Remote Intervention Shows Promise in Stabilizing Blood Pressure Variability

Blood pressure variability, particularly in systolic readings, is increasingly recognized as a strong predictor of cardiovascular events, stroke, dementia, kidney impairment, and all-cause mortality. The concept of variability refers not only to biological fluctuations but also to therapeutic adherence and lifestyle habits, making it a distinct clinical parameter beyond absolute blood pressure levels.   

Although many antihypertensive drugs (calcium channel blockers) are known to reduce variability, few behavioural interventions have been systematically studied. To address this gap, investigators from Mount Sinai and NYC Health and Hospitals implemented a proof-of-concept, single-arm, prospective trial to evaluate whether a tailored, remote behavioral treatment could reduce blood pressure variability in patients with extreme fluctuations. 

The trial (NCT05814562) was conducted at Elmhurst in Queens, New York. Adult patients aged 18 years and older with hypertension and hypercholesterolemia were screened using electronic health records. Eligibility required a systolic blood pressure coefficient of variation (BPCoV) (greater than 10%), calculated from at least three prior clinic visits. Exclusion criteria included unstable cardiovascular disease, severe psychiatric conditions, or thromboembolic events within the prior three months. 

Among 551 patients screened, 107 (19.4%) exceeded the BPCoV threshold, and 25 were enrolled (6 women, 19 men, mean age 64.24 years). The mean BPCoV decreased from 12.96 (SD 2.11) in the 6 months preceding enrollment to 7.02 (SD 3.54) during the intervention (p<0.001). Other indications of variability also showed similar improvements.  

The intervention consisted of structured problem-solving sessions aimed at addressing medication non-adherence and stress-related avoidance behaviors like hiding medications, avoiding calls, or skipping doses. Sessions occurred weekly during the first month and biweekly during the second and third months, delivered via either telephone or video. Blood pressure was measured at each session, while cholesterol and triglycerides were assessed at baseline and the at completion.  

The primary analysis included patients over 18 years of age who had three measurements of blood pressure in the six months prior to enrollment and three post-enrollment at weeks 2, 4, 8, and 12. Differences in blood pressure reading pre- and post-intervention were based on the last observation carried forward using an intent-to-treat analysis. 

Participation was high. Approximately 84% of participants (21/25) completed at least three sessions. Sixteen participants contributed sufficient readings for the primary analysis. The mean standard deviation decreased from 17.04 (SD 3.11) just prior to enrollment to 9.37 (SD 4.97) during the intervention (p < 0.001). Likewise, the coefficient of variation mean decreased from 12.96 (SD 2.11) to 7.02 (SD 3.54) and p < 0.001. 

Clinic-measured systolic blood pressure at enrollment was 124.3 (SD 10.1) mmHg compared with a systolic blood pressure at study end of 126.04 (SD 9.50), with a p value of 0.23. This indicates that there was no significant change in average blood pressure levels. Sensitivity analyses further confirmed that reductions in variability were consistent across time points and measurement sources. 

The lipid results were mixed, with no significant changes occurring in the total cholesterol, LDL, or HDL; however, triglycerides decreased significantly from 148.24 to 125.80 mg/dL (p=0.02). This study provides support that patients with extreme blood pressure variability can actuarially participate in remote behavioral settings and exhibit significant reductions in variability without decreasing overall systolic pressure, suggesting improved medication consistency rather than a direct pharmacologic effect.  

Unlike prior studies that reduced variability indirectly by decreasing the mean pressure, this precision medicine approach targeted patients with increased variability as a distinct subgroup. By addressing the behavioral components, including stress-linked medication avoidance, the intervention successfully mitigated variability, highlighting a novel pathway for improving cardiovascular risk management. 

References: Shemesh E, Reynolds D, Sidhu J, et al. Reducing blood pressure variability: results from a single arm proof of concept prospective trial. Sci Rep. 2025;15:29449. doi:10.1038/s41598-025-14968-z