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Role of web-based monitoring in management of hypertension

Role of web-based monitoring in management of hypertension

When used in conjunction with other methods, mobile health applications could help improve long-term control of blood pressure

There are thousands of mobile health applications (mHealth apps) available. Most focus on fitness or wellness, such as counting calories or tracking steps. Several hundred apps for smartphones and mobile devices record blood pressure. Some also provide advice on the management of hypertension. Those that display information in a graphic format are particularly useful for both patient and physician to monitor progress at a glance. It is easier to calculate the average levels and see fluctuations over time in a graphic display than with a set of recorded numbers (sometimes jotted down on scraps of paper).

These apps provide an important strategy to improve adherence to self-care – an essential aspect of the effective long-term control of blood pressure. They require self-measured blood pressure monitoring, as recommended in all recent hypertension guidelines. The technology of blood pressure monitors is continually improving, and some can link directly with mHealth apps. It is essential that the devices provide accurate recordings and they should ideally be validated according to criteria developed by the hypertension societies.

It is important to consider whether the use of mHealth apps will improve the control of blood pressure. A recent American Heart Association Scientific Statement reviewed their use for cardiovascular disease prevention. 1 Trials that included feedback to the patient were reviewed. This could be delivered by the internet, e-mail, SMS or similar electronic means, or occasionally by direct telephone contact. It was concluded that a combination of feedback strategies or modes of intervention delivery may be needed to engage patients and provide relevant education, counselling and motivational support.

Many studies have assessed whether mHealth apps can improve blood pressure control. These studies often used the completers’ analysis approach rather than intention to treat. Since many patients dropped out during these studies, the results are representative of those who were compliant with the mHealth technology used. Thus they may not be generalizable to a broad hypertensive population. Several meta-analyses and systematic reviews of these studies and other mHealth approaches have provided cautious support, but have concluded that longer and larger studies are needed. 2-4

In my opinion, one of the most useful mHealth apps for blood pressure monitoring is the EUROHYPERTENSION APP. 5 Its scientific contents are supported and validated by the European Society of Hypertension. Patients can upload their data to a dedicated online platform and authorize their doctor to access their personal data, which should help optimize hypertension management.

References

  1. Burke LE, Ma J, Azar KMJ, et al. Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention: A Scientific Statement From the American Heart Association. Circulation. 2015;132:1157-1213. http://circ.ahajournals.org/content/132/12/1157.short
  2. Liu S, Dunford SD, Leung YW, et al. Reducing blood pressure with Internet-based interventions: a meta-analysis. Can J Cardiol. 2013;29:613-621.http://www.ncbi.nlm.nih.gov/pubmed/23618507
  3. Pfaeffli Dale L, Dobson R, Whittaker R, Maddison R. The effectiveness of mobile-health behaviour change interventions for cardiovascular disease self-management: A systematic review. Eur J Prev Cardiol. 2015.http://cpr.sagepub.com/content/early/2015/10/21/2047487315613462.abstract
  4. Uhlig K, Patel K, Ip S, et al. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Ann Intern Med. 2013;159:185-194.http://www.ncbi.nlm.nih.gov/pubmed/23922064
  5. EUROHYPERTENSION APP. http://www.eshonline.org/guidelines/blood-pressure-monitoring/

Brian Tomlinson

Specialist in Internal Medicine & Clinical Pharmacology
Department of Medicine and Therapeutics
Adjunct Professor
The Chinese University of Hong Kong
Hong Kong, China
new technology
blood pressure monitoring
hypertension societies