Effectiveness of blood pressure self-monitoring program with smartphone app

1. An enhanced self-monitoring blood pressure program (SMBP) with smartphone-based patient engagement features was not associated with a significant difference in BP reduction, compared to a standard SMBP program.

Level of evidence assessment: 1 (Excellent)

For people with uncontrolled blood pressure (BP), guidelines around the world recommend self-monitoring of BP (SMBP) as a component of management, combined with interventions that emphasize blood pressure. engagement or counseling of the patient. As a result, some programs have been initiated that leverage SMBP by transmitting data from these devices to healthcare providers, to optimize drug therapy and patient education. However, these are also associated with significant costs and the transformation of health record systems. Another strategy is enhanced SMBP, which transmits data from the BP machine to the patient’s smartphone and allows the patient to receive reminders, data visualization and recommendations, at no additional cost to the healthcare system. Because the effectiveness of this is unclear, this randomized controlled trial aimed to compare changes in systolic blood pressure after 6 months in patients who received standard SBMP versus enhanced SBMP. This study was conducted across 23 health systems, with the population consisting of adults who reported a systolic BP above 145 mmHg during a clinic visit, wanted to lower their BP, and had a smartphone. 1050 patients were randomized to receive standard SMBP and 1051 to enhanced SMBP. Blood pressure measuring devices and instructions were mailed to all participants, and clinic systolic blood pressures were compared at baseline and at 6 months follow-up. The study population had a mean age (SD) of 58 (13) years and the level of comfort with technology was 4.1 (1.1) out of 5. The results showed no difference in the mean change in systolic BP, with a mean difference of -10.6 (18) mmHg in the standard SMBP group and a difference of -10.8 (18) mmHg in the enhanced SMBP group (difference -0.19, 95% CI -1.83 to 1.44, p = 0.81). Other outcomes such as change in diastolic BP, proportion of individuals with systolic BP reduction >10 mmHg and proportion of individuals with controlled BP less than 130/80 were not significantly different, whereas the proportion of individuals with controlled BP less than 140/90 favored the improved SMBP group (32% versus 29%, odds ratio 1.15, 95% CI 1.01-1.34, p = 0.03). Overall, this study demonstrated that there was no significant benefit to an enhanced SMBP program with device-initiated patient engagement tools, compared to a standard SMBP group.

Click to read the study in JAMA Internal Medicine

Picture: PD

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