MONITORING OF HYPERTENSION USING SMARTPHONE APPLICATIONS: A SYSTEMATIC REVIEW

Abstract

s S213 309 MONITORING OF HYPERTENSION USING SMARTPHONE APPLICATIONS: A SYSTEMATIC REVIEW CN Floyd, K Parmesar, A Ferro London, United Kingdom BACKGROUND: Smartphone applications (apps) have become integrated with many aspects of modern life, with >100,000 apps currently available for use in healthcare. Apps are unregulated and potentially place patients at risk if the information they contain is inaccurate. Additionally, any app that transforms clinical data (e.g. calculating a mean blood pressure (BP)) is a Class 1 medical device and should be registered with the Medicines and Healthcare Regulatory Agency in the UK. Here we present a systematic review of blood pressure (BP) monitoring apps available in the UK. METHODS: The Apple App Store (UK) was searched on 15th March 2014 using the terms “hypertension” OR “blood pressure”. Inclusion criteria were iPhone compatibility, free to use, English language, targeted for patient use, ability to record multiple BP readings and app functionality independent of other medical devices. Data were extracted from each app according to a predefined protocol: conformity to guidelines, presence of data transformation, limits to data input and data protection policy. RESULTS: Following the removal of duplicates, 608 apps were identified of which 96 met the inclusion criteria. Five apps provided advice on how to measure BP, of which four claimed conformity to national and/or international guidelines. A further 11 apps providing advice unrelated to BP measurement technique also claimed conformity to guidelines (15 apps in total; 16%). No apps stated approval by recognised societies. Data transformation was performed by 24 apps (25%), none of which displayed regulatory approval. Three apps did recommend using a specific approved sphygmomanometer, with one providing formulae used for subsequent data transformation. Data input was subject to checks in 60% (58 apps) to ensure that diastolic values were lower than systolic. 25% (24 apps) required a passcode to access stored data, but it was unclear where data was stored (e.g. locally on device or on a server) in 89% of apps. CONCLUSION: There are many apps freely available to patients that enable them to record BP measurements. These unregulated apps conform poorly to recognised guidelines and have the potential to harm if their advice or data transformations are inaccurate. 310 LEFT VENTRICULAR DIASTOLIC DYSSYNCHRONY IN PATIENTS WITH TREATMENT-NAIVE HYPERTENSION AND THE EFFECTS OF ANTIHYPERTENSIVE THERAPY B Kwon, J Roh, H Kim, S Ihm Seogwipo, Korea, Republic of BACKGROUND: We investigated (1) DD in patients with treatment-naive hypertension, compared with normal controls; (2) the determinants of the presence of DD by performing comprehensive studies including laboratory, arterial stiffness, central blood pressure (BP), ambulatory BP monitoring (ABPM), and transthoracic echocardiography (TTE) evaluations; (3) the effects of 6-month antihypertensive therapy on DD; and (4) the predictors associated with change of DD after medical therapy. METHODS: 325 treatment-naive hypertensive patients and 172 normal controls were prospectively enrolled. Hypertensive patients were followed up at 6 months after medical therapy, and were assessed by serial TTE (at baseline and 6-month follow-up visit) and clinical evaluations. The time-to-peak myocardial early diastolic velocity (Te) of the 12 LV segments was measured with reference to the QRS complex. The standard deviation (SD) of Te of all 12 LV segments (TeSD12) and the maximal difference in Te between any 2 of the 12 LV segments (Te-Max) were calculated. A Te-SD12 34 or Te-Max 113 ms was regarded as indicating the presence of DD. RESULTS: DD was more prevalent in treatment-naive hypertensive patients, compared with normal controls (15.4% vs. 7.0%, P1⁄40.007). Male (odds ratio [OR], 7.60, 1.6934.30), magnesium (OR per 1 SD, 4.18, 1.54-11.30), nighttime heart rate (HR) (OR per 1 SD, 2.79, 1.19-6.53), and mitral E/A (OR per 1 SD, 0.11, 0.03-0.41) were independent determinants for the DD in hypertensive patients. A 6-month follow-up echocardiography was performed in 74 of 275 patients without DD (group 1) and 26 of 50 patients with DD (group 2). DD (Te-SD12, D1⁄4-8.3 ms and Te-Max, D1⁄4-27.6 ms and prevalence, D1⁄4-42.3%, all P<0.05) improved in group 2, while those did not in group 1. Baseline daytime HR (P1⁄40.008) and magnesium levels (P 1⁄4 0.029) and changes of the mitral E/A (P 1⁄4 0.003), mean annulus Ea (P 1⁄4 0.003), mean annulus Ea/Aa (P 1⁄4 0.020), and mitral peak E (P 1⁄4 0.042) were independent predictors for changes of DD. CONCLUSION: DD is not rare in treatment-naive hypertensive patients. Male gender, magnesium levels, nighttime HR, and mitral E/A are independent determinants for the impaired DD. Antihypertensive therapy reduces both the severity and prevalence of DD in patients with impaired DD. Daytime HR, magnesium levels, and indicative of diastolic dysfunction are independent predictors for improvements in DD. Thus, magnesium levels, HR, and diastolic dysfunction seem to have important implications for DD in hypertensive patients, whereas LV hypertrophy, office BPs, arterial stiffness, central BPs, and ABPM parameters do not.