Standard vs. Enhanced Self-Measurement of Blood Pressure With Smartphone
- Surprisingly, in a randomized controlled trial, there was no clinical benefit or patient satisfaction using enhanced self-measurement with smartphone communication that provided reminders to take BP, BP tracking, interpretation, and support for emailing a summary of their self-measurement BP to family members or others, which in this study did not include the physician.
- The study did not address the potential for a health care team to use telemedicine that would help the decision process, including nocturnal monitoring of BP, enhance education, medication tracking and treatment intensification or lessening, and reduce office visits, improve medication adherence and safety, and reduce management costs (Omboni S, et al., Hypertension 2020;76:1368-83).
What is the effectiveness of enhanced self-measurement of blood pressure (SMBP) paired with a connected smartphone application compared to standard SMBP for BP reduction or patient satisfaction?
This pragmatic randomized clinical trial was conducted among 23 health systems participating in PCORnet, the National Patient-Centered Clinical Research Network, and included patients who reported having uncontrolled BP at their last clinic visit, a desire to lower their BP, and a smartphone. Enrollment and randomization occurred from August 3, 2019–December 31, 2020, which was followed by 6 months of follow-up for each patient. Analysis commenced shortly thereafter. Eligible participants were randomly assigned to enhanced SMBP using a device that paired with a connected smartphone application (enhanced) or a standard device (standard). Participants received their device in the mail, along with web-based educational materials and phone-based support as needed. No clinician engagement was undertaken, and the study provided no special mechanisms for delivering measurements to clinicians for use in BP management.
Of the enrolled participants (1,051 enhanced [50.0%] vs. 1,050 standard [50.0%]; 56.7% women, mostly middle-aged or older (age 58  years), nearly a third were non-Hispanic Black or Hispanic, and most were relatively comfortable using technology (4.1 [1.1] of 5). Mean baseline BP was 157/88 mm Hg differing by about 0.05 mm Hg. The mean (standard deviation) change in systolic BP from baseline to 6 months was −10.8 (18) mm Hg vs. −10.6 (18) mm Hg (enhanced vs. standard groups). Secondary outcomes were mostly null, except for documented attainment of BP control to lower than 140/<90 mm Hg, which occurred in 32% in the enhanced group versus 29% in the standard group (odds ratio, 1.15; 95% confidence interval, 1.01-1.34; nominal p = 0.03). Most participants were very likely to recommend their SMBP device to a friend (70% vs. 69%).
This randomized clinical trial found that enhanced SMBP paired with a smartphone application is not superior to standard SMBP for BP reduction or patient satisfaction.
While this study is a well-designed and well-powered step to test the value of enhancing care with smart tools, because the participants could not communicate results to the physician’s office, it does not help in the quest for more telemedicine.
Keywords: Ambulatory Care, Blood Pressure, Hypertension, Patient Care Team, Patient Satisfaction, Patient-Centered Care, Primary Prevention, Smartphone, Technology, Telemedicine
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