Researchers examined data on 28,198 adults with either slightly elevated blood pressure or a hypertension diagnosis who used Hello Heart, a smartphone application with a connected blood pressure monitor that delivered a self-management program for hypertension. Previous studies have linked this app to decreased blood pressure for up to 22 weeks, and the current analysis sought to determine how engagement - or frequency of utilization - might impact blood pressure outcomes over as long as three years.
At baseline, median systolic blood pressure was 129.5 mmHg and median diastolic blood pressure was 81.7 mmHg. Researchers measured the success of app utilization based on changes in blood pressure categories, which they defined based on systolic blood pressure as normal (less than 120 mmHg), elevated (120-129 mmHg), stage 1 hypertension (130-139 mmHg), or stage 2 hypertension (at least 130 mmHg).
After one year, median systolic blood pressure improved by at least one category for 495 of 934 participants (53%) who had elevated baseline blood pressure, researchers report in JAMA Network Open.
Median systolic blood pressure also improved by at least one category for 673 of 966 (69.7%) of people with baseline stage 1 hypertension, and for 920 of 1,075 (85.7%) of individuals with baseline stage 2 hypertension.
By the end of three years, the mean systolic blood pressure reduction was 7.2 mmHg for those with baseline elevated blood pressure, 12.2 mmHg for individuals with baseline stage 1 hypertension, and 20.9 mmHg for participants with baseline stage 2 hypertension.
Overall, participants used the app for a median of 25 weeks, with a median of 1.8 interactions per week. A "low" engagement group used the app a median of 1.3 times weekly, a "medium" engagement group used it 1.7 times weekly, and a "high" engagement group used it 2.8 times weekly.
Over time, systolic blood pressure was lowest in the high engagement group (131.2 mmHg), followed by the groups with medium (133.4 mmHg) and low (135.5 mmHg) engagement.
"It is not necessarily surprising that people using a program that combines self-measurement and automated health behavior coaching were able to lower their blood pressure," said senior study author Dr. Alexis Beatty, an associate professor of epidemiology and medicine at the University of California, San Francisco.
"However, so few companies have shared their data that the number of people represented, demonstrated engagement, and number of people that were able to achieve blood pressure lowering are remarkable," Dr. Beatty, a former Apple Inc. employee and shareholder, said by email.
One limitation of the study is that participants were middle-aged individuals who received access to the app through employee health insurance programs, which may limit generalizability to other populations.
Another limitation is the potential for selection bias to shape which individuals chose to use the app, and to continue utilization over time, as well as which participants had low versus high engagement levels, researchers note.
However, the results suggest that the app might be one tool clinicians could consider recommending to patients who need support managing their blood pressure, Dr. Beatty said.
"I recommend blood pressure self-measurement to all of my patients with hypertension," Dr. Beatty said. "In our clinic, we find that some patients require additional training or technology support to be able to successfully use blood pressure self-measurement and report their values back to their clinicians so that when medication intensification is needed that we can make changes to their medical regimen."
SOURCE: https://bit.ly/3oFlJPe JAMA Network Open, online October 15, 2021.
By Lisa Rapaport
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