March 04, 2020
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Coaching app similar to tracking app for hypertension control

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Patients who received an at-home BP monitor and coaching via a smartphone app to promote healthy behaviors experienced similar reductions in BP as patients who used a BP tracking app and monitor, according to research published in JAMA Network Open.

Mean systolic BP among the intervention participants who received smartphone coaching was 140.6 mm Hg at baseline and, after 6 months, decreased to 132.3 mm Hg. Among the participants in the control group who received the BP tracking app, mean systolic BP decreased from 141.8 mm Hg at baseline to 135 mm Hg at 6 months.

The between-group adjusted difference in systolic BP was 2 mm Hg (95% CI, 4.9 to 0.8).

At 6 months, the secondary outcome of self-efficacy in BP control was greater in the intervention group (0.36 points on a 5-point scale; 95% CI, 0.18-0.54).

Researchers observed no other differences between groups in any of the other secondary outcomes, including self-reported antihypertensive adherence, home monitoring and self-management practices, weight and self-reported health behaviors.

Scalable coaching solution

“The degree of blood pressure elevation observed here was lower than in many prior studies. We did not exclude participants with only low levels of blood pressure elevation because a large portion of the population with hypertension has blood pressures that are only mildly elevated and a scalable coaching solution might be a particularly useful way to reach a large group with less severe hypertension,” Stephen D. Persell, MD, MPH, associate professor of general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine, and colleagues wrote. “It is possible that many participants thought that the degree of elevation was not high enough to warrant taking action. Further adoption of the 2017 American College of Cardiology and American Heart Association hypertension guideline may lead to more attention to blood pressures in the range observed here.”

In other findings, the adjusted difference in self-reported physical activity between the intervention and control groups was 26.7 minutes per week (95% CI, 5.4 to 58.8).

In addition, there was a trend toward the treatment effect of the intervention being more pronounced in participants at or above the median age of 61 years compared with younger participants (P for interaction = .09).

BP effects

“Even though baseline blood pressure elevations were mild, blood pressure decreased by a mean of 6.8 mm Hg systolic and 3.6 mm Hg diastolic in the control group,” the researchers wrote. “It is likely that, at least in part, this decrease was associated with regression to the mean for individuals whose enrollment blood pressure was greater than their true average, but it is also possible that there were blood pressure effects due to the control intervention. The high usage of home BP monitoring in both groups supports this possibility.”

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For this randomized clinical trial, participants with uncontrolled hypertension (mean age, 59 years; 61% women; 35% black) were recruited from 2016 to 2017 and followed up for 6 months. Overall, 297 participants completed the follow-up assessment.

“Given the direction of the difference in systolic blood pressure and some secondary outcomes between groups, and the possibility for differences in treatment effects across age subgroups, future studies are warranted,” the researchers wrote. – by Scott Buzby

Disclosures: Persell reports he received research funding from Pfizer and grants from Omron Healthcare. Please see the study for all other authors’ relevant financial disclosures.