Self-monitoring Of Blood Pressure Research Articles

Effectiveness of medication self-management, self-monitoring and a lifestyle intervention on hypertension in poorly controlled patients: The MEDICHY randomized trial

BackgroundUncontrolled hypertension is a common problem worldwide, despite the availability of many effective antihypertensive drugs and lifestyle interventions. We assessed the efficacy of a multi-component intervention in individuals with uncontrolled hypertension in a primary care setting.MethodsThis study was a randomized, multicenter, parallel, two-arm, single-blind controlled trial performed in primary healthcare centers in Mallorca (Spain). All participants were 35 to 75-years-old and had poorly controlled hypertension. Patients were randomly assigned in a 1:1 ratio to a control group (usual care) or an intervention group (self-monitoring of blood pressure, self-titration of hypertensive medications, dietary interventions, and physical activity interventions). The primary outcome was decrease in the mean SBP at 6 months relative to baseline.ResultsA total of 153 participants were randomized to an intervention group (77) or a control group (76). After 6 months, the intervention group had a significantly lower systolic blood pressure (135.1 mmHg [±14.8] vs. 142.7 mmHg [±15.0], adjusted mean difference: 8.7 mmHg [95% CI: 3.4, 13.9], p < 0.001) and a significantly lower diastolic blood pressure (83.5 mmHg [±8.8] vs. 87.00 mmHg [±9.0], adjusted mean difference: 5.4 [95% CI: 2.9, 7.8], p < 0.0001). The intervention group also had significantly more patients who achieved successful blood pressure control (<140/90 mmHg; 54.4% vs. 32.9%, p = 0.011).DiscussionSelf-monitoring of blood pressure in combination with self-management of hypertensive medications, diet, and physical activity in a primary care setting leads to significantly lower blood pressure in patients with poorly controlled hypertension.Clinical Trial Registration:ClinicalTrials.gov, identifier ISRCTN14433778.

Long-Term Effect of Home Blood Pressure Self-Monitoring Plus Medication Self-Titration for Patients With Hypertension

Patient empowerment through pharmacologic self-management is a common strategy for some chronic diseases such as diabetes, but it is rarely used for controlling blood pressure (BP). Several trials have shown its potential for reducing BP in the short term, but evidence in the longer term is scarce. To evaluate the longer-term effectiveness of BP self-monitoring plus self-titration of antihypertensive medication vs usual care for patients with poorly controlled hypertension, with passive follow-up and primary-care nursing involvement. The ADAMPA (Impact of Self-Monitoring of Blood Pressure and Self-Titration of Medication in the Control of Hypertension) study was a randomized, unblinded clinical trial with 2 parallel arms conducted in Valencia, Spain. Included participants were patients 40 years or older, with systolic BP (SBP) over 145 mm Hg and/or diastolic BP (DBP) over 90 mm Hg, recruited from July 21, 2017, to June 30, 2018 (study completion, August 25, 2020). Statistical analysis was conducted on an intention-to-treat basis from August 2022 to February 2024. Participants were randomized 1:1 to usual care vs an individualized, prearranged plan based on BP self-monitoring plus medication self-titration. The main outome was the adjusted mean difference (AMD) in SBP between groups at 24 months of follow-up. Secondary outcomes were the AMD in DBP between groups at 24 months of follow-up, proportion of patients reaching the BP target (SBP <140 mm Hg and DBP <90 mm Hg), change in behaviors, quality of life, health service use, and adverse events. Among 312 patients included in main trial, data on BP measurements at 24 months were available for 219 patients (111 in the intervention group and 108 in the control group). The mean (SD) age was 64.3 (10.1) years, and 120 patients (54.8%) were female; the mean (SD) SBP was 155.6 (13.1) mm Hg, and the mean (SD) diastolic BP was 90.8 (7.7) mm Hg. The median follow-up was 23.8 months (IQR, 19.8-24.5 months). The AMD in SBP at the end of follow-up was -3.4 mm Hg (95% CI, -4.7 to -2.1 mm Hg; P < .001), and the AMD in DBP was -2.5 mm Hg (95% CI, -3.5 to -1.6 mm Hg; P < .001). Subgroup analysis for the main outcome showed consistent results. Sensitivity analyses confirmed the robustness of the main findings. No differences were observed between groups in behaviors, quality of life, use of health services, or adverse events. In this secondary analysis of a randomized clinical trial, BP self-monitoring plus self-titration of antihypertensive medication based on an individualized prearranged plan used in primary care reduced BP in the longer term with passive follow-up compared with usual care, without increasing health care use or adverse events. These results suggest that simple, inexpensive, and easy-to-implement self-management interventions have the potential to improve the long-term control of hypertension in routine clinical practice. ClinicalTrials.gov Identifier: NCT03242785.

Report from a text-based blood pressure monitoring prospective cohort trial among postpartum women with hypertensive disorders of pregnancy

BackgroundHypertensive disorders of pregnancy are a main cause of maternal morbidity and mortality in the United States and worldwide, and it is estimated that approximately 60% of maternal deaths in the United States occur during the postpartum period. The utilization of telehealth modalities such as home blood pressure monitoring has shown improvement in blood pressure control and adherence with follow up visits. Our study sought to determine if standardized education improved patient hypertension knowledge and if this when combined with home blood pressure telemonitoring increased participants’ postpartum self-blood pressure monitoring and postpartum visit attendance.MethodsThis is an Institutional Review Board approved prospective cohort study conducted at the University of Mississippi Medical Center. Women with a hypertensive disorder of pregnancy who met the inclusion criteria and provided written informed consent to participate were enrolled. Participants received a baseline pre-education questionnaire designed to assess their knowledge of their hypertensive diagnosis, hypertension management, and postpartum preeclampsia (PreE). Participants then received standard education, a blood pressure monitor, and were scheduled a follow-up visit during the first 10 days following discharge. Remote home blood pressure monitoring was performed via text messages and voice calls for 6-weeks postpartum. At the conclusion of the study, participants repeated their original questionnaire.Results250 women provided informed consent to participate in the study and were included in this analysis. Relative to the baseline survey, there was a significant increase (p = 0.0001) in the percentage of correct responses. There was not an association between study engagement and percentage of correct responses on end of study questionnaire (p = 0.33) or postpartum visit attendance (p = 0.69). Maternal age was found to drive study engagement, even when adjusted for community-level distress (p = 0.03) and maternal race (p = 0.0002).ConclusionImplementing a standardized postpartum education session was associated with improvement in patient’s knowledge. Further studies are needed with more longitudinal follow up to assess if this program would also result in improved long-term outcomes and decreased hospital readmission rates.Trial registrationNCT04570124.

IJCM_146A: Development and validation of an infographic educational tool for self-management of hypertension.

Background: Hypertension is a serious condition affecting 33 % of urban &amp; 25 % of rural Indian population. It can be controlled by the antihypertensive medications, but self-management approaches also play a very important role in lowering blood pressure. Infographics are one such material which uses visuals to educate the audience. This study assesses the understandability and actionability of the newly developed infographic aimed at self-blood pressure monitoring, medication adherence and lifestyle modifications with dietary approaches and exercise. Objectives: The objectives of the study were to develop an infographic tool for educating the patients with hypertension and to validate the infographic tool using PEMAT A/V. Methodology: “The study was divided into two phases. First phase was to develop an infographic tool. An infographic was designed using Canva and Procreate. In the second phase, the infographic was validated using the Patient Education Material Assessment Tool - Audio visual (PEMAT-A/V) by 10 participants. PEMAT is a systematic method to evaluate and compare patient education materials. Result: Using Canva, the infographic tool was developed, and then PEMAT-A/V was used to validate it. In terms of understandability and actionability, the mean score was 87.8% and 89.2%. The standard deviations for understandability and actionability were 0.12 and 0.14, respectively. Conclusion: The infographic developed in the study scored a mean percentage of more than 70 in both understandability and actionability and hence, it was concluded that it can be easily understandable by the patients.

Challenges encountered during the implementation of the project Self-monitoring of Blood Pressure and Urinalysis by Pregnant Mothers in Cumberland infirmary. NCIC

Challenges encountered during the implementation of the project Self-monitoring of Blood Pressure and Urinalysis by Pregnant Mothers in Cumberland infirmary. NCIC

Improving Hypertension Control in the Black Patient Population: A Quality Improvement Study of Workflow Redesign Using the Electronic Health Record to Integrate Self-Monitoring, Education, and Reporting.

Nearly half of American adults have hypertension (HTN), and non-Hispanic Black patients are diagnosed at a higher rate than others. Our local clinic population reflected disproportionate rates of uncontrolled HTN among Black patients. A quality improvement pre-/postintervention design was used to evaluate an educational intervention to reduce blood pressure (BP) and improve self-monitoring of BP in Black patients using the Chronic Care Model. A team-based approach was used to redesign clinic workflows and patient education, prescribe self-paced videos from an electronic health record (EHR) patient portal, and provide home BP cuffs. Black participants (n = 79) improved viewing of prescribed videos (7.9% to 68.5%), knowledge scores (67.9 to 75.2), and mean systolic BP (-20.3 mm Hg; P > .001). This team-based approach enhanced patient engagement, self-monitoring skills, EHR-reported BP, and overall BP control for a cohort of Black patients with uncontrolled BP.

Detection and Control of Pregnancy Hypertension Using Self-Monitoring of Blood Pressure With Automated Telemonitoring: Cost Analyses of the BUMP Randomized Trials.

Pregnancy hypertension continues to cause maternal and perinatal morbidity. Two linked UK randomized trials showed adding self-monitoring of blood pressure (SMBP) with automated telemonitoring to usual antenatal care did not result in earlier detection or better control of pregnancy hypertension. This article reports the trials' integrated cost analyses. Two cost analyses. SMBP with usual care was compared with usual care alone in pregnant individuals at risk of hypertension (BUMP 1 trial [Blood Pressure Monitoring in High Risk Pregnancy to Improve the Detection and Monitoring of Hypertension], n=2441) and with hypertension (BUMP 2 trial, n=850). Clinical notes review identified participant-level antenatal, intrapartum, and postnatal care and these were costed. Comparisons between trial arms used means and 95% CIs. Within BUMP 2, chronic and gestational hypertension cohorts were analyzed separately. Telemonitoring system costs were reported separately. In BUMP 1, mean (SE) total costs with SMBP and with usual care were £7200 (£323) and £7063 (£245), respectively, mean difference (95% CI), £151 (-£633 to £936). For the BUMP 2 chronic hypertension cohort, corresponding figures were £13 384 (£1230), £12 614 (£1081), mean difference £323 (-£2904 to £3549) and for the gestational hypertension cohort were £11 456 (£901), £11 145 (£959), mean difference £41 (-£2486 to £2567). The per-person cost of telemonitoring was £6 in BUMP 1 and £29 in BUMP 2. SMBP was not associated with changes in the cost of health care contacts for individuals at risk of, or with, pregnancy hypertension. This is reassuring as SMBP in pregnancy is widely prevalent, particularly because of the COVID-19 pandemic. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03334149.

Effect of intelligent hypertension management system on blood pressure: protocol for a randomised controlled multicentre trial

IntroductionHypertension is one of the most serious global health problems, and its prevention and treatment mainly rely on lifestyle intervention and medication. However, the current situation of hypertension control in...

Exploring perceptions and operational considerations for use of a smartphone application to self-monitor blood pressure in pregnancy in Lombok, Indonesia: protocol for a qualitative study

IntroductionHypertensive disorders of pregnancy (HDP) are a leading cause of maternal deaths globally and require close monitoring of blood pressure (BP) to mitigate potential adverse effects. Despite the recognised need...

Economic Evaluation of Blood Pressure Monitoring Techniques in Patients With Hypertension

Blood pressure monitoring is critical to the timely diagnosis and treatment of hypertension. At-home self-monitoring techniques are highly effective in managing high blood pressure; however, evidence regarding the cost-effectiveness of at-home self-monitoring compared with traditional monitoring in clinical settings remains unclear. To identify and synthesize published research examining the cost-effectiveness of at-home blood pressure self-monitoring relative to monitoring in a clinical setting among patients with hypertension. A systematic literature search of 5 databases (PubMed, MEDLINE, Embase, EconLit, and CINAHL) followed by a backward citation search was conducted in September 2022. Full-text, peer-reviewed articles in English including patients with high blood pressure (systolic blood pressure ≥130 mm Hg and diastolic blood pressure ≥80 mm Hg) at baseline were included. Data from studies comparing at-home self-monitoring with clinical-setting monitoring alternatives were extracted, and the outcomes of interest included incremental cost-effectiveness and cost-utility ratios. Non-peer-reviewed studies or studies with pregnant women and children were excluded. To ensure accuracy and reliability, 2 authors independently evaluated all articles for eligibility and extracted relevant data from the selected articles. Of 1607 articles identified from 5 databases, 16 studies met the inclusion criteria. Most studies were conducted in the US (6 [40%]) and in the UK (6 [40%]), and almost all studies (14 [90%]) used a health care insurance system perspective to determine costs. Nearly half the studies used quality-adjusted life-years gained and cost per 1-mm Hg reduction in blood pressure as outcomes. Overall, at-home blood pressure monitoring (HBPM) was found to be more cost-effective than monitoring in a clinical setting, particularly over a minimum 10-year time horizon. Among studies comparing HBPM alone vs 24-hour ambulatory blood pressure monitoring (ABPM) or HBPM combined with additional support or team-based care, the latter were found to be more cost-effective. In this systematic review, at-home blood pressure self-monitoring, particularly using automatic 24-hour continuous blood pressure measurements or combined with additional support or team-based care, demonstrated the potential to be cost-effective long-term compared with care in the physical clinical setting and could thus be prioritized for patients with hypertension from a cost-effectiveness standpoint.

Randomized Trial of a Social Support Intervention to Improve Home Blood Pressure Monitoring in Patients With Cerebrovascular Disease.

A pilot randomized trial evaluating whether a social support intervention improves adherence to home blood pressure (BP) monitoring among patients with cerebrovascular disease. Subjects with ischemic stroke, intracerebral hemorrhage, or transient ischemic attack within 5 years with BP >140/90, were given a centrally monitored home BP cuff and asked to check their BP twice a day for 90 ± 7 days. Subjects received text and/or email reminders for missed measurements and weekly reports on adherence/BP control. Subjects were randomized 1:1 to a social support intervention, in which close personal contact also received all study-related education and communications. The primary outcome was the proportion of requested measurements completed. A secondary outcome was a change in BP over time. Thirty-three subjects were enrolled, 15 in the control arm and 18 in the social support arm. The social support arm completed a greater proportion of BP measurements at day 30 (88% vs 78%), day 60 (72% vs 54%), and day 83 (60% vs 40%), but none of these differences were statistically significant (P > 0.05). Comparing the first 7 days of BP readings to the last 7 days across subjects, there was a nonsignificant decrease in BP over time (systolic BP = -2.8 mm Hg, P = 0.29 and diastolic BP = -1.7, P = 0.36). The social support intervention did not modify the change in BP over time. A social support intervention may increase adherence to home BP monitoring. This pilot study provides important preliminary data to inform the design of larger more definitive trials utilizing self-monitoring of BP in patients with cerebrovascular disease.

Blood pressure measurement knowledge and counselling among hospital pharmacists - an interventional study

BackgroundPharmacists occupy a vantage position to educate patients with hypertension on self-monitoring of blood pressure (BP). An update on their knowledge and counselling on BP measurement is needful to ascertain proper information dissemination to patients.MethodsAn interventional study was carried out for a six-month period among consecutively sampled pharmacists working at a tertiary healthcare facility, using a semi-structured questionnaire for data collection. Sequel to preintervention assessment of pharmacists’ knowledge and counselling on BP measurement, an educational intervention comprising didactic lecture, case studies, demonstrations, and interactive question and answer sessions was carried out to address the gaps observed. Knowledge and counselling were then reassessed one-month postintervention to find out the impact of the intervention. Data was summarized with descriptive and inferential statistics with significance level set at p < 0.05.ResultsOne hundred and forty-four pharmacists completed the study. Preintervention knowledge and counselling on BP measurement among the pharmacists was poor. Median scores of pharmacists’ knowledge on BP measurement increased significantly from 13.00 preintervention to 25.00 postintervention (p < 0.001); while their counselling on BP measurement also increased significantly from 1.00 preintervention to 12.00 postintervention (p < 0.001). The knowledge category of the pharmacists’ improved as majority who were categorized as having either “poor” (67, 46.5%) or “fair” (68, 47.2%) knowledge preintervention advanced to “excellent” (99, 68.7%) knowledge postintervention. Similarly, the pharmacists’ counselling category was upgraded from the majority categorized as poor (141, 97.9%) preintervention to excellent (87, 60.4%) postintervention. Prior to the educational intervention, only 62 (43.1%) pharmacists knew that BP measurement had to be carried out in both arms for a first-time patient. Also, when asked the question “What BP reading will be recorded for a patient whose BP readings when taken thrice were 149/82 mmHg, 141/78 mmHg, and 139/78 mmHg?” only 38 (26.4%) provided the right answer. Similarly, majority of the pharmacists (51, 35.4%) could only state one out of five precautions during blood pressure measurement. In this study, pharmacists’ gender, additional educational qualification, and work experience did not significantly influence their knowledge and counselling on BP measurement.ConclusionsThe educational intervention significantly improved pharmacists’ knowledge and counselling on BP measurement.

Modelling change processes in multivariate interrupted time series data using a multivariate dynamic additive model: An application to heart rate and blood pressure self-monitoring in heart failure with drug changes

Abstract Heart rate (HR) and blood pressure (BP) measured by a patient can be used to monitor response to pharmacologic therapies. Continuously measured HR and BP are multivariate time series as sequences of values at regularly spaced intervals over time and changes in pharmacologic therapies interrupt the multivariate time series and create phases. In the multivariate interrupted time series, there are change processes in multiple phases, such as level changes, linear or non-linear trend changes, and time-varying serial dependence. This paper presents an application of a multivariate dynamic additive model to account for these change processes. In addition, a simulation study is conducted to evaluate the model’s parameter recovery and to demonstrate the consequences of ignoring the time-varying serial dependence in HR and BP when detecting level changes and trend changes. The results of the simulation study show that the accuracy and precision of parameter estimates are satisfactory. Furthermore, the simulation results present that ignoring time-varying serial dependence in the same conditions as those found in the application results in biased estimates and standard errors for the level changes and trend changes.

Perceptions and Challenges of Telehealth Obstetric Clinics Among Pregnant Women in Hong Kong: Cross-Sectional Questionnaire Study.

Integrating telehealth in an obstetric care model is important to prepare for possible infection outbreaks that require social distancing and limit in-person consultations. To ensure the successful implementation of obstetric telehealth in Hong Kong, it is essential to understand and address pregnant women's concerns. This study aimed to assess pregnant women's attitudes, concerns, and perceptions regarding telehealth obstetric clinic services in Hong Kong. We conducted a prospective cross-sectional questionnaire study at Queen Mary Hospital between November 2021 and August 2022. Utilizing a 5-point rating scale, the questionnaire aimed to capture pregnant women's preferences, expectations, feasibility perceptions, and privacy concerns related to telehealth clinic services. We used statistical analyses, including chi-square tests and multinomial logistic regression, to compare questionnaire responses and investigate the association between advancing gestation and attitudes toward telehealth clinics. The study included 664 participants distributed across different pregnancy stages: 269 (40.5%) before 18 gestational weeks, 198 (29.8%) between 24 and 31 weeks, and 197 (29.7%) after delivery. Among them, 49.8% (329/664) favored face-to-face consultations over telehealth clinics, and only 7.3% (48/664) believed the opposite. Additionally, 24.2% (161/664) agreed that telehealth clinics should be launched for obstetric services. However, the overall preference for telehealth clinics was <20% for routine prenatal checkups (81/664, 12.2%) and addressing pregnancy-related concerns, such as vaginal bleeding (76/664, 11.5%), vaginal discharge (128/664, 19.4%), reduced fetal movement (64/664, 9.7%), uterine contractions (62/664, 9.4%), and suspected leakage of amniotic fluid (54/664, 8.2%). Conversely, 76.4% (507/664) preferred telehealth clinics to in-person visits for prenatal education talks, prenatal and postpartum exercise, and addressing breastfeeding problems. Participants were more comfortable with telehealth clinic tasks for tasks like explaining pregnancy exam results (418/664, 63.1%), self-administering urinary dipsticks at home (373/664, 56.4%), medical history-taking (341/664, 51.5%), and self-monitoring blood pressure using an electronic machine (282/664, 42.8%). %). During the postpartum period, compared to before 18 weeks of gestation, significantly more participants agreed that telehealth clinics could be an option for assessing physical symptoms such as vaginal bleeding (aOR 2.105, 95% CI 1.448-3.059), reduced fetal movement (aOR 1.575, 95% CI 1.058-2.345), uterine contractions (aOR 2.906, 95% CI 1.945-4.342), suspected leakage of amniotic fluid (aOR 2.609, 95% CI 1.721-3.954), fever (aOR 1.526, 95% CI 1.109-2.100), and flu-like symptoms (aOR 1.412, 95% CI 1.030-1.936). They were also more confident with measuring the symphysis-fundal height, arranging further investigations, and making diagnoses with the doctor via the telehealth clinic. The main perceived public health advantage of telehealth clinics was the shorter traveling and waiting time (526/664, 79.2%), while the main concern was legal issues from wrong diagnosis and treatment (511/664, 77.4%). Face-to-face consultation remained the preferred mode of consultation among the participants. However, telehealth clinics could be an alternative for services that do not require physical examination or contact. An increased acceptance of and confidence in telehealth was found with advancing gestation and after delivery. Enforcing stricter laws and guidelines could facilitate the implementation of telehealth clinics and increase confidence in their use among pregnant women for obstetric care.

Reporting of blood pressure levels and self-monitoring practices: a survey among outpatients diagnosed with hypertension in Bogotá, Colombia

BackgroundRoutine blood pressure (BP) self-monitoring is recommended for patients already diagnosed with hypertension. How often these patients can report their BP levels is unknown, particularly in low-and-middle income countries.MethodsWe surveyed (January 2021 to May 2022) representative samples of patients with established diagnosis of hypertension from 3 health care networks (involving 74 outpatient clinics) and 2 university hospitals in Bogotá, Colombia. Trained health care professionals conducted a telephone survey including questions on demographics, medical history, and general understanding about hypertension and its potential complications. The outcome variables were the self-report of participant’s BP levels (primary) and monitoring practices among participants.ResultsOut of 2609 consecutively contacted patients sampled from institutional records, 2323 were invited and 1566 (mean age 66.5, SD = 12.1 years, 74.4% females, 64.0% living low socio-economic strata) gave consent to participate. While 66% of participants had over 5 years of diagnosis, 39.5% had most (≥ 60%) of their follow-up visits with the same doctor. Overall, 645 (41.5%, 95%CI 39.1 -43.9) participants reported their BP levels. This proportion was independent of time from diagnosis, but higher among those of younger age, living in higher socio-economic strata, having more years of education and using more information technologies. Also, more patients reported their BP levels if seen ≥ 60% of the times by the same physician (43.4% Vs. 36.7%). Those reporting closer BP self-monitoring more often used electronic devices, received 2 + medications, and had better knowledge about hypertension.ConclusionA minority of hypertensive patients seen in Bogotá were aware of their own BP levels. Those in such capacity were in a better social position, more often seen by the same doctor, knew their condition better and handled more complex treatments. Hypertensive patients from Bogotá may benefit from a more continuous medical care, patient education programs and promoting BP home monitoring.

Self-monitoring of Blood Pressure: Awareness, Practice, Perceived Barriers and Associated Sociodemographic Factors Among Adult Hypertensives Attending a Tertiary Hospital in South-South Nigeria

Self-monitoring of Blood Pressure: Awareness, Practice, Perceived Barriers and Associated Sociodemographic Factors Among Adult Hypertensives Attending a Tertiary Hospital in South-South Nigeria

Abstract P339: Association Between Self-monitored Blood Pressure, Heart Rate, And Anxiety Symptoms In A Digital Heart Health Self-management Program

Introduction: Anxiety is a risk factor for hypertension and other cardiovascular (CV) diseases, and this relationship may be mediated by direct biological effects and/or indirectly via behaviors. We aimed to study the association between change in blood pressure (BP), heart rate (HR), and anxiety symptom severity among participants enrolled in a smartphone-based CV risk self-management program. Methods: We retrospectively studied participants with hypertension engaging with digital coaching focused on non-pharmacological lifestyle interventions, and who completed at least two generalized anxiety disorder (GAD-7) questionnaires between April 2020 and March 2023. Change in GAD-7 score was correlated with change in systolic BP, diastolic BP, and HR, controlling for age, gender, number of GAD-7 self-assessments, and initial GAD-7 score. Median BP and HR for the week of each GAD-7 self-assessment was used, and all change scores were converted to rate of change per day to control for variable time between scores. Results: A total of 5079 (age 58 ± 0.15y, 58% female) participants were included. Median days between GAD-7 scores was 148 (IQR 47-330). At baseline, mean GAD-7 was 7 (± 0.001), mean BP was 135/83 (± 0.28/0.18) mm Hg, and mean HR was 75 (± 0.22) bpm. Severe anxiety (GAD-7 &gt; 14) was reported in 605 (12%) participants, and 34.3% were stage 2 hypertensive. By follow up, most of those with severe anxiety at baseline (430, 71%) showed reduced GAD-7 score (mean change = -4.5 ± 0.23). Both SBP (β = 0.03 ± 0.008, t = 3.6) and HR (β = 0.02 ± 0.009, t = 2.3) rate of change were associated with GAD-7 change such that the more participants reduced SBP or HR, the greater the reduction in anxiety symptoms. Initial GAD-7 scores were negatively associated with GAD change (β = -0.2 ± 0.016, t = -12.3). No other variable was statistically significant (all ps &gt; 0.15). Conclusion: In a smartphone-based CV risk self-management program, reduction in systolic BP and HR is associated with improvement in anxiety symptoms, suggesting that digital coaching targeting CV risk factors has the potential to also improve mental health.

Long-Term Results of a Digital Hypertension Self-Management Program: Retrospective Cohort Study.

Digital health programs that incorporate frequent blood pressure (BP) self-monitoring and support for behavior change offer a scalable solution for hypertension management. We examined the impact of a digital hypertension self-management and lifestyle change support program on BP over 12 months. Data were analyzed from a retrospective observational cohort of commercially insured members (n=1117) that started the Omada for Hypertension program between January 1, 2019, and September 30, 2021. Paired t tests and linear regression were used to measure the changes in systolic blood pressure (SBP) over 12 months overall and by SBP control status at baseline (≥130 mm Hg vs <130 mm Hg). Members were on average 50.9 years old, 50.8% (n=567) of them were female, 60.5% (n=675) of them were White, and 70.5% (n=788) of them had uncontrolled SBP at baseline (≥130 mm Hg). At 12 months, all members (including members with controlled and uncontrolled BP at baseline) and those with uncontrolled SBP at baseline experienced significant mean reductions in SBP (mean -4.8 mm Hg, 95% CI -5.6 to -4.0; -8.1 mm Hg, 95% CI -9.0 to -7.1, respectively; both P<.001). Members with uncontrolled SBP at baseline also had significant reductions in diastolic blood pressure (-4.7 mm Hg; 95% CI -5.3 to -4.1), weight (-6.5 lbs, 95% CI -7.7 to -5.3; 2.7% weight loss), and BMI (-1.1 kg/m2; 95% CI -1.3 to -0.9; all P<.001). Those with controlled SBP at baseline maintained within BP goal range. Additionally, 48% (418/860) of members with uncontrolled BP at baseline experienced enough change in BP to improve their BP category. This study provides real-world evidence that a comprehensive digital health program involving hypertension education, at-home BP monitoring, and behavior change coaching support was effective for self-managing hypertension over 12 months.

Self-care interventions for advancing sexual and reproductive health and rights – implementation considerations

Self-care refers to the ability of people to promote their own health, prevent disease, maintain health, and cope with illness and disability, with or without the support of a health or care worker. Self-care interventions are tools that support self-care as additional options to facility-based care. Recognizing laypersons as active agents in their own health care, the World Health Organization (WHO)’s global normative guideline on self-care interventions recommends people-centred, holistic approaches to health and well-being for sexual and reproductive health and rights. Examples of such interventions include pregnancy self-testing, self-monitoring of blood glucose and/or blood pressure during pregnancy and self-administration of injectable contraception. Building on previous studies and aligning with the WHO classification for self-care, we discuss nine key implementation considerations: agency, information, availability, utilization, social support, accessibility, acceptability, affordability, and quality. The implementation considerations form the foundation of a model implementation framework that was developed using an ecological health systems approach to support sustainable changes in health care delivery.

Impact of home blood pressure monitors on self-monitoring and control of blood pressure in vulnerable adults.

To evaluate associations between home blood pressure monitoring (HBPM) and blood pressure (BP) in vulnerable adults during the COVID-19 pandemic, when access to in-person care was restricted. A retrospective cohort study was conducted in adults with hypertension or elevated BP given a home BP monitor vs. usual care. Change in BP from baseline to follow-up was compared between groups, controlling for potential confounders. Subgroup analyses of BP outcomes were also assessed in patients age >50 years. There was no difference in SBP reduction between n = 82 HBPM patients (-11.7/-2.9 mmHg) and n = 280 usual care patients (-12.5/-5.8 mmHg; P > 0.05). Results were similar in multivariable analysis controlling for potential confounders [coefficient 0.44, 95% confidence interval (CI) -3.98 to 4.87]. However, in the subgroup of patients aged>50 years, there was a significant association between SBP reduction and HBPM in the multivariable analyses (coefficient -7.2, 95% CI -13.8 to -0.62, P = 0.032). HBPM use was not associated with BP reduction in vulnerable adults overall during high telehealth use. An association between SBP reduction and HBPM was observed in those aged>50 years. Targeting limited HBPM resources to those aged >50 years old may have the most impact on BP.