Self-monitoring Of Blood Pressure Research Articles

Towards an integrated blood pressure self-monitoring solution for stroke/TIA in Ireland: a mixed methods feasibility study for the TASMIN5S IRL randomised controlled trial

BackgroundOptimising blood pressure (BP) control is one of the most important modifiable risk factors in preventing subsequent stroke where the risk increases by one-third for every 10 mmHg rise in systolic BP. This study evaluated the feasibility and potential effectiveness of blood pressure self-monitoring with planned medication titration, to inform a definitive trial of the intervention, in patients with a previous stroke or transient ischaemic attack (TIA).MethodsPatients with a history of stroke/TIA and sub-optimal BP control were invited to take part in a mixed methods feasibility study for a randomised controlled trial. Those meeting the inclusion criteria with systolic BP >130 mmHg were randomised to a self-monitoring intervention group or usual care group. The intervention involved self-monitoring BP twice a day for 3 days within a 7-day period, every month, following text message reminders. Treatment escalation, based on a pre-agreed plan by the general practitioner (GP) and patient, was initiated according to the results of these readings. Semi-structured interviews were carried out with patients and clinicians and analysed thematically.ResultsOf those identified, 47% (32/68) attended for assessment. Of those assessed, 15 were eligible for recruitment and were consented and randomised to the intervention or control group on a 2:1 basis. Of those randomised, 93% (14/15) completed the study and there were no adverse events. Systolic BP was lower in the intervention group at 3 months. Participants found the intervention acceptable and easy to use. GPs found it easy to incorporate into their practice activity without increasing workload.ConclusionsTASMIN5S, an integrated blood pressure self-monitoring intervention in patients with a previous stroke/TIA, is feasible and safe to deliver in primary care. A pre-agreed three-step medication titration plan was easily implemented, increased patient involvement in their care, and had no adverse effects. This feasibility study provides important information to inform a definitive trial to determine the potential effectiveness of the intervention in patients post-stroke or TIA.Trial registrationISRCTN57946500. Registered on 12/08/2019.

S-15-2: COMMUNITY-BASED APPROACHES TO PREVENTION AND MANAGEMENT OF HYPERTENSION

There are multiple level factors that contribute to hypertension prevalence and control across various racial/ethnic populations. Hypertension rates in non-Hispanic Black (African American) adults in the USA are among the highest globally, impacted by the social determinants of health. Clinical approaches include team-based care, encouraging self-measured blood pressure, and strengthening community-clinical linkages. Prevention of new-onset hypertension and complications has been clearly demonstrated with community-level NaCl substitution in China and Peru. In the USA, Black population treatment approaches as community interventions include early initiatives from the Association of Black Cardiologists and the Healthy Heart Community Prevention Project (HHCPP) in New Orleans. The HHCPP was one of the early adopters of using barbers and hair stylists as hypertension control centers, working with faith-based institutions, and doing community education and outreach. Evidence-based approaches, now proven to be effective, include the faith-based treatment program for hypertension in New York, NY and a very successful in cluster-randomized trial demonstrating hypertension control in Black barbershops in Los Angeles, CA. The positive components of the Los Angeles barbershop intervention include trusted site of blood pressure intervention, physician-pharmacist collaboration, and effective anti-hypertensive medication including initial two drug protocol with amlodipine and a long-acting RAS blocker, and the appropriate use of aldosterone antagonists. Ongoing research include a small pilot study, simple text messaging and social support in New Orleans for medication adherence which will be reported at the AHA 2022 scientific sessions, and a large church-based health intervention study addressing primary prevention, including hypertension in New Orleans among 42 selected African American churches using community health workers in a combination of exercise weight-loss programs, self-monitoring blood pressure, glucose, and physical activity, and group education centers. In the USA, the American Heart Association in conjunction with the US Department of Health and Human services have initiated a national hypertension control initiative. Overarching strategies include patient and public education, community outreach and integration, and healthcare organization including provider and clinician training, as well as management evaluation of the project. This national program will engage community partners with federal health centers. In conclusion, hypertension can be controlled with evidence-based medicines, not only in clinical settings, but also with interventions in the community environment. Therapeutic lifestyle and evidence-based pharmacotherapy along with self-monitored blood pressure can lead to blood pressure control, especially in racial/ethnic populations.

Investigating the effect of an mHealth coaching intervention on health beliefs, adherence and blood pressure of patients with hypertension: A longitudinal single group pilot study.

Mobile health technologies have shown promise as delivery platforms for digital health coaching for chronic conditions. However, the impacts of such strategies on users' health beliefs, intentions and ultimately clinical outcomes are understudied. This study sought (1) to evaluate the effects of a digital health coaching intervention on participants' belief constructs; and (2) to assess relationships between these belief constructs and intentions to utilize the technological intervention, actual adherence metrics and clinical outcomes related to hypertension. Thirty-four participants with hypertension were recruited from a university community from January to May 2021. They self-measured weight and blood pressure (BP) for 30 days followed by digital coaching delivered via a mobile application for 30 days. Surveys assessed constructs from the Health Belief Model and Technology Acceptance Model, compared to intention, health belief, BP self-monitoring adherence and BP outcomes. A path analysis model was used to assess the relationships between constructs and intention, adherence metrics and clinical outcomes. A Kruskal-Wallis test was used to identify changes in beliefs. Participant health beliefs significantly improved after coaching, including self-efficacy (H(1) = 15.12, p < 0.001), cues to action (H(1) = 5.33, p = 0.02), attitude (H(1) = 10.35, p = 0.002), perceived usefulness (H(1) = 15.02, p < 0.001) and decreased resistance to change (H(1) = 4.05, p = 0.04). Adherence to BP measurements positively correlated with perceived health threat (β = .033, p = 0.007) and perceived ease of use (β = .0277, p < 0.001). Self-efficacy (β = -2.92, p = 0.02) and perceived usefulness (β = -3.75, p = 0.01) were linked with a decrease in diastolic BP. A mobile health coaching intervention may help participants improve beliefs regarding hypertension self-management.

S-23-2: CLINICAL SIGNIFICANCE OF WORK STRESS INDUCED INCREASE IN BLOOD PRESSURE IN HYPERTENSION MANAGEMENT

We usually spend about one third time of a day for working. So it is critically important for our health if the working condition is comfortable or stressful. In many developed countries including Japan, retirement age tended to be delayed due to several reasons. This means that we must spend more time for work in our life. Elderly people are vulnerable to brain and heart diseases. So the establishment of less stressful work condition and risk management is increasingly important to prevent work-related cardiovascular events or Karoshi. Among 203 Karoshi cases received worker compensation in Japan, 60 % died of stroke while remaining cardiovascular diseases. For occupational factor, long working has been considered as a risk of Karoshi. Meta-analysis has also shown that long working hours are associated with increased risk of cardiovascular diseases, especially for stroke. In Karoshi cases, most prevalent risk factor was hypertension (40%). However, the review of literature has shown that the relationship between long working hours and blood pressure increase or hypertension is inconsistent. Interestingly, some data showed that long working hours are associated with lower risk of hypertension, suggesting that the relationship between working long hours and blood pressure increase is confounded by other factors like qualitative work stress. Karoshi unexpectedly occur. Therefore in a real world, we need to obtain an individual information on blood pressure response during work to adequately manage work-related hypertension. Ambulatory blood pressure monitoring is an ideal method to monitor blood pressure behavior during work but is not practical to perform repeatedly with short duration. Self-measurement of blood pressure may replace ambulatory monitoring to examine work-related blood pressure variation. We studied 207 treated hypertensive subjects working for 29 Rosai hospitals. Blood pressures and heart rate were measured by themselves with an automated device at standardized conditions 4 times a day: after waking, 10:00 h, 16:00 h, and before sleep on three days (Monday, Friday, and Saturday or Sunday). We could observe clear daily and weekly variation of rate pressure product (systolic blood pressure × heart rate). The increase in rate pressure product on Monday morning was significantly correlated with urinary albumin excretion and job strain index in women. Our data showed the feasibility of self-monitoring of blood pressure and heart rate at workplace. This method would be useful to monitor work-stress related hypertension in several overwork situation.

The Logics of Invited and Uninvited Material Participation

This paper addresses debates concerning the ‘participatory turn’ in healthcare. It focuses on the case of blood pressure self-monitoring, understanding this as a form of patient participation at the level of individual care. Drawing and expanding on the work of Marres and Wynne and their notions of material participation and of uninvited engagement, we examine how patients’ home blood pressure self-monitoring is incorporated into clinical care, how the materials of blood pressure self-monitoring mediate participation and how we might characterise the practices of participation found within everyday clinical care. Our analysis makes new conceptual links, suggesting that, in this context, invited participation appears to align with participation made easy, while uninvited participation involves more invested, more engaged participation. We offer two further developments of these concepts. First, we trouble characterisations of invited and uninvited participation as distinct and separate, observing movement between these. Second, through applying the logics of material participation in a new context, everyday clinical practice, we suggest that the logic of participation made easy might be extended beyond lay people, to apply to professionals as well. Our analysis illustrates how materials are mobilised to facilitate invited and uninvited participation within the context of the on-going asymmetries in doctor patient relationships.

Digital interventions for hypertension and asthma to support patient self-management in primary care: the DIPSS research programme including two RCTs

Digital interventions for hypertension and asthma to support patient self-management in primary care: the DIPSS research programme including two RCTs

Effectiveness of an mHealth application on remote monitoring and self-management of persons with hypertension in a coastal taluk of Udupi district: A study protocol

Background: Hypertension is the most important risk factor for cardiovascular disease, a major cause of death and disability globally. There is increasing evidence that demonstrates clinically relevant benefits from self-monitoring and self-management of blood pressure. Evidence suggests a reduction of systolic BP by 3.2 mm/hg through self-monitoring. The use of mHealth applications in health care monitoring and self-management can help in the timely delivery of health information. Around 33% of Indians use mHealth applications in their daily life. However, well-designed, user complied mHealth applications are essential to reach the masses and to be effective. A previously conducted study in India demonstrated that applications are not customized according to users' needs and expectations and lacked usability assessment by patients. Therefore, we aimed to develop and test a novel mHealth application on remote monitoring and self-management in hypertension. Methods: The study will be carried out in three phases. The first phase will be an in-depth interview to identify the required parameters to develop a customized mHealth android-based application to monitor hypertension. The second phase is to develop the customized application through the Agile development design using the android studio platform. In the third phase, a community-based cluster randomized trial will be carried out to assess the effectiveness of the mHealth intervention on the remote monitoring and self-management of people with hypertension. A sample of 236 people from 12 villages will be randomized and the mHealth application will be delivered to the intervention group and the standard regimen will be continued in the control group. Results: In the proposed study if the intervention is found to be helpful, then hypertension patients in the community can be encouraged to install the mHealth application. This application, if found effective can improve the health status, knowledge, and self-care approach among hypertensive patients. Registration: CTR India (CTRI/2022/03/041544).

Abstract 12551: Self-Monitoring of Blood Pressure and Feedback Using App in Treatment of Uncontrolled Hypertension: SMART-BP Study

Introduction: Self-monitoring of blood pressure (SMBP) is a reliable method used to assess blood pressure (BP) accurately. However, patients do not often know how to respond to the measured BP value. We developed a mobile application-based feedback for tailored recommendations and aimed to evaluate whether this feedback is superior to SMBP alone in terms of BP reduction and drug compliance improvement in patients with hypertension. Methods: Self-Monitoring of and Feed-back using APP in TReatment of UnconTrolled Blood Pressure (SMART-BP) is a prospective, randomized, open-label, multicenter trial to evaluate the efficacy of SMBP-App compared with SMBP alone. In the SMBP alone group, the patients performed home BP measurement and receive the standard care, whereas in the SMBP-App group, the patients received additional recommendations from the application using feedback algorithm in response to the obtained BP value. The primary endpoints were mean home BP and adherence of antihypertensive medication. Follow-up visits were scheduled at 12 and 24 weeks after randomization. Results: Among total 173 patients (88 for SBMP-App and 85 for SMBP alone) with full-analysis set, 53% were men, and mean age was 59.8 years. Baseline characteristics including BP were not significantly different between the two groups. At 24 weeks, mean reduction in home systolic BP was significantly higher in SMBP-App group than SBMP alone group (-22.4±13.5 vs. -17.2±13.3, P=0.019). Also, SMBP-App group showed higher drug adherence value and proportion of ≥95% adherence than in SMBP alone group (100% [97.2%-100.0%] vs. 97.6% [94.0%-100.0%], P=0.025; 86.1% vs. 68.0%, P=0.013). Reduction in home systolic BP at 12 weeks and office systolic BP at 12 or 24 weeks were also higher in SBMP-App, similar with primary end point. Conclusions: SMBP-App is superior to SMBP alone in terms of blood pressure reduction and improved drug adherence in patients with hypertension.

Abstract 11861: Reach Out Behavioral Intervention for Hypertension Initiated in the Emergency Department Connecting Multiple Health Systems: A Randomized Control Trial

Introduction: Hypertension (HTN) is the most important modifiable risk factor for cardiovascular disease and disproportionally impacts Black and low-income people. The emergency department (ED) cares for medically underserved populations, many of whom have HTN. Mobile health (mHealth) strategies initiated in safety-net EDs may be one approach to control blood pressure (BP) in a medically underserved population. Hypothesis: A multicomponent, ED initiated multiphase optimization strategy would identify intervention components that reduce BP at 12 months. Methods: Reach Out is a health system focused, health theory based, mHealth 2x2x2 factorial behavioral trial to reduce BP among hypertensive patients evaluated in a safety-net ED. Intervention components included: 1) healthy behavior text messaging (yes vs. no), 2) prompted BP self-monitoring (SMBP) (weekly vs. daily), and 3) facilitated primary care provider (PCP) appointment scheduling and transportation (yes vs. no). The primary outcome was change in systolic BP (SBP) from baseline to 12 months. We fit linear regression models accounting for intervention components, age, sex, race and prior use of BP medications. Results: We randomized 488 participants to the intervention and 211 (43%) participants completed 12-month follow-up. The mean age was 45.5 years, 61% were women, 54% were Black people, 22% did not have a PCP, 10% were uninsured, 21% lacked transportation, 21% did not have a previous diagnosis of HTN and 51% were not taking BP medications. SBP declined in all 8 groups. Overall, across all groups, SBP declined (-9.2 mmHg, 95%CI, -12.2 to -6.3) after 6 months and (-6.6 mmHg, -9.3 to -3.8) after 12 months. In fully adjusted models, no intervention components were associated with a change in systolic BP at 12 months. Conclusions: Higher intensity of the intervention components were not associated with greater reduction in BP. Overall, participants receiving lower intensity levels of our intervention had reductions of BP that were clinically relevant. Future studies should focus on further tailoring intervention components to the needs of participants.

Effect of Self-Monitoring of Blood Pressure on Diagnosis of Hypertension During Higher-Risk Pregnancy: The BUMP 1 Randomized Clinical Trial

ABSTRACT (Abstracted from JAMA 2022;327:1656–1665 It is estimated that approximately 10% of pregnancies worldwide in 2019 were affected by elevated blood pressure (BP). The United Kingdom has previously reported inadequate monitoring of elevated BP as a significant contributing factor to maternal death.

Home Blood Pressure Self-monitoring plus Self-titration of Antihypertensive Medication for Poorly Controlled Hypertension in Primary Care: the ADAMPA Randomized Clinical Trial

BackgroundPatient empowerment through pharmacological self-management is a common strategy in some chronic diseases such as diabetes, but it is rarely used for controlling blood pressure.ObjectiveThis study aimed to assess self-monitoring plus self-titration of antihypertensive medication versus usual care for reducing systolic blood pressure (SBP) at 12 months in poorly controlled hypertensive patients.DesignThe ADAMPA study was a pragmatic, controlled, randomized, non-masked clinical trial with two parallel arms in Valencia, Spain.ParticipantsHypertensive patients older than 40 years, with SBP over 145 mmHg and/or diastolic blood pressure (DBP) over 90 mmHg, were recruited from July 2017 to June 2018.InterventionParticipants were randomized 1:1 to usual care versus an individualized, pre-arranged plan based on self-monitoring plus self-titration.Main MeasureThe primary outcome was the adjusted mean difference (AMD) in SBP between groups at 12 months.Key ResultsPrimary outcome data were available for 312 patients (intervention n=156, control n=156) of the 366 who were initially recruited. The AMD in SBP at 12 months (main analysis) was −2.9 mmHg (95% CI, −5.9 to 0.1, p=0.061), while the AMD in DBP was −1.9 mmHg (95% CI, −3.7 to 0.0, p=0.052). The results of the subgroup analysis were consistent with these for the main outcome measures. More patients in the intervention group achieved good blood pressure control (<140/90 mmHg) at 12 months than in the control group (55.8% vs 42.3%, difference 13.5%, 95% CI, 2.5 to 24.5%, p=0.017). At 12 months, no differences were observed in behavior, quality of life, use of health services, or adverse events.ConclusionSelf-monitoring plus self-titration of antihypertensive medication based on an individualized pre-arranged plan used in primary care may be a promising strategy for reducing blood pressure at 12 months compared to usual care, without increasing healthcare utilization or adverse events.Trial RegistrationEudraCT, number 2016-003986-25 (registered 17 March 2017) and clinicaltrials.gov, NCT03242785.

A novel blood pressure monitoring technique by smart HUAWEI WATCH: A validation study according to the ANSI/AAMI/ISO 81060-2:2018 guidelines.

BackgroundGiven the rapid innovation of wearable technology, additional physical indicators can be detected, and blood pressure (BP) has become the focus of many emerging medical-device manufacturers. This study aimed to validate the accuracy of the newly developed HUAWEI WATCH in BP monitoring, according to the American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO 81060-2:2018) guidelines.Materials and methodsThe same arm sequential BP measurement was applied. One validation included four reference BP measurements taken simultaneously by two independent observers using a mercury sphygmomanometer, alternating with three test-watch measurements. Each test-watch measurement was compared against the average of the previous and subsequent reference BP readings. Two criteria were required for validation: (1) a mean BP difference of 5 mm Hg or less, with a standard deviation (SD) of 8 mm Hg or less for systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the 255 pairs of measurements, and (2) an SD for the of 85 averaged BP differences within the threshold defined by the mean test-reference BP difference listed in the ANSI/AAMI/ISO 81060-2:2018 guidelines.ResultsThe mean age of the 85 participants was 48 ± 18 years (range: 21–85), and 53 (62.4%) were male. The mean differences between the test and reference BPs were -0.25 ± 5.62 mm Hg and -1.33 ± 6.81 mm Hg for SBP and DBP, respectively (according to Criterion 1). The mean differences between the test BPs and reference BPs were -0.25 ± 5.00 mm Hg and -1.33 ± 6.31 mm Hg for SBP and DBP, respectively, according to Criterion 2.ConclusionBlood pressure measurement using the HUAWEI WATCH showed excellent consistency with reference BPs, and fulfilled both validation criteria of the guidelines, show its promise as a wearable device for BP self-monitoring.

A Critical Review of Medication Adherence in Hypertension: Barriers and Facilitators Clinicians Should Consider.

Hypertension is a global public health problem, and its prevalence is increasing worldwide. Impacting all human societies and socioeconomic strata, it remains the major modifiable risk factor for global burden of cardiovascular disease all-cause mortality and the leading cause of loss of disability-adjusted life years. Despite increased awareness, the rate of blood pressure control remains unsatisfactory, particularly in low- to middle-income countries. Apparent treatment-resistant hypertension is associated with worse adverse health outcomes. It includes both true resistant and pseudo-resistant hypertension, which requires out-of-office blood pressure monitoring to exclude white-coat effect and confirmation of adherence to the agreed recommended antihypertensive therapy. The depth of medication non-adherence remains poorly recognized among medical practitioners, thus presenting an underestimated modifiable risk factor. Medication non-adherence is a complex and multidimensional variable with three quantifiable phases: initiation, implementation, and discontinuation, collectively called persistence. Non-adherence can be both intentional and non-intentional and usually involves several interconnected factors. Persistence declines over time in the treatment of chronic diseases like hypertension. The risk is higher in patients with new diagnosis, poor insurance status, polypharmacy, and multiple comorbidities, particularly psychiatric disorders. The World Health Organization divides the contributing factors impacting adherence into five categories. Screening and detection for medication non-adherence are challenging due to its dynamic nature and potential white-coat effect. Easy-to-conduct screening methods have low reliability and validity, whereas more reliable and valid methods are costly and difficult to perform. Medication non-adherence is associated with poor clinical outcome and potential negative impact on health-care costs. Evaluation of adherence should become an integral part of assessment of patients treated for hypertension. Medication adherence can significantly improve with a patient-centered approach, non-judgmental communication skills, and collaborative multidisciplinary management, including engagement of the patients in their care by self-blood pressure monitoring.

MEASURING WITH MEANING: PATIENTS' PERSPECTIVE ON SELF-MONITORING OF BLOOD PRESSURE VIA VIRTUAL VISIT

Hypertension is the principal cause of death and disability worldwide, in addition to being a major risk factor for most cardiovascular diseases. The World Health Organization estimated that globally 1.28 billion adults between ages of 30-79 have hypertension. In Canada, between 2012-2015, 1 in 4 adults were impacted by hypertension. Due to the COVID-19 pandemic, virtual visits (VV) replaced the majority of in-person visits world-wide. To adapt to the new reality, action was taken by our hypertension clinic to enhance self-monitoring of blood pressure virtually.

The Fourth Trimester: a Time for Enhancing Transitions in Cardiovascular Care.

Purpose of ReviewThe “fourth trimester” concept, defined as the first 12 weeks after delivery (and beyond), is a critical window of time for clinicians to intervene to optimize women’s cardiovascular health after pregnancy. A timely and comprehensive postpartum cardiovascular assessment should be performed in all women following delivery in order to (1) follow up medical conditions present prior to conception, (2) evaluate symptoms and signs of common postpartum complications, and (3) identify risk factors and prevent future adverse cardiovascular outcomes. In this review, we aim to discuss major maternal cardiovascular risk factors such as hypertensive disorders of pregnancy, gestational diabetes mellitus, postpartum weight retention, and postpartum depression, as well as lactation as a potential protective risk modifying factor. Additionally, we will review effectiveness of outpatient interventions to enhance transitions in cardiovascular care during the fourth trimester.Recent FindingsA seamless hand-off from obstetric to primary care, and potentially cardiology, is needed for early detection and management of hypertension, weight, glycemic control, stress and mood, and long-term cardiovascular risk. Additionally, the use of telemedicine, blood pressure self-monitoring, remote activity monitoring, and behavioral health coaches are potentially feasible modalities to augment clinic-based care for cardiovascular risk factors and weight management, but additional studies are needed to study their long-term effectiveness.SummaryDevelopment of a comprehensive postpartum care plan with careful consideration of each patient’s risk profile and access to resources is critical to improve maternal morbidity and mortality, reduce health disparities, and achieve long-term cardiovascular health for women. Supporting postpartum well-being of women during this transition period requires a multidisciplinary approach, especially primary care engagement, and planning should start before delivery.

Abstract P207: The Feasibility Of A 6-week, Pharmacist-Led, Self-Monitored Blood Pressure Treatment Program

Background: Guidelines recommend concomitant out-of-office blood pressure (BP) measurements with telehealth counseling for titration. While high quality home BP measurement coupled with pharmacist care reduces the time needed to achieve BP goal, it remains unclear how rapidly BP titrations can be applied in clinical practice. Objective: To examine the impact of home BP monitoring coupled with a rapid, biweekly, pharmacist-led BP medication titration program on BP control and patient safety. Methods: Forty patients were referred if BP ≥140/90, using ≤2 anti-hypertensive medications, and failed a trial of lifestyle modification. The initial visit with the pharmacist included validation of home BP monitor compared with an Omron HEM-907XL. Patients monitored BP twice daily in the morning and evening for a week then had their medication regimen adjusted every 2 weeks until reaching their goal or completing a 6-week follow-up period. Results: Of the 29 patients completing the program, mean enrollment SBP/DBP was 155.2 (SD, 15.8)/89.7 (SD, 11.5) mm Hg. The completion SBP/DBP was 132.1 (SD, 10.9)/ 77.6 (SD, 10). The number of HTN medications prescribed increased by an average of 0.3 (from 1.3 to 1.6) over the follow-up period. There were no incidences of falls or hypotension. One patient had a clinically significant electrolyte change requiring medication adjustment. Two patients had a clinically significant change in serum creatinine, but both stabilized after altering their hypertension medication regimen. Conclusion: A 6-week, pharmacist-led, home BP monitoring program with rapid titration had high retention and increased the percentage of patients achieving BP goals without safety concerns.

Abstract P009: Feasibility And Acceptability Of A Digitally-Based Blood Pressure Self-monitoring Program That Promotes Hypertension Self-management And Health Education Among Low-income Patients.

Introduction: According to evidence-based clinical guidelines, adults with hypertension should self-monitor their blood pressure regularly. We developed a remote patient monitoring (RPM) program that supports self-monitoring and promotes improved self-management among low-income patients. Hypothesis: We hypothesized that the program would have high feasibility and acceptability among patients with varying digital health literacy and at least 50% of patients would utilize their monitor at a rate required for reimbursement of the cost of the device (16 days of measurements in any 30-day period). Methods: Between 01/2022 and 05/2022, we deployed cellularly connected monitors to patients with hypertension at Family Health Centers of San Diego. Program elements included training on measurement, behavior change, SMS reminders, and physician communication. Data was monitored via a RPM platform provided by Withings. Participants completed a baseline and follow-up survey on digital health literacy and usability. We used descriptive statistics to quantify the utilization of the monitors over time and evaluate usability. Results: Patients who received blood pressure monitors (N=177) had a mean (SD) age of 55 (12.0) years and 57.6% (102 out of 177) were female. Most patients were Hispanic (71.8%, 127 out 177), spoke Spanish (62.7%, 111 out 177), and owned a smartphone (79.7%, 141 out 177). However, only 63.3% (112 out 177) had access to internet or Wi-Fi at home. The mean (SD) SBP was 136.45 mm Hg (20.5) and the mean (SD) DBP was 83.85 mm Hg (13.9). Only 20.9% (37 out of 177) of patients were able to comply with the measurement rate that would result in device cost reimbursement. This did not differ by levels of digital health literacy; with 86.2% (50 out of 58) participants having said they would recommend the monitor to others and 74.1% (43 out of 58) having said they would like to continue using the monitor in the future. Conclusion: Providing a simple and low-cost method to monitor blood pressure was feasible and acceptable to patients. However, relatively few patients were able to use the monitors at a rate that would result in device cost reimbursement. While RPM programs show promise, plans for sustaining costs among low-income patients need to be further evaluated.

The Impact of eHealth Interventions on the Improvement of Self-Care in Chronic Patients: An Overview of Systematic Reviews.

Promoting self-care is one of the most promising strategies for managing chronic conditions. This overview aimed to investigate the effectiveness of eHealth interventions at improving self-care in patients with type-2 diabetes mellitus, cardiovascular disease, and chronic obstructive pulmonary disease when compared to standard care. We carried out a review of systematic reviews on PubMed, Scopus, Cochrane, PsychInfo, and CINAHL. AMSTAR-2 was used for quality appraisal. Eight systematic reviews (six with meta-analysis) were included, involving a total of 41,579 participants. eHealth interventions were categorized into three subgroups: (i) reminders via messaging apps, emails, and apps; (ii) telemonitoring and online operator support; (iii) internet and web-based educational programs. Six systematic reviews showed an improvement in self-care measurements through eHealth interventions, which also led to a better quality of life and clinical outcomes (HbA1C, blood pressure, hospitalization, cholesterol, body weight). This overview provided some implications for practice and research: eHealth is effective in increasing self-care in chronic patients; however, it is required to designate the type of eHealth intervention based on the needed outcome (e.g., implementing telemonitoring to increase self-monitoring of blood pressure). In addition, there is a need to standardize self-care measures through increased use of validated assessment tools.

Analysis of blood pressure measurement among Chinese adults in 2018

Objective: To analyze the blood pressure measurement of Chinese adult residents in 2018 and provide a scientific basis for early detection and intervention of hypertension. Methods: In 2018, China Chronic Disease and Risk Factor Surveillance were conducted in 298 counties (districts) of 31 provinces (autonomous regions, municipalities) across the country, using a multi-stage stratified cluster random sampling method to survey permanent residents aged 18 years and above. We selected 184 509 people and carried out a face-to-face questionnaire survey and body measurement method to collect demographic data, major chronic diseases, and blood pressure measurement information of the survey subjects. Blood glucose and blood lipid-related indicators were obtained by laboratory testing. There were 170 551 adult residents included in the study after excluding abnormal and missing data for key variables. After complex weighting, blood pressure detection rates and detection times in people with different blood pressure levels and other diseases were analyzed. SAS 9.4 software was used to perform the χ2-test and trend test. Results: Among adult residents in China, the proportions of those with normal blood pressure, commonly recognized 'high' blood pressure, and newly detected hypertension who had their blood pressure tested within three months were 44.4%, 50.4%, and 52.6%, respectively. The proportions all appeared higher in women than in men (all P<0.05), in urban than in rural areas (all P<0.05), and showed an increasing trend with age (all P<0.001); The proportion of these three populations who had never had their blood pressure measured was 27.6%, 24.2%, and 23.5% respectively. The proportion of people with diagnosed hypertension who had their blood pressure tested within seven days was 44.0%, 51.4% in urban areas, higher than 37.7% in rural areas (P<0.001), and the proportion of people who had their blood pressure tested increased with education, per capita annual income and BMI (all P<0.001). Conclusions: The behavior of regular self-monitoring of blood pressure among adult residents in China still needs to be improved, especially among men and rural areas. Relevant health promotion and education should be strengthened. More targeted policies and measures should be developed to improve blood pressure measurement behavior in people with normal high blood pressure and other high-risk groups to control elevated blood pressure effectively.

Self-monitoring of blood pressure in pregnancy: A mixed methods evaluation of a national roll-out in the context of a pandemic.

ObjectiveTo evaluate how English maternity units implemented self-monitoring of blood pressure (SMBP) in pregnancy in response to the COVID-19 pandemic.DesignMixed methods including surveys, anonymised patient data and in-depth interviews with women.SettingMaternity units across England.Participants45 maternity units completed a survey about the implementation of SMBP (supported by the provision of guidance and blood pressure monitors) during the pandemic, 166 women completed a survey about their experiences of SMBP, and 23 women took part in in-depth interviews. Clinical data from 627 women undertaking SMBP were available from 13 maternity units.ResultsSMBP was predominantly used to provide additional BP monitoring for hypertensive or high-risk pregnant women. Overall maternity units and women were positive about its use in terms of reducing the need for additional face-to-face contacts and giving women more control and insight into their own BP. However, there were challenges in setting up SMBP services rapidly and embedding them within existing care pathways, particularly around interpreting readings and managing the provision of monitors.ConclusionsA considerable proportion of maternity units in England commenced a SMBP service for hypertensive or high-risk women from March 2020. There is a need for further research into appropriate care pathways, including guidance around white coat or masked hypertension and the use of SMBP postnatally.