 months will also be assessed. The second aim will assess whether these two interventions interact. Automated messaging that includes prompting to perform self-monitoring and other feedback could lead patients to sufficiently self- report their blood pressures and obviate the need for direct transmission of blood pressures. Alternatively, the two interventions could have synergistic effects leading to more than additive benefits. Third, we aim to evaluate intervention effects on resource utilization and clinician attitudes towards the use of these remote monitoring systems and examine how the remote blood pressure monitoring information is used by physicians, advanced practice providers, and their teams to deliver patient care. This trial has the potential to demonstrate the effectiveness of practical strategies to accelerate the achievement of evidence-based hypertension treatment goals that could be incorporated into existing health systems. Public health benefit: a modest reduction in population systolic blood pressure of 5 MM HG or even less is expected to produce important reductions in cardiovascular events, stroke and heart failure and to confer other important health benefits. Identifying and testing light-touch strategies to accelerate the achievement of evidence-based hypertension goals that are feasible and affordable for health systems to implement and for patients to use is needed to realize the proven benefits of controlling hypertension.