Mobile health apps help reduce BP, improve patient-provider coordination

Use of a mobile health application (mHealth app) in clinical practice results in better patient-provider coordination, enables customized care, and is associated with a substantial decrease in blood pressure (BP) for average and high-severity patients, a study has shown.

“In this observational study of patients seen at a hypertension clinic, use of a physician-supervised mHealth app was significantly associated with improved health outcomes,” the researchers said. “Therefore, the use of an mHealth app enables a healthcare system to be proactive (especially for a silent killer such as hypertension) and can significantly improve quality of care.”

A total of 1,633 patients seen at a hypertension clinic managed by an endocrinologist were included in this study, of whom 726 adopted the app and 907 had not. The app allowed patients and physicians to monitor BP, blood sugar, and other vital signs.

Patients decided whether to opt in to using the app and how often to upload their readings. The provider could then offer feedback and communicate with patients through the app.

The researchers evaluated the change in office-based BP measurement before and after the app adoption, at least 12 months apart, and conducted a difference-in-difference analysis along with matching based on patient-individual characteristics.

The difference-in-difference estimates were 6.23 mm Hg systolic (95 percent confidence interval [CI], 0.87–11.59) for patients with systolic (S)BP of ≥150 mm Hg, 4.01 mm Hg systolic (95 percent CI, 1.11–6.91) for patients with SBP ≥140 mm Hg, 4.37 mm Hg diastolic (95 percent CI, 1.06–7.68) for patients with diastolic (D)BP ≥90 mm Hg, and 1.89 mm Hg systolic (95 percent CI, 0.58–3.2) and 0.87 mm Hg diastolic (95 percent CI, 0.17–1.57) overall for an average patient. [J Hypertens 2021;39:2265-2271]

Of note, higher frequency of app usage resulted in greater BP reduction. The app improved information flow and provided more opportunities for the provider to intervene, as well as filled in for the sporadic office visits and offered a more complete picture of the patient profile since the last office visit.

In addition, the mHealth app could track and visually present the mean arterial BP, mean SBP and DBP, and pulse with Kalman filter and age adjuster. It could also show longitudinal information on pulse variability, stiffening index, and pulse stiffening ratio.

“Technology can be used to reduce asymmetry and improve coordination, deliver patient-centred care, improve quality of care, and reduce healthcare cost,” the researchers said.

A study by Dishman in 2015 identified three “pillars of personal health,” namely “care anywhere, care customization, and care networking.” [Dishman E. Toward personal health: going home and beyond. Washington (DC): National Academies Press (US); 2015]

The current study had limitations. “One of the barriers to wider adoption of mHealth apps by providers is the uncertainty around operational implications of using such an app in practice; we showed that there is significant benefit to both patients and physicians, a fact that when publicized, may serve to mitigate this barrier,” the researchers said.

Measuring BP through mHealth can complement office BP monitoring and personalize interventions, thus contributing to a more precise medicine, they added. [Hypertension 2017;70:e20-e31]

“Our research focused on investigating the benefits of this specific app in a clinical practice without focusing on a specific functionality of the app,” the researchers noted. “Although we did establish a significant association, we did not establish which of the different factors in the app benefit patients.”

Additionally, anecdotal evidence indicated provider supervision based on extended longitudinal data as the main driver behind the benefit of mHealth apps. However, proving the effect of supervision empirically was beyond the scope of the data the researchers had access to.