Mobile App Helps Patients Achieve Sustained BP Reduction, Particularly in Stage 2 Hypertension

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A hypertension (HTN) self-management program with a blood pressure (BP) monitor and connected smartphone application was associated with mean reductions in systolic BP of as much as 20.9 mm Hg, according to new research published in JAMA Network Open.

Specifically, investigators reported that more than 84% of study participants with stage 2 HTN who participated for 3 years achieved the average 20.9 mm Hg systolic BP reduction, more than 2 times that seen in comparable published results.

Researchers conducted a cohort study of 28 189 US adults (median age, 51 years; 59.6% men) with elevated BP or HTN who used the self-management program, which includes a BP monitor and connected smartphone application with clinically based digital coaching (Hello Heart program, Hello Heart Inc.) via employer-sponsored coverage.

“This is the first peer-reviewed, published study reporting the long-term experience of a digital health application for blood pressure management, with a magnitude of association that is clinically meaningful,” said lead author Alexis Beatty, MD, MAS, cardiologist, associate professor, University of California, San Francisco, in a press release.

Participants were enrolled between January 1, 2015 and July 1, 2020. Systolic and diastolic BP were measured by a Food and Drug Administration-cleared BP monitor, with categories defined as normal (systolic BP <120 mm Hg), elevated (systolic BP 120-129 mm Hg), stage 1 HTN (systolic BP 130-139 mm Hg), and stage 2 HTN (systolic BP 140 mm Hg), according to the study.

More engagement, better control

Overall, median baseline systolic BP was 129.5 mm Hg and diastolic BP was 81.7 mm Hg. Median systolic BP at 1 year improved at least 1 category for 53% of participants with elevated BP, 69.7% of those with stage 1 HTN, and 85.7% of those with stage 2 HTN at baseline.

According to investigators, participants in the program for 3 years had a mean systolic BP reduction of 7.2 mm Hg, 12.2 mm Hg, and 20.9 mm Hg compared with baseline for those starting with elevated, stage 1 HTN, and stage 2 HTN, respectively.

Over time, greater engagement in the program was associated with lower systolic BP (high-engagement group, 131.2 mm Hg; medium-engagement group, 133.4 mm Hg; low-engagement group, 135.5 mm Hg; P<.001), wrote researchers who noted that these results persisted after adjusting for age, gender, depression, anxiety, diabetes, hypercholesterolemia, smoking, area deprivation index rank, and region.

Sustained reductions in BP

Another key finding was that greater engagement was associated with lower risk of very high BP (systolic BP >180 mm Hg). The estimated probability of a very high BP was greater in the low-engagement group (1.42%; 95% CI, 1.26%-1.59%) than the medium-engagement group (0.79%; 95% CI, 0.71%-0.87%) and the high-engagement group (0.53%; 95% CI, 0.45%-0.60%; P<.001 for comparison with both groups), according to the study.

“This real-world evidence of a BP self-management program with a BP monitor connected to a smartphone app with automated lifestyle coaching demonstrates the potential of this strategy to achieve better BP control,” concluded investigators. “Future studies should examine the efficacy and dissemination of mobile technology–facilitated BP self-management interventions and their real-world effectiveness in other settings and populations as well as deeper investigations into the mechanisms that drive their effects on BP control.”

Reference: Gazit T, Gutman M, Beatty AL. Assessment of hypertension control among adults participating in a mobile technology blood pressure self-management program. JAMA Netw Open. 2021:4; e2127008.