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Item new Preprint · not peer-reviewed Added

Home blood pressure monitoring in US veterans and later deaths and cardiovascular events

In 30,203 veterans using home blood pressure monitoring and 30,096 matched controls, monitoring was linked to 8% lower all-cause mortality.

This preprint studied US veterans with uncontrolled hypertension, defined as systolic pressure above 140 mmHg, in Veterans Health Administration care. A target trial emulation matched 30,203 telehealth enrollees in home blood pressure monitoring, 2013 to 2019, with 30,096 usual-care controls. Over a median 6.4 years, monitoring was associated with lower all-cause mortality (hazard ratio 0.92; 95% CI 0.89–0.95). It was also associated with slightly more major adverse cardiovascular events (HR 1.04; 95% CI 1.01–1.08). The excess events lost significance after a bias check against negative control outcomes, which monitoring should not affect. The design is observational, and the excess events may reflect closer detection of events among enrollees.

Why it is interesting: Randomised trials show home monitoring lowers blood pressure, but its effect on deaths was unknown. This large routine-care emulation links it to fewer deaths, with no clear change in cardiovascular events once checked for bias.

Source
medRxiv, 29 October 2026
Paper
Effect of home blood pressure monitoring on major adverse cardiovascular events and all-cause mortality: results from the VA HOMESTEAD study
Authors
Birkelo B, Velusamy K, Rai NK, Taylor BC, Abdalla M, Margolis K et al.
DOI
10.64898/2026.10.27.26366626
Type
Preprint
Design
Target trial emulation with matched cohorts in the US Veterans Health Administration; 30,203 home-monitoring enrollees vs 30,096 matched controls, enrolment 2013-2019, median 6.4 years follow-up
Verdict
New finding
Driver
Heart and stroke
Driver
Medicine at a distance

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