Successful hypertension self-management through mobile technology

Hypertension self-management can be successfully achieved over a three-year period by harnessing the support of mobile technology

Use of mobile technology may support self-management of hypertension in patients with the condition, according to results of a three-year study by a group from the University’s Department of Epidemiology and Biostatistics from California, CA, USA. Hypertension is a global problem, with the World Health Organization (WHO) estimating that it affects 1.28 billion adults between the ages of 30 and 79. However, perhaps more concerning is the WHO statistic that only 1 in 5 adults (21%) with hypertension have their condition under control.

Although self-monitoring may lead to reductions in blood pressure (BP) beyond usual care, a 2017 systematic review concluded that self-monitoring alone is not associated with lower BP or better control , but requires co-interventions such as education or lifestyle counseling to achieve clinically meaningful reductions that persist for at least 12 months. The use of mobile technology in the form of smartphone health apps has been suggested as a method for effective self-management of hypertension. Yet despite this potential role, a 2018 review of these apps concluded that although available studies suggest a reduction in blood pressure in those who use health apps, the finding should be interpreted with caution, as many studies were at high risk of bias.

Given the high risk of bias and the importance of co-interventions, the California team used a smartphone app in conjunction with BP monitoring that included digital coaching to help support self-management. hypertension. Participants were American adults with high blood pressure recruited under an employer health plan. Blood pressure was measured using an FDA-approved Bluetooth-enabled monitor coupled to the smartphone app, which also allowed participants to track their weight and physical activity level. The app included medication reminders and coaching to guide lifestyle changes based on usage patterns to personalize advice. At baseline, participants were categorized based on their systolic BP as: normal and 140 mmHg (stage 2 hypertension). Blood pressure measurements (systolic and diastolic) were assessed at week 1 (week 0) and then repeatedly through weeks 148 to 163.

Results

A total of 28,189 people with a median age of 51 years (59.6% male) were included in the hypertension self-management study. After 3 years, median systolic blood pressure was reduced in 53.7% of people with systolic BP between 120 and 129 mmHg, 75.3% of those with stage 1 hypertension and 84.4% of those with stage 1 hypertension. stage 2 hypertension. Similarly, after 3 years, mean reductions in diastolic BP were -4.4 mmHg, -6.8 mmHg, and -11.6 mmHg, respectively.

A subset of 3,229 participants recorded their body mass index (BMI) and for every unit reduction in BMI there was a 0.74 mmHg decrease in systolic BP. Similarly, among 590 people who recorded their physical activity, for each increase of 1000 steps per day there was a lower systolic blood pressure of 0.8 mmHg (P = 0.03).

The authors concluded that their mobile technology-supported hypertension self-management program achieves long-term BP control, suggesting that this approach may be useful for BP monitoring and control.

Quote

Gazit T et al. Evaluation of hypertension control in adults participating in a blood pressure self-management program using mobile technology. JAMA Netw Open 2021

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