Linking the Clinic and Home

Dr. Rifkin

Dena Rifkin, MD, checks an individual's blood pressure using a BP cuff similar to those used in the home for self-monitoring.

CTRI Pilot Project Grant Enables Clinical Effectiveness Trial of Innovative Blood Pressure Monitoring System

Dena Rifkin, MD, wanted to see if older kidney patients who monitored their blood pressure (BP) at home could improve their health by using a novel wireless monitoring device. Home monitoring is essential to managing blood pressure and hypertension, but traditional methods require patients to manually maintain logs and bring them to medical visits, which are often months later.

Rifkin, a nephrologist and assistant professor of medicine at UC San Diego, believed a new device could lead to more accurate readings and faster, as well as better, data sharing between patients and clinical staff – speeding up medical intervention for patients who needed it.

In 2011, CTRI awarded Rifkin an Innovative Technology Pilot Grant to conduct a clinical trial to study the effects of real-time, wireless BP monitoring for older patients with kidney disease and hypertension. Preliminary data were promising, suggesting that patients benefitted from using the new monitoring system. The results are in a paper published in the February, 2013, Blood Pressure Monitoring journal, and the pilot project helped Rifkin receive a five-year NIH K23 grant to conduct related studies.

"At CTRI, the pilot grant program is one of the ways we support investigators early in their careers. Dr. Rifkin's study yielded promising early data, which encouraged her to pursue related research, with the ultimate goal of improving the lives of blood pressure patients," said Gary S. Firestein, MD, Director of CTRI, Dean and Associate Vice Chancellor of Translational Medicine at UC San Diego School of Medicine.

"In the pilot study, we saw a trend toward better BP control in the study group," said Rifkin. "We found that the wireless monitoring strategy led to greater sharing of data between patients and clinic."

Older adults with chronic kidney disease have a high rate of uncontrolled hypertension, which could lead to kidney failure, cardiovascular events, and death, Rifkin noted. Home monitoring of blood pressure is an important part of management – and timely medical action is critical.

In the pilot project, the study group transmitted more BP readings per month – an average of 29 each – than the control group. Since readings were electronically recorded and transmitted for the study group, they were more accurate than those recorded by the control group. The control group self-monitored their BP at home, kept manual logs, and brought the logs to in-person medical visits, which were generally months apart. For the study group, medical staff reviewed the readings weekly and noted any significant changes in patients' BP sooner, which led to earlier medical intervention and ultimately better health. Additional readings in the study group meant that health care providers could better monitor the patient's changes in BP and hypertension.

The pilot study included 43 participants over a six-month period. Seventy-eight percent of the study group continued to use the telemonitoring device regularly, while only 20 percent of the control group brought readings to their medical visits. Through the CTRI pilot grant, Rifkin developed the monitoring device with UC San Diego CalIT2 engineers, who adapted off-the shelf components. "The novel telemonitoring device paired a Bluetooth-enabled BP cuff with an Internet-enabled hub," Rifkin said. The receiving device could be plugged into a socket at a patient's home and transmit BP readings to the medical staff, which reviewed them each week.

"Engineer Phil Rios put the pieces together, and programmed the device and web interface," said Rifkin. "The only things a patient needed were an electrical outlet and a home blood pressure monitoring cuff. Internet access and technologically savvy were not required."

The innovation, she added, was to do monitor blood pressure in such a way that patients could use a plug and a home BP cuff. "We hope that in the future, technologies like this will help older patients feel more empowered in taking care of their health and more connected to the health care system," Rifkin said.

Now the nephrologist is conducting a related study. "The pilot grant got me started on the BP question, and now I am asking a slightly different question with the NIH K23 grant study," Rifkin said. She is studying patterns in older adults with kidney disease, using a home BP cuff that inflates every 20 minutes over the course of a day.

Rifkin's NIH K23 award is a five-year award for $900,000 ($180K per year). The K23 is a mentored, patient-oriented research career development award.

Written by Patti Wieser


About UC San Diego Altman Clinical and Translational Research Institute:

UC San Diego Altman Clinical and Translational Research Institute (ACTRI) is part of a national Clinical and Translational Science Award consortium, led by the National Institutes of Health National Center for Advancing Translational Science. Established in 2010, ACTRI provides infrastructure and support for basic, translational and clinical research throughout the San Diego region to bring discoveries from the laboratory to the bedside, and facilitates training and education of the next generation of researchers. ACTRI carries out its activities in collaboration with institutional and corporate partners and currently has more than 1,500 members.

actri.ucsd.edu