Telemonitoring at scale for hypertension in primary care: An implementation study
Open accessAbstract
BACKGROUND: While evidence from randomised controlled trials shows that telemonitoring for hypertension is associated with improved blood pressure (BP) control, healthcare systems have been slow to implement it, partly because of inadequate integration with existing clinical practices and electronic records. Neither is it clear if trial findings will be replicated in routine clinical practice at scale. We aimed to explore the feasibility and impact of implementing an integrated telemonitoring system for hypertension into routine primary care. METHODS AND FINDINGS: This was a quasi-experimental implementation study with embedded qualitative process evaluation set in primary care in Lothian, Scotland. We described the overall uptake of telemonitoring and uptake in a subgroup of representative practices, used routinely acquired data for a records-based controlled before-and-after study, and collected qualitative data from staff and patient interviews and practice observation. The main outcome measures were intervention uptake, change in BP, change in clinician appointment use, and participants' views on features that facilitated or impeded uptake of the intervention. Seventy-five primary care practices enrolled 3,200 patients with established hypertension. In an evaluation subgroup of 8 practices (905 patients of whom 427 [47%] were female and with median age of 64 years [IQR 56-70, range 22-89] and median Scottish Index of Multiple Deprivation 2012 decile of 8 [IQR 6-10]), mean systolic BP fell by 6.55 mm Hg (SD 15.17), and mean diastolic BP by 4.23 mm Hg (SD 8.68). Compared with the previous year, participating patients made 19% fewer face-to-face appointments, compared with 11% fewer in patients with hypertension who were not telemonitoring. Total consultation time for participants fell by 15.4 minutes (SD 68.4), compared with 5.5 minutes (SD 84.4) in non-telemonitored patients. The convenience of remote collection of BP readings and integration of these readings into routine clinical care was crucial to the success of the implementation. Limitations include the fact that practices and patient participants were self-selected, and younger and more affluent than non-participating patients, and the possibility that regression to the mean may have contributed to the reduction in BP. Routinely acquired data are limited in terms of completeness and accuracy. CONCLUSIONS: Telemonitoring for hypertension can be implemented into routine primary care at scale with little impact on clinician workload and results in reductions in BP similar to those in large UK trials. Integrating the telemonitoring readings into routine data handling was crucial to the success of this initiative.
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In 2014, a study randomizing patients with untreated hypertension to management based on clinic and ABPM measurement or HBPM alone showed no significant difference between groups in LVMI regression after 1 year.
“In 2014, a study, which randomized patients with untreated hypertension to management based on clinic and ABPM measurement or HBPM alone showed that after 1 year, there was no significant difference between groups in LVMI regression. [160,161]”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [161]
The Methods and Results sections describe blood-pressure changes during a telemonitoring implementation study, not LVMI regression in a randomized trial. Searches for LVMI, ABPM, and left ventricular mass found no passage reporting the claimed 2014 study or its one-year comparison. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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BackgroundWhat next for COVID Oximetry and virtual ward?
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Kraselnik, A., McGowan, H., Amiali, I. A., Gibson, I., Joshi, S., Magero, N., Miller, C. H., Oulousian, S., Sharma, A., Sonyuy, M. F., et al. (2026) · Global Heart · doi:10.5334/gh.1561 · Cited by 2 · see citing works
Potential of digital technology for hypertension management: current status and future prospects
Fujiwara, T., & Kario, K. (2026) · Expert Review of Medical Devices · doi:10.1080/17434440.2026.2626018 · Cited by 2 · see citing works
“…treatments [32,33], and compared with traditional face-to-face consultations, an approach using digital interventions may reduce the frequency of hospital visits and make more efficient use of medical resources, potentially reducing the economic burden on both patients and the medical system [34].”
Smith, A., Tucker, K., Barnes, R. K., Drakesmith, C. W., Agwunobi, A., Bateman, P. A., Forbes, A., de Lusignan, S., Ford, G., Fujiwara, T., et al. (2024) · BMC Cardiovascular Disorders · doi:10.1186/s12872-024-04279-y · Cited by 2 · see citing works
Self-citationEvaluation of Real-World Patient Engagement in a Remote Patient Monitoring for Hypertension Program
Berlot, A. A., Stark, A., Islam, R., Zhang, C., Rodriguez, C. J., & Rikin, S. (2026) · Journal of general internal medicine · doi:10.1007/s11606-026-10303-y · Cited by 1 · see citing works
Groom, L. L., Schoenthaler, A. M., Budhrani, R., Mann, D. M., & Brody, A. A. (2025) · Telemedicine journal and e-health · doi:10.1177/15305627251362373 · Cited by 1 · see citing works
“23 Studies relying on patient-collected home BP data 24,25 can detect white-coat and masked hypertension, associated with increased cardiovascular risk.”
Riches, P. L., Alexander, D., Brown, C., Abbas, H., Hart, R., & Krause, A. (2024) · Exploration of Musculoskeletal Diseases · doi:10.37349/emd.2024.00075 · Cited by 1
Earlier identification of hypertensive events in a telemonitoring system
Do, E., Lavu, S., Kum, H.-C., & Mortazavi, B. (2023) · International Conference on Wearable and Implantable Body Sensor Networks · doi:10.1109/bsn58485.2023.10330992 · Cited by 1 · see citing works
“Telemonitoring has been used to support self-management and remote care, including for blood pressure management, by providing a communication pipeline between patients and clinicians [4], [5].”
MethodIneffective health management in people with hypertension: Accuracy study
da Silva, R. C., de Lima, N. X., Lopes, M. V. D. O., da Silva, V. M., & Cavalcante, A. M. R. (2022) · International Journal of Nursing Terminologies and Classifications · doi:10.1111/2047-3095.12370 · Cited by 1 · see citing works
“Therefore, distance follow-up can reduce the symptoms related to disease and improve self-care activities (Hammersley et al., 2020).”
Ionov, M., Yudina, Y., Kurapeev, D. I., Zvartau, N., & Konradi, A. (2024) · Russian Journal of Preventive Medicine · doi:10.17116/profmed20242712137 · Cited by 1 · see citing works
Hanley, J., Paterson, M., Parker, R., Pearsons, A., Pollock, R., Neubeck, L., Atherton, I., & McKinstry, B. (2026) · European Heart Journal - Digital Health · doi:10.1093/ehjdh/ztag069
“The purpose of this study was to update the earlier study of the implementation of this service 13 and go beyond the focus on change in BP demonstrated in that study to compare clinical cardiovascular outcomes for those using BP telemonitoring with a matched group who did not use the service.”
InfluentialSelf-citationGonçalves, C. S. D. R., & Sousa, K. H. J. F. (2026) · Cuadernos de Educación y Desarrollo · doi:10.55905/cuadv18n1-081
mHEALTH APPLICATION AS A TOOL TO ASSIST FAMILY DOCTORS IN THE MANAGEMENT OF HYPERTENSION
Janevska, S., Gogjoski, A., Gerasimovska, B., Kovachevikj, K., & Ristoska, K. (2025) · Academic Medical Journal · doi:10.53582/amj2553174j
Wu, F. M., Moriarty, S., Toole, H., Wherton, J., Mohebbi, D., Sheppard, J. P., Shaw, S. E., & Marjanovic, S. (2025) · NIHR Open Research · doi:10.3310/nihropenres.14008.1
Qin, L., & Samsir, M. S. B. (2023) · Applied Mathematics and Nonlinear Sciences · doi:10.2478/amns.2023.2.00483
Telehealth Blood Pressure Monitoring Models In Hypertensive Patients: A Scoping Review
Fathurrizki, A. I., Lestari, A. P., Azizah, W., & Sari, E. A. (2022) · Journal of Nursing Care · doi:10.24198/jnc.v5i1.37002
Telehealth in hypertensive patients: to whom, how and for how long?
Ionov, M., & Konradi, A. (2022) · Arterial'naya Gipertenziya (Arterial Hypertension) · doi:10.18705/1607-419x-2022-28-2-108-125
Gordon, K., Seto, E., Dainty, K., Steele-Gray, C., & DeLacy, J. (2022) · doi:10.2196/preprints.36346
- Authors
- Hammersley, V., Parker, R., Paterson, M., Hanley, J., Pinnock, H., Padfield, P., Stoddart, A., Park, H. G., Sheikh, A., & McKinstry, B.
- Affiliations
- University of Edinburgh (GB)
- Edinburgh Napier University (GB)
- Corresponding author
- McKinstry, Brian
- ORCID
- Venue
- PLOS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-06-17
- Volume
- 17
- Issue
- 6
- Pages
- e1003124
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC7299318
- OpenAlex
- W3036809109
- Cited by
- 61
- References
- 47
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 12 · 2023: 13 · 2022: 11 · 2021: 14 · 2020: 2
- FWCI
- 7.50
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (acceptedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, cc-by)
- Funders
- Chief Scientist Office, Scottish Government Health and Social Care Directorate (CZH/4/1135.)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- remote patient monitoring, hypertension, blood pressure control, primary care, implementation, remote blood pressure monitoring, electronic health record integration, clinician workload, consultation time, feasibility, routine clinical practice, Scottish Index of Multiple Deprivation, regression to the mean, health disparities
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Humans, Hypertension, Male, Middle Aged, Patient Participation, Primary Health Care, Program Development, Blood Pressure Monitoring, Ambulatory, Young Adult
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