Mobile apps may help patients with hypertension manage their blood pressure levels over the long term, according to a new study, but more evidence is needed to determine if such tools can address longstanding health gaps among more vulnerable patients.
Using a blood pressure monitor paired with a smartphone app that provided medication reminders and lifestyle coaching was associated with lowering blood pressure levels in more than 85% of adults with stage 2 hypertension after one year. Those who participated for three years had a mean sys`tolic blood pressure reduction of 20.9 mmHG and maintained lower levels over the study period.
The study, published Friday in JAMA Network Open, marks the first peer-reviewed, multi-year analysis that could potentially offer some insight on the long-term efficacy of digital blood pressure management tools.
"The level of engagement is something I have not seen in other digital hypertension management programs.," said study lead author Dr. Alexis Beatty, a cardiologist and associate professor of epidemiology and biostatistics at the University of California, San Francisco School of Medicine in a released statement. "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."
The study tracked blood pressure levels and the level of engagement in the self-management program among more than 28,000 patients with elevated blood pressure or hypertension between 2015 and 2020.
The company that created the hypertension self-management program used for the study, Hello Heart, commissioned the analysis and participated in the study's design. Two of the study's authors are employed by the company.
Both the app and the blue-tooth enabled blood pressure cuff were provided to study participants' through their employer-based, health insurance plan.
Researchers found adults with high levels of engagement with the app had lower blood pressure over the study period compared to those with medium and low engagement. But the study found an association with a reduction in blood pressure for most users at any level of engagement with the program even after adjusting for demographic, socioeconomic conditions, and behavioral factors.
The findings echo previous studies that suggest mobile apps could be useful in chronic disease management.
An estimated 47% of adults in the U.S. have hypertension, according to the American Heart Association, yet only 22% of individuals with hypertension have adequate control of their blood pressure levels.
What remains uncertain is what role mobile health technologies may ultimately play toward addressing the disparities in chronic health conditions outcomes that persist among some of the most vulnerable patient groups. Many marginalized communities, including ethnic and racial minorities, are more likely to get diagnosed for chronic diseases when they are already at more advanced stages, making them more difficult to treat or manage successfully.
Study authors noted one of the limitations was the lack of diversity within the pool of participants despite the large sample size. The study population was made up of middle-aged, adults with employer-based health insurance. A July study published in the journal npj Digital Medicine identified only 25 studies on the efficacy of mobile health tools that included older populations, those with limited education, or minority populations.
Researchers of the new study acknowledged their results may not extend to safety-net and older populations.