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Masanneck L, Stern AD. Tracing Digital Therapeutics Research Across Medical Specialties: Evidence from ClinicalTrials.gov. Clin Pharmacol Ther 2024; 116:177-185. [PMID: 38563641 DOI: 10.1002/cpt.3260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
Digital therapeutics (DTx), evidence-based software interventions for preventing, managing, or treating medical disorders, have rapidly evolved with healthcare's shift toward online, patient-centric solutions. This study scrutinizes DTx clinical trials from 2005 to 2022, analyzing their growth, funding, underlying medical specialties, and other R&D characteristics, using ClinicalTrials.gov data. Our analysis includes trials categorized via the ICD-11 system, covering active, recruiting, or completed studies and considering trials listing multiple conditions. In analyzing 5,889 registered DTx trials, we document a more than five-fold increase in such trials since 2011, and a compound annual growth rate of 22.82% since 2005. While most trials were single-center, the median number of study subjects increased in recent years, driven by larger interventional trials. The key disciplines driving this growth were psychiatry, neurology, oncology, and endocrinology. Mental health dominated DTx trials in recent years, led by neurocognitive disorders, substance abuse disorders, and mood disorders. Industry funding varied across disciplines and was particularly high in visual system diseases and dermatology. DTx trials have surged since 2005, accelerated by recent growth in mental health trials. These trends mirror developments toward remote healthcare delivery, amplified by digital health investments during the COVID-19 pandemic. Growing numbers of participants in DTx trials point to increased demand for more robust trials. However, because most trials are single-center and country-specific, more international cooperation and harmonized evaluation standards will be essential for DTx trials to become more efficient and provide validation across countries, health systems, and groups of individuals.
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Affiliation(s)
- Lars Masanneck
- Department of Neurology, Medical Faculty University Hospital Düsseldorf, Düsseldorf, Germany
- Digital Health Cluster, Hasso-Plattner Institute, Potsdam, Germany
| | - Ariel D Stern
- Digital Health Cluster, Hasso-Plattner Institute, Potsdam, Germany
- Technology and Operations Management Unit, Harvard Business School, Boston, Massachusetts, USA
- Harvard-MIT Center for Regulatory Science, Boston, Massachusetts, USA
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2
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Rosa D, Peverelli M, Poliani A, Villa G, Manara DF. Exploring Hypertension Patient Engagement Using mHealth. A Scoping Review. High Blood Press Cardiovasc Prev 2024:10.1007/s40292-024-00656-y. [PMID: 38913296 DOI: 10.1007/s40292-024-00656-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/01/2024] [Indexed: 06/25/2024] Open
Abstract
INTRODUCTION Widespread use of smartphone applications has opened new perspectives for home Blood Pressure monitoring based on mobile health (mHealth) technologies. Patient engagement has been dubbed 'the silver bullet of the century'. AIM The aim was to identify the impact of engagement in patients with blood pressure using mHealth. METHODS This scoping review was conducted in accordance with the Ark0sey and O'Malley framework. DATABASE Pubmed, CINAHL, Scopus and PsycInfo. This review considered both qualitative and quantitative primary searches. We excluded articles belonging to grey literature, secondary literature and paediatric setting. Between September and November 2023, the review was carried out. RESULTS A total of 569 documents were retrieved from the four databases. After the deduplication process, five articles were removed. The selection process based on titles and abstracts included 133 records. Ten studies were selected and analysed. The reviewers identified the following themes: device type and mobile applications, engagement, blood pressure control, health behaviours and hypertension knowledge. Self-management using digital technologies in the home is strongly linked to engagement, reduction and control of Blood Pressure, improved health practices and increased knowledge of hypertension. Healthcare interventions using IT platforms have had a significant impact on the health outcomes of patients diagnosed with hypertension. CONCLUSIONS The review findings suggest the value of these technologies in improving patient engagement and, consequently, adherence to antihypertensive treatment and achieving blood pressure control rates, potentially reducing cardiovascular risk.
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Affiliation(s)
- Debora Rosa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Via Olgettina, 58, Milan, Italy
| | - Matteo Peverelli
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Via Olgettina, 58, Milan, Italy
| | - Andrea Poliani
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Via Olgettina, 58, Milan, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Via Olgettina, 58, Milan, Italy.
| | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Via Olgettina, 58, Milan, Italy
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Skolarus LE, Lin CC, Mishra S, Meurer W, Dinh M, Whitfield C, Bi R, Brown D, Oteng R, Buis LR, Kidwell K. Engagement in mHealth-Prompted Self-Measured Blood Pressure Monitoring Among Participants Recruited From a Safety-Net Emergency Department: Secondary Analysis of the Reach Out Trial. JMIR Mhealth Uhealth 2024; 12:e54946. [PMID: 38889070 PMCID: PMC11186514 DOI: 10.2196/54946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 06/20/2024] Open
Abstract
Background Hypertension, a key modifiable risk factor for cardiovascular disease, is more prevalent among Black and low-income individuals. To address this health disparity, leveraging safety-net emergency departments for scalable mobile health (mHealth) interventions, specifically using text messaging for self-measured blood pressure (SMBP) monitoring, presents a promising strategy. This study investigates patterns of engagement, associated factors, and the impact of engagement on lowering blood pressure (BP) in an underserved population. Objective We aimed to identify patterns of engagement with prompted SMBP monitoring with feedback, factors associated with engagement, and the association of engagement with lowered BP. Methods This is a secondary analysis of data from Reach Out, an mHealth, factorial trial among 488 hypertensive patients recruited from a safety-net emergency department in Flint, Michigan. Reach Out participants were randomized to weekly or daily text message prompts to measure their BP and text in their responses. Engagement was defined as a BP response to the prompt. The k-means clustering algorithm and visualization were used to determine the pattern of SMBP engagement by SMBP prompt frequency-weekly or daily. BP was remotely measured at 12 months. For each prompt frequency group, logistic regression models were used to assess the univariate association of demographics, access to care, and comorbidities with high engagement. We then used linear mixed-effects models to explore the association between engagement and systolic BP at 12 months, estimated using average marginal effects. Results For both SMBP prompt groups, the optimal number of engagement clusters was 2, which we defined as high and low engagement. Of the 241 weekly participants, 189 (78.4%) were low (response rate: mean 20%, SD 23.4) engagers, and 52 (21.6%) were high (response rate: mean 86%, SD 14.7) engagers. Of the 247 daily participants, 221 (89.5%) were low engagers (response rate: mean 9%, SD 12.2), and 26 (10.5%) were high (response rate: mean 67%, SD 8.7) engagers. Among weekly participants, those who were older (>65 years of age), attended some college (vs no college), married or lived with someone, had Medicare (vs Medicaid), were under the care of a primary care doctor, and took antihypertensive medication in the last 6 months had higher odds of high engagement. Participants who lacked transportation to appointments had lower odds of high engagement. In both prompt frequency groups, participants who were high engagers had a greater decline in BP compared to low engagers. Conclusions Participants randomized to weekly SMBP monitoring prompts responded more frequently overall and were more likely to be classed as high engagers compared to participants who received daily prompts. High engagement was associated with a larger decrease in BP. New strategies to encourage engagement are needed for participants with lower access to care.
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Affiliation(s)
- Lesli E Skolarus
- Department of Neurology, Stroke and Vascular Neurology, Northwestern University, Chicago, IL, United States
| | - Chun Chieh Lin
- Department of Neurology, The Ohio State University, Columbus, OH, United States
| | - Sonali Mishra
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, United States
| | - William Meurer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Mackenzie Dinh
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Candace Whitfield
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Ran Bi
- Department of Neurology, The Ohio State University, Columbus, OH, United States
| | - Devin Brown
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Rockefeller Oteng
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Lorraine R Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Kelley Kidwell
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
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Paz E, Pargaonkar VS, Roach BJ, Meadows M, Roberts JM, Gazit T, Zaleski AL, Craig KJT, Serra SJ, Dunn P, Michos ED. Comprehensive Cardiovascular Risk Factor Control With a Mobile Health Cardiovascular Risk Self-Management Program. J Am Heart Assoc 2024; 13:e033328. [PMID: 38757455 PMCID: PMC11179803 DOI: 10.1161/jaha.123.033328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/04/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Mobile health technology's impact on cardiovascular risk factor control is not fully understood. This study evaluates the association between interaction with a mobile health application and change in cardiovascular risk factors. METHODS AND RESULTS Participants with hypertension with or without dyslipidemia enrolled in a workplace-deployed mobile health application-based cardiovascular risk self-management program between January 2018 and December 2022. Retrospective evaluation explored the influence of application engagement on change in blood pressure (BP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and weight. Multiple regression analyses examined the influence of guideline-based, nonpharmacological lifestyle-based digital coaching on outcomes adjusting for confounders. Of 102 475 participants, 49.1% were women. Median age was 53 (interquartile range, 43-61) years, BP was 134 (interquartile range, 124-144)/84 (interquartile range, 78-91) mm Hg, TC was 183 (interquartile range, 155-212) mg/dL, LDL-C was 106 (82-131) mg/dL, and body mass index was 30 (26-35) kg/m2. At 2 years, participants with baseline systolic BP ≥140 mm Hg reduced systolic BP by 18.6 (SEM, 0.3) mm Hg. At follow up, participants with baseline TC ≥240 mg/dL reduced TC by 65.7 (SEM, 4.6) mg/dL, participants with baseline LDL-C≥160 mg/dL reduced LDL-C by 66.6 (SEM, 6.2) mg/dL, and participants with baseline body mass index ≥30 kg/m2 lost 12.0 (SEM, 0.3) pounds, or 5.1% of body weight. Interaction with digital coaching was associated with greater reduction in all outcomes. CONCLUSIONS A mobile health application-based cardiovascular risk self-management program was associated with favorable reductions in BP, TC, LDL-C, and weight, highlighting the potential use of this technology in comprehensive cardiovascular risk factor control.
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Affiliation(s)
- Edo Paz
- Hello Heart, Inc Menlo Park CA USA
| | | | | | | | | | | | - Amanda L Zaleski
- Clinical Evidence Development, Aetna Medical Affairs, CVS Health® Hartford CT USA
| | | | - Steven J Serra
- Aetna Commercial, Clinical Business Support CVS Health Philadelphia PA USA
| | - Pat Dunn
- American Heart Association Dallas TX USA
| | - Erin D Michos
- Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD USA
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Nakrys M, Valinskas S, Aleknavicius K, Jonusas J. Pilot Investigation of Blood Pressure Control Using a Mobile App (Cardi.Health): Retrospective Chart Review Study. JMIR Cardio 2023; 7:e48454. [PMID: 37847544 PMCID: PMC10618889 DOI: 10.2196/48454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/26/2023] [Accepted: 09/13/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The high prevalence of hypertension necessitates effective, scalable interventions for blood pressure (BP) control. Self-monitoring has shown improved adherence to medication and better BP management. Mobile apps offer a promising approach with their increasing popularity and potential for large-scale implementation. Studies have demonstrated associations between mobile app interventions and lowered BP, yet real-world data on app effectiveness and engagement remain limited. OBJECTIVE In this study, we analyzed real-world user data from the Cardi.Health mobile app, which is aimed at helping its users monitor and control their BP. Our goal was to find out whether there is an association between the use of the mobile app and a decrease in BP. Additionally, the study explored how engagement with the app may influence this outcome. METHODS This was a retrospective chart review study. The initial study population comprised 4407 Cardi.Health users who began using the app between January 2022 and April 2022. After applying inclusion criteria, the final study cohort comprised 339 users with elevated BP at the baseline. The sample consisted of 108 (31.9%) men and 231 (68.1%) women (P=.04). This retrospective chart review study obtained permission from the Biomedical Research Alliance of New York Institutional Review Board (June 2022, registration ID 22-08-503-939). RESULTS The study's main findings were that there is a possible relationship between use of the Cardi.Health mobile app and a decrease in systolic BP. Additionally, there was a significant association between active use of the app and systolic BP decrease (χ21=5.311; P=.02). Finally, active users had an almost 2 times greater chance of reducing systolic BP by 5 mm Hg or more over 4 weeks (odds ratio 1.932, 95% CI 1.074-3.528; P=.03). CONCLUSIONS This study shows a possible relationship between Cardi.Health mobile app use and decreased BP. Additionally, engagement with the app may be related to better results-active use was associated with an almost 2-fold increase in the odds of reducing BP by 5 or more mm Hg.
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Affiliation(s)
| | | | | | - Justinas Jonusas
- Lithuania Business University of Applied Sciences, Klaipėda, Lithuania
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Harzand A, Alrohaibani A, Idris MY, Spence H, Parrish CG, Rout PK, Nazar R, Davis-Watts ML, Wright PP, Vakili AA, Abdelhamid S, Vathsangam H, Adesanya A, Park LG, Whooley MA, Wenger NK, Zafari AM, Shah AJ. Effects of a patient-centered digital health intervention in patients referred to cardiac rehabilitation: the Smart HEART clinical trial. BMC Cardiovasc Disord 2023; 23:453. [PMID: 37700245 PMCID: PMC10496208 DOI: 10.1186/s12872-023-03471-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 08/23/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) improves outcomes in heart disease yet remains vastly underutilized. Remote CR enhanced with a digital health intervention (DHI) may offer higher access and improved patient-centered outcomes over non-technology approaches. We sought to pragmatically determine whether offering a DHI improves CR access, cardiac risk profile, and patient-reported outcome measures. METHODS Adults referred to CR at a tertiary VA medical center between October 2017 and December 2021 were offered enrollment into a DHI alongside other CR modalities using shared decision-making. The DHI consisted of remote CR with a structured, 3-month home exercise program enhanced with multi-component coaching, a commercial smartphone app, and wearable activity tracker. We measured completion rates among DHI participants and evaluated changes in 6-min walk distance, cardiovascular risk factors, and patient-reported outcomes from pre- to post-intervention. RESULTS Among 1,643 patients referred to CR, 258 (16%) consented to the DHI where the mean age was 60 ± 9 years, 93% were male, and 48% were black. A majority (90%) of the DHI group completed the program. Over 3-months, significant improvements were seen in 6MWT (mean difference [MD] -29 m; 95% CI, 10 to 49; P < 0.01) and low-density lipoprotein cholesterol (MD -11 mg/dL; 95% CI, -17 to -5; P < 0.01), and the absolute proportion of patients who reported smoking decreased (10% vs 15%; MD, -5%; 95% CI, -8% to -2%; P < 0.01) among DHI participants with available data. No adverse events were reported. CONCLUSIONS The addition of a DHI-enhanced remote CR program was delivered in 16% of referred veterans and associated with improved CR access, markers of cardiovascular risk, and healthy behaviors in this real-world study. These findings support the continued implementation of DHIs for remote CR in real-world clinical settings. TRIAL REGISTRATION This trial was registered on ClinicalTrials.gov: NCT02791685 (07/06/2016).
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Affiliation(s)
- Arash Harzand
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA.
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA.
| | - Alaaeddin Alrohaibani
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
- Department of Pathology, Oregon Health and Science University, Portland, OR, USA
| | - Muhammed Y Idris
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Cate G Parrish
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
| | - Pratik K Rout
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Rene Nazar
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
| | | | - Phyllis P Wright
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
| | - Alexander A Vakili
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Smah Abdelhamid
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
| | | | | | - Linda G Park
- School of Nursing, University of California, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
| | - Mary A Whooley
- San Francisco VA Medical Center, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Nanette K Wenger
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - A Maziar Zafari
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Amit J Shah
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
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Dele-Ojo BF, Oseni TIA, Duodu F, Echieh CP, Blankson PK, Alabi BS, Sarpong DF, Tayo BO, Boima V, Coleman MA, Ogedegbe G. The effect of mobile health technology on blood pressure control among patients with hypertension in Ghana and Nigeria. RESEARCH SQUARE 2023:rs.3.rs-3272069. [PMID: 37790348 PMCID: PMC10543310 DOI: 10.21203/rs.3.rs-3272069/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background More than half of patients with hypertension in sub-Saharan African do not achieve blood pressure control. This study determined the effect of mobile health technology on systolic blood pressure reduction and blood pressure (BP) control among patients with hypertension in Nigeria and Ghana. Methods A randomised control trial of 225 adults with hypertension attending two General/Medical Outpatient Clinics each in Nigeria and Ghana was randomized into intervention (n = 116) and control (n = 109) arm respectively. Patients in the intervention arm received messages twice weekly from a mobile app for six months in addition to the usual care while the control arm received usual care only. The study outcomes were systolic blood pressure (SBP) reduction and blood pressure control at six months, while the secondary outcome was medication adherence at six months. Data were collected at 0 and 6 months, it was analysed using SPSS-21 software at a significance level of p < 0.05. Binary logistic regression was used to generate the predictors of good blood pressure control. Results The mean age for the control and intervention were 60.2 ± 13.5 and 62.6 ± 10.8 years respectively; p-value = 0.300. The intervention group had greater reductions in SBP (-18.7mmHg vs -3.9mmHg; p < 0.001) and greater BP control rate (44.3% vs 24.8%; p-value 0.002). Conclusions The mobile health intervention resulted in significant SBP reduction rate and improvement in BP control rate in the 6th month. However, improvement in adherence level in the 3rd month and was not sustained in the 6th month. The addition of mobile health technology may be extended for use in the national hypertension control plan. Female gender, formal education and being in the intervention arm were predictors of blood pressure control.
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Minuz P, Albini FL, Imbalzano E, Izzo R, Masi S, Pengo MF, Pucci G, Scalise F, Salvetti M, Tocci G, Cicero A, Iaccarino G, Savoia C, Sechi L, Parati G, Borghi C, Volpe M, Ferri C, Grassi G, Muiesan ML. Telemedicine and Digital Medicine in the Clinical Management of Hypertension and Hypertension-Related Cardiovascular Diseases: A Position Paper of the Italian Society of Arterial Hypertension (SIIA). High Blood Press Cardiovasc Prev 2023; 30:387-399. [PMID: 37594686 PMCID: PMC10600275 DOI: 10.1007/s40292-023-00595-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023] Open
Abstract
High blood pressure is the leading cause of death and disability globally and an important treatable risk factor for cardiovascular, cerebrovascular and chronic kidney diseases. Digital technology, including mobile health solutions and digital therapy, is expanding rapidly in clinical medicine and has the potential to improve the quality of care and effectiveness of drug treatment by making medical interventions timely, tailored to hypertensive patients' needs and by improving treatment adherence. Thus, the systematic application of digital technologies could support diagnosis and awareness of hypertension and its complications, ultimately leading to improved BP control at the population level. The progressive implementation of digital medicine in the national health systems must be accompanied by the supervision and guidance of health authorities and scientific societies to ensure the correct use of these new technologies with consequent maximization of the potential benefits. The role of scientific societies in relation to the rapid adoption of digital technologies, therefore, should encompass the entire spectrum of activities pertaining to their institutional role: information, training, promotion of research, scientific collaboration and advice, evaluation and validation of technological tools, and collaboration with regulatory and health authorities.
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Affiliation(s)
- Pietro Minuz
- Department of Medicine, University of Verona, Medicina Generale C, Policlinico GB Rossi, Piazzale LA Scuro 10, 37134, Verona, Italy.
| | | | - Egidio Imbalzano
- Hypertension Unit, Division of Internal Medicine, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Institute of Cardiovascular Science, University College London, London, UK
| | - Martino F Pengo
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, "Santa Maria" Terni Hospital, Terni, Italy
| | - Filippo Scalise
- Center for the Study of Hypertension and Vascular Diseases-Clinical Institute Verano Brianza, Policlinico di Monza, Monza, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia and Emergency Medicine ASST Spedali Civili di Brescia, Brescia, Italy
| | - Giuliano Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Azienda Ospedaliero-Universitaria Sant'Andrea, Rome, Italy
| | - Arrigo Cicero
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Guido Iaccarino
- Center for Research on Hypertension and Related Conditions, Federico II University of Naples, Naples, Italy
| | - Carmine Savoia
- Clinical and Molecular Medicine, University of Rome Sapienza and IRCCS San Raffaele Roma, Rome, Italy
| | - Leonardo Sechi
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- IRCCS, Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Massimo Volpe
- Clinical and Molecular Medicine, University of Rome Sapienza and IRCCS San Raffaele Roma, Rome, Italy
| | - Claudio Ferri
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Guido Grassi
- Clinica Medica, University of Milano-Bicocca, Milan, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia and Emergency Medicine ASST Spedali Civili di Brescia, Brescia, Italy
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Shah H, Patel S, Prajapati T, Patel H, Vaishnav B. Comparison of heart rate variability in normotensive and hypertensive Indian adults. Indian Heart J 2023:S0019-4832(23)00045-7. [PMID: 36966854 DOI: 10.1016/j.ihj.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/03/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
Autonomic imbalance is seen in hypertensive. This study was designed to compare heart rate variability in normotensive and hypertensive Indian adults. HRV records beat to beat variation in R-R intervals in milliseconds in electrocardiogram. Lead II ECG was recorded and a 5 minutes' stationary, artifacts free recording was selected for data analysis. HRV measures like total power was significantly less in hypertensive (303.37 ± 438.1) as compared to normotensive (534.16 ± 818.41). Standard deviation of normal-to-normal RR intervals was significantly reduced in hypertensive. A significant reduction of HRV was seen in hypertensive as compared to normotensive.
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Affiliation(s)
- Hasmukh Shah
- Department of Physiology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat, India.
| | - Srushti Patel
- Department of Physiology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat, India
| | - Tejas Prajapati
- Department of Physiology, SAL Institute of Medical Sciences, Ahmedabad, Gujarat, India
| | - Harmesh Patel
- Department of Medicine, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat, India
| | - Bhalendu Vaishnav
- Department of Medicine, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat, India
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10
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Meng F, Jiang Y, Yu P, Song Y, Zhou L, Xu Y, Zhou Y. Effect of health coaching on blood pressure control and behavioral modification among patients with hypertension: A systematic review and meta-analysis of randomized controlled trials. Int J Nurs Stud 2023; 138:104406. [PMID: 36473304 DOI: 10.1016/j.ijnurstu.2022.104406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health coaching has emerged as a potential supporting tool for improving hypertension health behavior. However, health coaching efficacy on hypertension has not been reviewed systematically. OBJECTIVE To evaluate the effects of health coaching on blood pressure and behavioral changes among patients with hypertension in randomized controlled trials. DESIGN A systematic review and meta-analysis. METHODS We searched Medline (via PubMed), Web of Science, Embase, Cochrane Central Register of Controlled Trials, Proquest, and Scopus from inception to November 30, 2021. All randomized controlled trials that estimated the effects of health coaching on blood pressure and behavioral changes in adults with hypertension were included. The Cochrane risk-of-bias tool was used to evaluate the quality of the included studies. Standardized mean differences (SMD) and 95 % confidence intervals (CIs) were calculated using random-effects or fixed-effects meta-analysis. Sensitivity analysis and subgroup analysis were also conducted. RESULTS A total of 1655 studies were screened and 12 randomized controlled trials were selected for inclusion, with 2497 participants were included. Most of the studies were at low risk of bias and the quality of evidence was high. The meta-analysis demonstrated that health coaching could significantly reduce systolic blood pressure (SMD: -0.26, 95 % CI: -0.39, -0.13, p < 0.001) and diastolic blood pressure in hypertension (SMD: -0.13, 95 % CI: -0.22, -0.03, p = 0.009). In addition, health coaching showed statistically significant positive effects on dietary behaviors (SMD: 0.76, 95 % CI: 0.08, 1.44, p = 0.02) and self-efficacy (SMD: 0.39, 95 % CI: 0.05, 0.73, p = 0.02). Subgroup analysis indicated that the most common and effective type of health coaching was the phone-based interventions (systolic blood pressure: SMD: -0.27, 95 % CI: -0.44, -0.10, p = 0.002; diastolic blood pressure: SMD: -0.14, 95 % CI: -0.25, -0.03, p = 0.02). The effects of nurse-delivered interventions were larger than other health care professionals (systolic blood pressure: SMD: -0.42, 95 % CI: -0.68, -0.16, p = 0.002; diastolic blood pressure: SMD: -0.19, 95 % CI: -0.35, -0.04, p = 0.02). CONCLUSION Current evidence suggested that health coaching could reduce blood pressure, improve dietary behaviors, and increase self-efficacy among patients with hypertension and thus could be an effective and alternative method in the management of hypertension. The most common and effective types of health coaching were phone-based and nurse-delivered interventions. Thus, more strategies and policies may be needed to implement these types of interventions to more patients with hypertension.
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Affiliation(s)
- Fei Meng
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Yunxia Jiang
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Pengli Yu
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Yuting Song
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Lixue Zhou
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Yanhong Xu
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Yunping Zhou
- School of Nursing, Qingdao University, Qingdao, Shandong, China.
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Sola J, Cortes M, Perruchoud D, De Marco B, Lobo MD, Pellaton C, Wuerzner G, Fisher NDL, Shah J. Guidance for the Interpretation of Continual Cuffless Blood Pressure Data for the Diagnosis and Management of Hypertension. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:899143. [PMID: 35655524 PMCID: PMC9152366 DOI: 10.3389/fmedt.2022.899143] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Hypertension remains the leading risk factor for death worldwide. Despite its prevalence, success of blood pressure (BP) management efforts remains elusive, and part of the difficulty lies in the tool still used to diagnose, measure, and treat hypertension: the sphygmomanometer introduced by Samuel Siegfried Karl von Basch in 1867. In recent years, there has been an explosion of devices attempting to provide estimates of BP without a cuff, overcoming many limitations of cuff-based BP monitors. Unfortunately, the differences in underlying technologies between traditional BP cuffs and newer cuffless devices, as well as hesitancy of changing a well-implemented standard, still generate understandable skepticism about and reluctance to adopt cuffless BP monitors in clinical practice. This guidance document aims to navigate the scientific and medical communities through the types of cuffless devices and present examples of robust BP data collection which are better representations of a person's true BP. It highlights the differences between data collected by cuffless and traditional cuff-based devices and provides an initial framework of interpretation of the new cuffless datasets using, as an example, a CE-marked continual cuffless BP device (Aktiia BP Monitor, Aktiia, Switzerland). Demonstration of novel BP metrics, which have the potential to change the paradigm of hypertension diagnosis and treatment, are now possible for the first time with cuffless BP monitors that provide continual readings over long periods. Widespread adoption of continual cuffless BP monitors in healthcare will require a collaborative and thoughtful process, acknowledging that the transition from a legacy to a novel medical technology will be slow. Finally, this guidance concludes with a call to action to international scientific and expert associations to include cuffless BP monitors in original scientific research and in future versions of guidelines and standards.
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Affiliation(s)
| | | | | | | | - Melvin D. Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Cyril Pellaton
- Division of Cardiology, Réseau Hospitalier Neuchâtelois (RHNe), Neuchâtel, Switzerland
| | - Gregoire Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Naomi D. L. Fisher
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women‘s Hospital, Boston, MA, United States
| | - Jay Shah
- Aktiia SA, Neuchâtel, Switzerland
- Division of Cardiology, Mayo Clinic Arizona, Phoenix, AZ, United States
- *Correspondence: Jay Shah
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12
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Castela Forte J, Folkertsma P, Gannamani R, Kumaraswamy S, van Dam S, Hoogsteen J. Effect of a Digitally-Enabled, Preventive Health Program on Blood Pressure in an Adult, Dutch General Population Cohort: An Observational Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074171. [PMID: 35409854 PMCID: PMC8998845 DOI: 10.3390/ijerph19074171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 02/04/2023]
Abstract
Worldwide, it is estimated that at least one in four adults suffers from hypertension, and this number is expected to increase as populations grow and age. Blood pressure (BP) possesses substantial heritability, but is also heavily modulated by lifestyle factors. As such, digital, lifestyle-based interventions are a promising alternative to standard care for hypertension prevention and management. In this study, we assessed the prevalence of elevated and high BP in a Dutch general population cohort undergoing a health screening, and observed the effects of a subsequent self-initiated, digitally-enabled lifestyle program on BP regulation. Baseline data were available for 348 participants, of which 56 had partaken in a BP-focused lifestyle program and got remeasured 10 months after the intervention. Participants with elevated SBP and DBP at baseline showed a mean decrease of 7.2 mmHg and 5.4 mmHg, respectively. Additionally, 70% and 72.5% of participants showed an improvement in systolic and diastolic BP at remeasurement. These improvements in BP are superior to those seen in other recent studies. The long-term sustainability and the efficacy of this and similar digital lifestyle interventions will need to be established in additional, larger studies.
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Affiliation(s)
- José Castela Forte
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9711 LM Groningen, The Netherlands
- Ancora Health B.V., 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.v.D.); (J.H.)
- Correspondence:
| | - Pytrik Folkertsma
- Ancora Health B.V., 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.v.D.); (J.H.)
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, 9711 LM Groningen, The Netherlands
| | - Rahul Gannamani
- Ancora Health B.V., 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.v.D.); (J.H.)
- Department of Neurology, University Medical Center Groningen, University of Groningen, 9711 LM Groningen, The Netherlands
| | - Sridhar Kumaraswamy
- Ancora Health B.V., 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.v.D.); (J.H.)
| | - Sipko van Dam
- Ancora Health B.V., 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.v.D.); (J.H.)
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, 9711 LM Groningen, The Netherlands
| | - Jan Hoogsteen
- Ancora Health B.V., 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.v.D.); (J.H.)
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How to deal with hypertension in the COVID-19 era-the impact "ON" and "OF" hypertension. Hypertens Res 2022; 45:548-550. [PMID: 34921300 PMCID: PMC8680064 DOI: 10.1038/s41440-021-00822-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/08/2022]
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