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Randomized feasibility trial of a digital intervention for hypertension self-management

Journal of Human Hypertension volume 36, pages 718–725 (2022)Cite this article

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Abstract

Home blood pressure monitoring (HBPM) can improve hypertension management. Digital tools to facilitate routinized HBPM and patient self-care are underutilized and lack evidence of effectiveness. MyBP provides video-based education and automated text messaging to support continuous BP self-monitoring with recurring feedback. In this pragmatic trial, we sought to generate preliminary evidence of feasibility and efficacy in community-dwelling adults ≥55 y/o with hypertension recruited from primary care offices. Enrollees were provided a standard automatic BP cuff and randomized 2:1 to MyBP vs treatment-as-usual (control). Engagement with MyBP was defined as the proportion of BP reading prompts for which a reading was submitted, tracked over successive 2-week monitoring periods. Preliminary measures of efficacy included BP readings from phone-supervised home measurements and a self-efficacy questionnaire. Sixty-two participants (40 women, 33 Blacks, mean age 66, mean office BP 164/91) were randomized to MyBP (n = 41) or a control group (n = 21). Median follow-up was 22.9 (SD = 6.7) weeks. In the MyBP group, median engagement with HBPM was 82.7% (Q1 = 52.5, Q3 = 89.6) and sustained over time. The decline in systolic [12 mm Hg (SD = 17)] and diastolic BP [5 mm Hg (SD = 7)] did not differ between the two treatment groups. However, participants with higher baseline systolic BP assigned to MyBP had a greater decline compared to controls [interaction effect estimate −0.56 (−0.96, −0.17)]. Overall hypertension self-efficacy improved in the MyBP group. In conclusion, trial results show that older hypertensive adults with substantial minority representation had sustained engagement with this digital self-monitoring program and may benefit clinically.

Globally, hypertension (HTN) is the leading risk factor affecting disability-adjusted life-years [1] by causing or contributing to heart failure, coronary artery disease, stroke, kidney failure, and dementia. Anti-hypertensive treatments are effective and widely available, yet national surveys show that BP control is poor worldwide [1,2,3]. While some cases of hypertension remain undetected, most uncontrolled hypertension is attributed to patients’ suboptimal self-management and providers’ therapeutic inertia [2, 4]. Both providers and patients contend with uncertainty regarding office BP measurement and variability [5].

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Fig. 1: Engagement with MyBP program.
Fig. 2: Engagement time trend.
Fig. 3: Scatter plots of change in systolic BP as a function of baseline systolic BP.

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Acknowledgements

We gratefully acknowledge the following organizations and individuals whose contributions were integral to the successful completion of this investigation: The Aging Institute of UPMC Senior Services for funding; Patients, providers, and staff from area regional primary care offices who participated or assisted in the study; Mr. Jack Doman who programmed MyBP; Emmi Solutions, Inc. whose hypertension education videos were used through a lease agreement with UPMC Health System.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Matthew F. Muldoon & Daniel E. Forman

  2. Heart and Vascular Institute Hypertension Center, UPMC Health System, Pittsburgh, PA, USA

    Matthew F. Muldoon & Daniel E. Forman

  3. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Julian Einhorn, Danielle Burton & Jeanne Basse

  4. Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Jonathan G. Yabes & Bruce L. Rollman

  5. Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA

    Jonathan G. Yabes

  6. Department of Predictive Analytics, Highmark Health, Pittsburgh, PA, USA

    Taya Irizarry

  7. Division of Geriatrics, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Daniel E. Forman

  8. Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Bruce L. Rollman

  9. Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA

    Lora E. Burke

  10. Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA

    Thomas W. Kamarck

  11. Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Brian P. Suffoletto

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Correspondence to Matthew F. Muldoon.

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Muldoon, M.F., Einhorn, J., Yabes, J.G. et al. Randomized feasibility trial of a digital intervention for hypertension self-management. J Hum Hypertens 36, 718–725 (2022). https://doi.org/10.1038/s41371-021-00574-9

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