App helps compliance, but not blood pressure


An elderly man measures blood pressure and pulse by mobile phone

More consumers are turning to health care apps to try and manage conditions like hypertension – but how effective are they?

A new study published in JAMA Internal Medicine looked at the efficacy of blood pressure apps – and found that using an app didn’t change a patient’s systolic blood pressure.

However they did find a small improvement in self-reported medication adherence – a major contributing factor in poorly controlled high blood pressure.

The researchers, from Harvard Medical School, enrolled 411 participants with poorly controlled high blood pressure, who were each taking between one and three antihypertensive medications.

Following recruitment through an online program, the participants were enrolled in a randomised clinical trial in which 209 were instructed to download the Medisafe app.

A related comment piece described Medisafe as a “highly rated” smartphone app for medication management, which lets its users track their medication intake and home blood pressure readings.

The app includes reminder alerts, adherence reports and optional peer support, where users can enlist a “Medifriend” to have access to their drug history and receive alerts if the user misses a dose.

Patients randomised to use the Medisafe app had a small but significant improvement in self-reported medication adherence with no difference in blood pressure compared with controls.

“At baseline, mean (SD) adherence as measured by theMMAS-8 was 6.0 (1.8) among the intervention arm and 5.7 (1.8) among controls,” the authors write.

“By 12 weeks of follow-up, the mean (SD) adherence increased by 0.4 (1.5) in the intervention arm and remained unchanged among controls (between-group difference, 0.4; 95% CI, 0.1-0.7; P = .01).

“The results remained unchanged after adjustment for differences in baseline characteristics in secondary analyses and in the complete case analysis.

“Subgroup analyses of the association of the intervention with adherence by sex, age, baseline systolic blood pressure, baseline adherence, and activation showed no significant between-group differences, although the magnitude of the improvement in adherence was largest for participants reporting low baseline adherence.

“Consistent with this, the overall improvement in adherence from the intervention resulted from a reduction in the proportion of patients with low levels of adherence and a commensurate rise in the proportion of individuals with moderate adherence.”

The researchers mused about ways smartphone apps could be improved to result in greater benefits for patients with hypertension.

“While the app we tested has received very high usability scores, it may be that individuals with hypertension have needs that are different from those of individuals with other conditions,” they suggest.

“Therefore, one solution is to offer more disease-specific customization of smartphone tools.

“An alternative idea is to link the app to clinical care. Several studies have shown greater effects on clinical outcomes when home self-monitoring of blood pressure is linked with additional support, mostly through connection to health care professionals.”

Nonetheless, as poor adherence to hypertension medication regimes is a significant cause of ineffective treatment, even a small increase in compliance is helpful, the researchers say.

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