Effect of home blood pressure monitoring on major adverse cardiovascular events and all-cause mortality: results from the VA HOMESTEAD study

In a VHA telehealth cohort of 60,299 Veterans with uncontrolled systolic BP >140 mmHg, home blood pressure monitoring is linked to lower all-cause mortality (HR 0.92).

• Why it matters: Home blood pressure monitoring lowers blood pressure in trials, but its real-world impact on cardiovascular events and death is unclear. This study addresses that outcome gap in routine clinical use.
• What they did: Using target trial emulation with matched cohorts, the study compared 30,203 HBPM-enrolled Veterans versus 30,096 usual-care controls, followed a median 6.4 years. Outcomes were all-cause mortality and MACE (first acute myocardial infarction, stroke, acute heart failure, or unstable angina).
• The result: HBPM was associated with 8.3% lower mortality risk (HR 0.92; 95% CI 0.89–0.95) but a 4.1% higher MACE risk (HR 1.04; 95% CI 1.01–1.08). After calibration using negative control outcomes, the MACE association was no longer statistically significant.

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