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E-Bulletin No. 5 - June 2022 | Digital Health and Hypertension Management

Published on: 30 Jun 2022 Viewed: 111

On June 9, 2022, the original article from Prof. Nadia A. Khan's research team--“Digital health technology and hypertension management: a qualitative analysis of patient and specialist provider preferences on data tracking ” was published in Connected Health (CH). The research shows that patients and hypertension specialists had similar perspectives for most aspects of data monitoring but differed in preference for a few aspects that were germane to patients, including monitoring medication adverse effects and symptoms. Meanwhile, some experts also published qualified papers on this topic recently:

Title: Clinic, Home, and Kiosk Blood Pressure Measurements for Diagnosing Hypertension: a Randomized Diagnostic Study
Authors: Beverly B Green, Melissa L Anderson, Andrea J Cook, Kelly Ehrlich, Yoshio N Hall, Clarissa Hsu, Dwayne Joseph, Predrag Klasnja, Karen L Margolis, Jennifer B McClure, Sean A Munson, Mathew J Thompson
Type: Original Article
Background: The US Preventive Services Task Force recommends blood pressure (BP) measurements using 24-h ambulatory monitoring (ABPM) or home BP monitoring before making a new hypertension diagnosis.
Objective: Compare clinic-, home-, and kiosk-based BP measurement to ABPM for diagnosing hypertension.
Design, Setting, and Participants: Diagnostic study in 12 Washington State primary care centers, with participants aged 18–85 years without diagnosed hypertension or prescribed antihypertensive medications, with elevated BP in clinic.
Interventions: Randomization into one of three diagnostic regimens: (1) clinic (usual care follow-up BPs); (2) home (duplicate BPs twice daily for 5 days); or (3) kiosk (triplicate BPs on 3 days). All participants completed ABPM at 3 weeks.
Main Measures: Primary outcome was difference between ABPM daytime and clinic, home, and kiosk mean systolic BP. Differences in diastolic BP, sensitivity, and specificity were secondary outcomes.
Key Results: Five hundred ten participants (mean age 58.7 years, 80.2% white) with 434 (85.1%) included in primary analyses. Compared to daytime ABPM, adjusted mean differences in systolic BP were clinic (−4.7mmHg [95% confidence interval −7.3, −2.2]; P<.001); home (−0.1mmHg [−1.6, 1.5];P=.92); and kiosk (9.5mmHg [7.5, 11.6];P<.001). Differences for diastolic BP were clinic (−7.2mmHg [−8.8, −5.5]; P<.001); home (−0.4mmHg [−1.4, 0.7];P=.52); and kiosk (5.0mmHg [3.8, 6.2]; P<.001). Sensitivities for clinic, home, and kiosk compared to ABPM were 31.1% (95% confidence interval, 22.9, 40.6), 82.2% (73.8, 88.4), and 96.0% (90.0, 98.5), and specificities 79.5% (64.0, 89.4), 53.3% (38.9, 67.2), and 28.2% (16.4, 44.1), respectively.
Limitations: Single health care organization and limited race/ethnicity representation.
Conclusions: Compared to ABPM, mean BP was significantly lower for clinic, significantly higher for kiosk, and without significant differences for home. Clinic BP measurements had low sensitivity for detecting hypertension. Findings support utility of home BP monitoring for making a new diagnosis of hypertension.
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Title: Pandemic-Related Impairment in the Monitoring of Patients With Hypertension and Diabetes and the Development of a Digital Solution for the Community Health Worker: Quasiexperimental and Implementation Study
Authors: Christiane Correa Rodrigues Cimini, Junia Xavier Maia, Magda Carvalho Pires, Leonardo Bonisson Ribeiro, Vânia Soares de Oliveira e Almeida Pinto, James Batchelor, Antonio Luiz Pinho Ribeiro, Milena Soriano Marcolino
Type: Original Article
Background: The restrictions imposed by the COVID-19 pandemic reduced health service access by patients with chronic diseases. The discontinuity of care is a cause of great concern, mainly in vulnerable regions.
Objective: This study aimed to assess the impact of the COVID-19 pandemic on people with hypertension and diabetes mellitus (DM) regarding the frequency of consultations and whether their disease was kept under control. The study also aimed to develop and implement a digital solution to improve monitoring at home.
Methods: This is a multimethodological study. A quasiexperimental evaluation assessed the impact of the pandemic on the frequency of consultations and control of patients with hypertension and DM in 34 primary health care centers in 10 municipalities. Then, an implementation study developed an app with a decision support system (DSS) for community health workers (CHWs) to identify and address at-risk patients with uncontrolled hypertension or DM. An expert panel assessment evaluated feasibility, usability, and utility of the software.
Results: Of 5070 patients, 4810 (94.87%) had hypertension, 1371 (27.04%) had DM, and 1111 (21.91%) had both diseases. There was a significant reduction in the weekly number of consultations (107, IQR 60.0-153.0 before vs 20.0, IQR 7.0-29.0 after social restriction; P<.001). Only 15.23% (772/5070) of all patients returned for a consultation during the pandemic. Individuals with hypertension had lower systolic (120.0, IQR 120.0-140.0 mm Hg) and diastolic (80.0, IQR 80.0-80.0 mm Hg) blood pressure than those who did not return (130.0, IQR 120.0-140.0 mm Hg and 80.0, IQR 80.0-90.0 mm Hg, respectively; P<.001). Also, those who returned had a higher proportion of controlled hypertension (64.3% vs 52.8%). For DM, there were no differences in glycohemoglobin levels. Concerning the DSS, the experts agreed that the CHWs can easily incorporate it into their routines and the app can identify patients at risk and improve treatment.
Conclusions: The COVID-19 pandemic caused a significant drop in the number of consultations for patients with hypertension and DM in primary care. A DSS for CHW has proved to be feasible, useful, and easily incorporated into their routines.
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Title: Patient and Health Professional Perceptions of Telemonitoring for Hypertension Management: Qualitative Study
Authors: Juliana Baratta, Cati Brown-Johnson, Nadia Safaeinili, Lisa Goldman Rosas, Latha Palaniappan, Marcy Winget, Megan Mahoney
Background: Hypertension is the most prevalent and important risk factor for cardiovascular disease, affecting nearly 50% of the US adult population; however, only 30% of these patients achieve controlled blood pressure (BP). Incorporating strategies into primary care that take into consideration individual patient needs, such as remote BP monitoring, may improve hypertension management.
Objective: From March 2018 to December 2018, Stanford implemented a precision health pilot called Humanwide, which aimed to leverage high-technology and high-touch medicine to tailor individualized care for conditions such as hypertension. We examined multi-stakeholder perceptions of hypertension management in Humanwide to evaluate the program’s acceptability, appropriateness, feasibility, and sustainability.
Methods: We conducted semistructured interviews with 16 patients and 15 health professionals to assess their experiences with hypertension management in Humanwide. We transcribed and analyzed the interviews using a hybrid approach of inductive and deductive analysis to identify common themes around hypertension management and consensus methods to ensure reliability and validity.
Results: A total of 63% (10/16) of the patients and 40% (6/15) of the health professionals mentioned hypertension in the context of Humanwide. These participants reported that remote BP monitoring improved motivation, BP control, and overall clinic efficiency. The health professionals discussed feasibility challenges, including the time needed to analyze BP data and provide individualized feedback, integration of BP data, technological difficulties with the BP cuff, and decreased patient use of remote BP monitoring over time.
Conclusions: Remote BP monitoring for hypertension management in Humanwide was acceptable to patients and health professionals and appropriate for care. Important challenges need to be addressed to improve the feasibility and sustainability of this approach by leveraging team-based care, engaging patients to sustain remote BP monitoring, standardizing electronic medical record integration of BP measurements, and finding more user-friendly BP cuffs.
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Title: Effect of Self-monitoring of Blood Pressure on Diagnosis of Hypertension During Higher-Risk Pregnancy
Authors: Katherine L. Tucker, Sam Mort, Ly-Mee Yu
Importance: Inadequate management of elevated blood pressure (BP) is a significant contributing factor to maternal deaths. Self-monitoring of BP in the general population has been shown to improve the diagnosis and management of hypertension; however, little is known about its use in pregnancy.
Objective: To determine whether self-monitoring of BP in higher-risk pregnancies leads to earlier detection of pregnancy hypertension.
Design, Setting, and Participants: Unblinded, randomized clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks’ gestation from 15 hospital maternity units in England between November 2018 and October 2019. Final follow-up was completed in April 2020.

Interventions: Participating individuals were randomized to either BP self-monitoring with telemonitoring (n = 1223) plus usual care or usual antenatal care alone (n = 1218) without access to telemonitored BP.
Main Outcomes and Measures: The primary outcome was time to first recorded hypertension measured by a health care professional.
Results: Among 2441 participants who were randomized (mean [SD] age, 33 [5.6] years; mean gestation, 20 [1.6] weeks), 2346 (96%) completed the trial. The time from randomization to clinic recording of hypertension was not significantly different between individuals in the self-monitoring group (mean [SD], 104.3 [32.6] days) vs in the usual care group (mean [SD], 106.2 [32.0] days) (mean difference, −1.6 days [95% CI, −8.1 to 4.9]; P = .64). Eighteen serious adverse events were reported during the trial with none judged as related to the intervention (12 [1%] in the self-monitoring group vs 6 [0.5%] in the usual care group).
Conclusions and Relevance: Among pregnant individuals at higher risk of preeclampsia, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly earlier clinic-based detection of hypertension.
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Title: Home Blood Pressure Monitoring for Hypertension Diagnosis by Current Recommendations: A Long Way to Go
Authors: Kelsey B. Bryant, Matthew B. Green, Daichi Shimbo, Joseph E. Schwartz, Ian M. Kronish, Yiyi Zhang, James P. Sheppard, Richard J. McManus, Andrew E. Moran and Brandon K. Bellows
Out-of-office blood pressure (BP) monitoring (eg, home BP monitoring [HBPM] or ambulatory BP monitoring) to confirm a diagnosis of hypertension before treatment initiation after initial office screening is recommended by the United States Preventive Services Task Force and 2017 American College of Cardiology and American Heart Association (ACC/AHA) BP guidelines.1,2 One tool that may be used to help identify those in need of confirmatory BP monitoring is the Predicting Out-of-Office BP (PROOF-BP) algorithm, which uses office BP measurements and clinical characteristics to predict a patient’s out-of-office BP.3 Though many providers report recommending out-of-office BP monitoring to patients, the baseline frequency of its use for specific indications, such as confirming a diagnosis of hypertension, is not known.4 Further, barriers relevant to the accessibility and affordability of out-of-office BP monitoring have led to concerns that there may be disparities in the uptake of hypertension screening recommendations.5 This analysis examined how historical use of HBPM aligns with current out-of-office BP monitoring recommendations for hypertensive US adults without a previous hypertension diagnosis, and how HBPM use varies by patient characteristics.
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Furthermore, we also list some NEWS about the related topic in the scientific circles:
Hello Heart snagged $45 million in fresh capital to build out its technology that helps patients to manage their blood pressure, pulse, medications and physical activity using artificial intelligence. Users can track their health information from a smartphone and then receive feedback and suggestions of health improvements via the phone (, last access: 28 June 2022). According to Globenewswire, a Transparency Market Research (TMR) study on the blood pressure monitoring devices market states that Government authorities of several nations around the world are taking initiatives in order to decrease the prevalence of hypertension and heart attack and the global blood pressure monitoring devices market is estimated to register growth at a CAGR of 9.2% during the forecast period, from 2021 to 2031 (, last access: 28 June 2022).

We hope our sharing will inspire you. Looking forward to meeting you next time in CH Bulletin.

Respectfully submitted by the Editorial Office of Connected Health

Written by Abby Zhang

Assistant Editor of Connected Health

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