Mobile Blood Pressure App Shows Promise in First-of-Its-Kind, Long-Term Study

Alexis Beatty, MD

New research is underlying the potential impact of mobile technology in helping patients achieve blood pressure goals.

The study, which was led by investigators at the University of California, San Francisco (UCSF), provides evidence suggesting use of mobile technology resulted in 84% of users with stage 2 hypertension reducing blood pressure at 3 years and also indicate increased engagement with technology was associated with lower risk of experiencing very high blood pressure.

“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 investigator Alexis Beatty, MD, MAS, a cardiologist and associate professor at UCSF, in a statement. “The level of engagement is something I have not seen in other digital hypertension management programs. Sustained engagement and decreases in systolic blood pressure of more than 20 mmHg could reduce a person’s chances of heart attack, stroke, kidney disease, and death.”

As the integration of technology into cardiology continues, Beatty and a team of colleagues sought to further understand how use of mobile self-management programs might influence long-term blood pressure control among patients with elevated blood pressure. Using a cohort of individuals enrolled in an employer-sponsored health insurance program, investigators designed their study to assess whether use of the Hello Heart hypertension self-management program, which includes a blood pressure monitor and connected smartphone application, over a long-term period.

Individuals enrolled in the health plan with either a diagnosis of elevated blood pressure or hypertension or a pharmacy claim for medication for treatment or management of hypertension were invited to participate in the study. With a study period ranging from January 1, 2015, through July 1, 2020, investigators identified 28,189 adults meeting inclusion criteria for the study, which required an individual to record at least 2 blood pressure measurements in the app during the study period.

For the purpose of analysis, median systolic and diastolic blood pressures were recorded during the first week, after 2 weeks, and again 4 (weeks 3-4), 6 (weeks 5-6), 12 (weeks 11-12), 26 (weeks 24-27), 52 (weeks 48-55), 104 (weeks 96-111), and 155 (weeks 148-163) weeks after the first reading. The primary outcome of interest for the study was changes in systolic and diastolic blood pressure over time. The exposure of interest for the study was program engagement, which investigators defined as the average number of application sessions. Based on engagement levels relative to the rest of the cohort, patients were placed into groups defined by low, medium, and high engagement.

The study cohort had a median age of 51 (IQR, 43-58) years, 40.4% were women, and the median systolic and diastolic blood pressure measurements at baseline were 129.5 (IQR, 120.5-139.6) mmHg and 81.7 (IQR, 75.7-88.4) mmHg, respectively. The mean number of blood pressure measurements per week ranged from a median of 1.3 (IQR, 0.6-2.8) in the low-engagement group to 2.8 (IQR, 1.5-5.3) in the high-engagement group.

Upon analysis, results indicated median systolic blood pressure improved at least 1 category for 495 of 934 participants (53.0%) with baseline elevated BP, 673 of 966 (69.7%) with baseline stage 1 hypertension, and 920 of 1075 (85.7%) with baseline stage 2 hypertension at 1 year. Among individuals enrolled in the program for 3 years, the mean reduction in systolic blood pressure was 7.2 (SEM, 0.4) mmHg among those with elevated blood pressure, 12.2 (SEM, 0.7) mmHg among those with stage 1 hypertension, and 20.9 (SEM, 1.7) mmHg, among those with stage 2 hypertension when compared to baseline measurements.

Further analysis indicated greater engagement was associated with lower systolic blood pressure over time, even after adjustment for age, gender, depression, anxiety, diabetes, high cholesterol, smoking, area deprivation index rank, and US region. Investigators also pointed out greater engagement was associated with a lower risk of very high blood pressure, with increased incidence seen among the low-engagement group (1.42%, [95% CI, 1.26%-1.59%]) compared with the medium-engagement group (0.79%, [95% CI, 0.71%-0.87%]; P <.001) and the high-engagement group (0.53%, [95% CI, 0.45%-0.60%]; P <.001 for comparison with both groups).

This study, “Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-Management Program,” was published in JAMA Network Open.