Key Points
- Home blood pressure (BP) monitoring and community health worker (CHW) interventions have demonstrated benefits for hypertension management. However, whether combining these approaches prevents progression to hypertension among adults with elevated BP or untreated stage 1 hypertension remains uncertain.
- LINKED-BP was a cluster-randomized trial of 472 adults across 20 primary care practices comparing home BP telemonitoring linked with CHW-led lifestyle counseling and support versus enhanced usual care, which included provision of home BP monitors.
- At 6 months, the intervention significantly reduced systolic BP (between-group difference -3.23 mmHg [-5.71, -0.75]) and diastolic BP (-2.66 mmHg [-4.57 , -0.76]) compared with enhanced usual care. However, the between-group BP benefit was not evident at 12 months.
- The intervention also did not significantly reduce progression to stage 2 hypertension, highlighting the challenges of achieving sustained BP improvements through behavioral and community-based interventions.
Hypertension is a leading modifiable risk factor for cardiovascular disease, and prevention of progression from elevated BP to hypertension or from stage 1 to stage 2 hypertension represents an important opportunity to reduce cardiovascular risk. Home BP monitoring and community health worker (CHW) interventions have independently demonstrated benefits for BP management, particularly in underserved populations. However, the additive benefit of combining home BP telemonitoring with CHW-led lifestyle counseling remains uncertain.
On November 8th, 2026, results from “Home Blood Pressure Telemonitoring Linked With Community Health Workers to Improve Blood Pressure” (LINKED-BP) were presented at the American Heart Association (AHA) Scientific Sessions 2026 in Chicago, IL, by Yvonne Commodore-Mensah, PhD, of Johns Hopkins University. The trial evaluated whether a multicomponent intervention combining home BP telemonitoring and CHW support improved BP compared with enhanced usual care among adults with elevated BP or untreated stage 1 hypertension.
LINKED-BP was a hybrid effectiveness-implementation, cluster-randomized trial conducted across 20 primary care practices in Maryland and Washington, DC. Practices were randomized 1:1 to the LINKED-BP intervention or enhanced usual care. Eligible patients were adults with elevated BP (120–129/<80 mmHg) or untreated stage 1 hypertension (130–139 mmHg systolic or 80–89 mmHg diastolic) who were not receiving antihypertensive medications. Patients with diabetes, chronic kidney disease, or cardiovascular disease were excluded.
Patients in the intervention group received training in home BP monitoring, with measurements transmitted through the Sphygmo mobile health application and accessible to clinicians and CHWs. Participants in the intervention group also received 12 months of CHW-led telehealth visits focused on lifestyle counseling, BP self-management, and connections to community resources. Patients assigned to enhanced usual care received home BP monitors and measurement training, with subsequent management by their primary care clinicians. The primary endpoint was the between-group difference in change in systolic BP at 12 months. Secondary outcomes included diastolic BP and progression to stage 2 hypertension. Analyses used linear mixed-effects models adjusted for age, sex, and body mass index (BMI), accounting for clustering by practice.
Among 472 participants, 234 were assigned to LINKED-BP and 238 to enhanced usual care. The mean age was 43.3 years, 31.1% were men, 46.0% were non-Hispanic Black, and 13.6% were Hispanic. Mean BMI was 30.4 kg/m², and baseline systolic and diastolic BP were 126.5 and 79.9 mmHg, respectively.
At 6 months, systolic BP decreased by 4.10 mmHg in the LINKED-BP group compared with 0.87 mmHg with enhanced usual care (adjusted between-group difference -3.23 mmHg [-5.71, -0.75]). Diastolic BP similarly decreased by 3.18 versus 0.51 mmHg (between-group difference -2.66 mmHg [-4.57 to -0.76]). However, these improvements were not sustained at 12 months. There was no significant difference between groups in the primary endpoint of change in systolic BP (adjusted difference 1.21 mmHg [-1.20,3.63]) or diastolic BP (-0.38 mmHg [-2.13, 1.37]; . There was also no significant difference in progression to stage 2 hypertension (adjusted HR 1.03 [0.65, 1.66]).
The LINKED-BP trial demonstrated that combining home BP telemonitoring with CHW-led lifestyle counseling can produce modest short-term improvements in BP, but these benefits were not sustained at 12 months and did not reduce progression to stage 2 hypertension. Importantly, the comparator group also received home BP monitors and measurement training, which could have potentially reduced the incremental benefit of the intervention. Additionally, the multicomponent design limits the ability to distinguish the effects of telemonitoring from those of CHW support. The exclusion of patients with established cardiovascular disease, diabetes, or CKD limits generalizability to higher-risk populations.
Overall, these findings highlight the potential of community-based and technology-enabled interventions to improve BP in the short term, but underscore the need to identify strategies that can sustain improvements over time. Further research is needed to determine which intervention components are most effective and how they can be integrated into routine primary care to prevent hypertension progression and potentially downstream cardiovascular outcomes.