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Tran KC, Mak M, Kuyper LM, Bittman J, Mangat B, Lindsay H, Kim Sing C, Xu L, Wong H, Dawes M, Khan N, Ho K. Home Blood Pressure Telemonitoring Technology for Patients With Asymptomatic Elevated Blood Pressure Discharged From the Emergency Department: Pilot Study. JMIR Form Res 2024; 8:e49592. [PMID: 38111177 PMCID: PMC10865197 DOI: 10.2196/49592] [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: 06/30/2023] [Revised: 11/17/2023] [Accepted: 12/19/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Hypertension affects 1 in 5 Canadians and is the leading cause of morbidity and mortality globally. Hypertension control is declining due to multiple factors including lack of access to primary care. Consequently, patients with hypertension frequently visit the emergency department (ED) due to high blood pressure (BP). Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring Blood Pressure is a pilot project that implements and evaluates a comprehensive home blood pressure telemonitoring (HBPT) and physician case management protocol designed as a postdischarge management strategy to support patients with asymptomatic elevated BP as they transition from the ED to home. OBJECTIVE Our objective was to conduct a feasibility study of an HBPT program for patients with asymptomatic elevated BP discharged from the ED. METHODS Patients discharged from an urban, tertiary care hospital ED with asymptomatic elevated BP were recruited in Vancouver, British Columbia, Canada, and provided with HBPT technology for 3 months of monitoring post discharge and referred to specialist hypertension clinics. Participants monitored their BP twice in the morning and evenings and tele-transmitted readings via Bluetooth Sensor each day using an app. A monitoring clinician received these data and monitored the patient's condition daily and adjusted antihypertensive medications. Feasibility outcomes included eligibility, recruitment, adherence to monitoring, and retention rates. Secondary outcomes included proportion of those who were defined as having hypertension post-ED visits, changes in mean BP, overall BP control, medication adherence, changes to antihypertensive medications, quality of life, and end user experience at 3 months. RESULTS A total of 46 multiethnic patients (mean age 63, SD 17 years, 69%, n=32 women) found to have severe hypertension (mean 191, SD 23/mean 100, SD 14 mm Hg) in the ED were recruited, initiated on HBPT with hypertension specialist physician referral and followed up for 3 months. Eligibility and recruitment rates were 40% (56/139) and 88% (49/56), respectively. The proportion of participants that completed ≥80% of home BP measurements at 1 and 3 months were 67% (31/46) and 41% (19/46), respectively. The proportion of individuals who achieved home systolic BP and diastolic BP control at 3 months was 71.4% (30/42) and 85.7% (36/42) respectively. Mean home systolic and diastolic BP improved by -13/-5 mm Hg after initiation of HBPT to the end of the study. Patients were prescribed 1 additional antihypertensive medication. No differences in medication adherence from enrollment to 3 months were noted. Most patients (76%, 25/33) were highly satisfied with the HBPT program and 76% (25/33) found digital health tools easy to use. CONCLUSIONS HBPT intervention is a feasible postdischarge management strategy and can be beneficial in supporting patients with asymptomatic elevated BP from the ED. A randomized trial is underway to evaluate the efficacy of this intervention on BP control.
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Affiliation(s)
- Karen C Tran
- Division of General Internal Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Meagan Mak
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Laura M Kuyper
- Division of General Internal Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jesse Bittman
- Division of General Internal Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Birinder Mangat
- Division of General Internal Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Heather Lindsay
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chad Kim Sing
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Liang Xu
- Center for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Hubert Wong
- Center for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Martin Dawes
- Division of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nadia Khan
- Division of General Internal Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Kendall Ho
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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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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Bradley CK, Choi E, Abdalla M, Mizuno H, Lam M, Cepeda M, Sangapalaarachchi D, Liu J, Muntner P, Kario K, Viera AJ, Schwartz JE, Shimbo D. Use of Different Blood Pressure Thresholds to Reduce the Number of Home Blood Pressure Monitoring Days Needed for Detecting Hypertension. Hypertension 2023; 80:2169-2177. [PMID: 37577827 PMCID: PMC10530450 DOI: 10.1161/hypertensionaha.123.21118] [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: 02/21/2023] [Accepted: 07/28/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Home blood pressure (BP) monitoring over a 7-day period is recommended to confirm the diagnosis of hypertension. METHODS We determined upper and lower home BP thresholds with >90% positive predictive value and >90% negative predictive value using 1 to 6 days of monitoring to identify high home BP (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg) based on 7 days of home BP monitoring. The sample included 361 adults from the Improving the Detection of Hypertension Study who were not taking antihypertensive medication. We used two 7-day periods, at least 3 days apart, the first being a sampling period and the second a reference period. For each number of days in the sampling period, we determined the percentage of participants who had a high likelihood of having (>90% positive predictive value) or not having (>90% negative predictive value) high BP and would not need to continue home BP monitoring. Only the participants in an uncertain category (ie, positive predictive value ≤90% and negative predictive value ≤90%) after each day were carried forward to the next day of home BP monitoring. RESULTS Of the 361 participants (mean [SD] age of 41.3 [13.2] years; 60.4% women), 38.0% had high home BP during the reference period. There were 63.7%, 17.1%, 10.5%, 3.3%, 3.6%, and 1.4% participants who would not need to continue after 1, 2, 3, 4, 5, and 6 days of monitoring. CONCLUSIONS In most people, high home BP can be identified or excluded with a high degree of confidence with 3 days or less of monitoring.
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Affiliation(s)
- Corey K Bradley
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York
| | - Eunhee Choi
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York
| | - Marwah Abdalla
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - Hiroyuki Mizuno
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York
- Department of Cardiology, Jichi University School of Medicine, Tochigi, Japan
| | - Michael Lam
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York
| | - Maria Cepeda
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York
| | - Dona Sangapalaarachchi
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York
| | - Justin Liu
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kazuomi Kario
- Department of Cardiology, Jichi University School of Medicine, Tochigi, Japan
| | - Anthony J Viera
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC
| | - Joseph E Schwartz
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York
| | - Daichi Shimbo
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York
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Litvin CB, Ornstein SM. Development and Initial Use of an Evidence-Based Home Blood Pressure Monitoring mHealth Platform. J Med Syst 2023; 47:53. [PMID: 37118616 DOI: 10.1007/s10916-023-01955-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: 02/14/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023]
Abstract
Home blood pressure monitoring (HBPM) has been shown to provide a more reliable assessment of blood pressure (BP) than in-office measurement and may lead to improved BP control. While many mHealth apps are available to help users track their blood pressure (BP), no apps incorporate the full set of evidence-based HBPM recommendations for ensuring accurate measurement at home. Through an agile development approach employing user stories, we translated an evidence-based standardized protocol for BP measurement and monitoring over a recommended 3-7 day monitoring period into a mHealth app and corresponding clinician portal. We then pilot tested this platform to assess its feasibility for guiding users to measure BP over multiple days according to this protocol. During this pilot testing, one hundred and twenty five users created an app account; 75 (60.0%) of these users recorded at least one BP reading and 47 (37.6%) completed at least one monitoring period. Through this work, we have demonstrated how a series of guidelines can be systematically translated into a mHealth platform for HBPM. Such platforms may be accessible resources to facilitate standardized HBPM and sharing of readings with providers.
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Affiliation(s)
- Cara B Litvin
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, 12th floor, Charleston, SC, 29425, USA.
| | - Steven M Ornstein
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, 12th floor, Charleston, SC, 29425, USA
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Beger C, Rüegger D, Lenz A, Wagner S, Haller H, Schmidt-Ott KM, Volland D, Limbourg FP. Blood pressure dynamics during home blood pressure monitoring with a digital blood pressure coach—a prospective analysis of individual user data. Front Cardiovasc Med 2023; 10:1115987. [PMID: 37089883 PMCID: PMC10113611 DOI: 10.3389/fcvm.2023.1115987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/23/2023] [Indexed: 04/09/2023] Open
Abstract
IntroductionSelf-monitoring of blood pressure at home is a better predictor of prognosis and recommended in hypertension guidelines. However, the influence of baseline blood pressure category and measurement schedule on BP values during a period of home blood pressure monitoring (HBPM) are still poorly defined, particularly when used in conjunction with a digital application.MethodsWe analysed temporal BP changes and performed BP classification tracking in users with self-reported hypertension performing HBPM with a digital and interactive blood pressure coach.ResultsOf 3175 users who enrolled in HBPM, 74.1% completed the first measurement period. Overall, mean systolic BP dropped significantly after the first day, but stratification by BP category demonstrated that initial category influenced BP course. BP classification tracking revealed that time to reach final BP category was dependent on baseline category, with users in categories high normal and grade 1 hypertension requiring more days to decrease BP class volatility and to reach their definitive BP class. This was driven by an intense switching between directly neighbouring categories until the middle phase of the HBPM period, while more distant class switching occurred less often and only early on. Overall, >90% of users maintained their category by day 5. Omitting the first day from analysis lead to therapeutically relevant reclassification in 3.8% of users. Users who completed at least two HBPM periods (n = 864) showed a mean SBP/DBP decrease of 2.6/1.6 mmHg, which improved hypertension control from 55.6% to 68.1%.ConclusionThe optimal length of HBPM period depends on BP category. HBPM with a digital coach is associated with a reduction in average BP and improvement in BP control.
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Affiliation(s)
- Christian Beger
- Vascular Medicine Research, Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | | | - Anna Lenz
- Pathmate Technologies GmbH, Mannheim, Germany
| | - Steffen Wagner
- Department II (Mathematics, Physics and Chemistry), Berliner Hochschule für Technik, Berlin, Germany
- INWT Statistics GmbH, Berlin, Germany
| | - Herrmann Haller
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | | | | | - Florian P. Limbourg
- Vascular Medicine Research, Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
- Correspondence: Florian P. Limbourg
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Home Blood Pressure Monitoring And Nocturia In Adults. J Community Health 2022; 48:238-244. [PMID: 36370256 DOI: 10.1007/s10900-022-01171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/15/2022]
Abstract
Although widely viewed as a urological condition, nocturia has been increasingly recognized to accompany various non-urological conditions such as hypertension and blood pressure (BP) elevation on office determination. Home BP monitoring (HBPM) has been shown superior to office-based readings and provides an opportunity to assess potential relationships between nocturia and novel indices derived from multiple BP recordings including BP load, BP variability, and arterial stiffness, which have prognostic significance. We retrospectively studied 103 home BP logs and nocturia frequencies provided by 61 stable cardiology patients ≥ 21 years without medication change. Nocturnal voids ranged from 0 to 5 voids per night, median: 1.5. Nocturia frequency was significantly correlated with home and office systolic BPs and with BP load, but not with diastolic BPs, BP variability or arterial stiffness. On Poisson regression analysis, the estimated prevalence ratio (PR) for home and office systolic BPs were 1.025 (CI: 1.01, 1.04; p < .001) and 1.01 (CI:1.00, 1.02; p = .019), indicating 2.5% and 1% increases in the risk of nocturia per mmHg increases in BP respectively. In conclusion, higher mean home and office systolic BPs are associated with self-reported nocturia frequency with stronger associations seen for home BP measurement. Nocturia frequency appears unrelated to mean home and office diastolic BPs. Nocturia may be related to BP load, (percentage of elevated BP values), but not to BP variability or arterial stiffness. Future prospective studies using HBPM are needed to confirm these findings and to contribute to the understanding of the elevated BP-nocturia link.
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Heckemann B, Graf T, Ung EJ, Jakobsson S, Ragnarsson O, Olsson DS, Blomdahl C. The importance of personal documentation for patients living with long-term illness symptoms after pituitary surgery: A Constructivist Grounded Theory study. Health Expect 2022; 26:226-236. [PMID: 36335563 PMCID: PMC9854328 DOI: 10.1111/hex.13648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 09/06/2022] [Accepted: 10/22/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Despite surgical treatment, pituitary adenomas often cause long-term illness symptoms, that profoundly impact patients' quality of life physically, psychologically and socially. Healthcare professionals often fail to recognize and discuss the ensuing problems. Personal documentation, such as symptom monitoring, reflective writing or even posts on social media, may help this patient group to manage their daily life and support communication of their care needs. Documentation strategies and the role of documentation for people with long-term symptoms after pituitary adenoma surgery are currently unknown. AIM To examine the effects and strategies of documenting symptoms, activities and physical and emotional well-being among people living with long-term pituitary adenoma. METHODS In this Constructivist Grounded Theory study, 12 individuals living with long-term illness symptoms after pituitary adenoma surgery described their documentation strategies in in-depth interviews using teleconferencing and photo-elicitation between August and October 2020. RESULTS Strategies for documentation included analogue and digital media. One core category (Exercising autonomy) and three categories describing processes (Gaining insight, Striving for control and Sharing) emerged from the analysis. These three interrelated processes become an expression of autonomy to manage life and make sense of chronic illness. Personal documentation is a flexible tool that is used more extensively in times of ill health and less in times of relative well-being. Sharing documentation with healthcare professionals facilitated care planning and sharing with friends and family fostered emotional well-being. CONCLUSION Personal documentation is a valuable resource for managing life after pituitary adenoma surgery. The current findings may be relevant to other chronic illnesses. Further research exploring potential tools for personal documentation is needed. PATIENT OR PUBLIC CONTRIBUTION We deliberately chose a Constructivist Grounded Theory approach for this interview study. Using Constructivist Grounded Theory, we gave people living with long-term symptoms a voice, allowing them to freely speak about managing their illness in connection with personal documentation. The theoretical sampling approach enabled us to invite participants that could provide a broad overview of the landscape of personal documentation.
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Affiliation(s)
- Birgit Heckemann
- Section for Care in Long‐term Conditions, Institute of Health and Care Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Anesthetics, Surgery and Intensive CareSahlgrenska University HospitalGothenburgSweden
| | - Tatjana Graf
- Department of SociologyUniversity of LucerneLucerneSwitzerland
| | - Eva Jakobsson Ung
- Section for Learning and Leadership for Health Care Professionals, Institute of Health and Care Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Sofie Jakobsson
- Section for Care in Long‐term Conditions, Institute of Health and Care Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Oskar Ragnarsson
- Department of MedicineSahlgrenska University HospitalGothenburgSweden,Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, Institute of MedicineUniversity of GothenburgGothenburgSweden
| | - Daniel S. Olsson
- Department of MedicineSahlgrenska University HospitalGothenburgSweden,Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, Institute of MedicineUniversity of GothenburgGothenburgSweden
| | - Christina Blomdahl
- Research and Development Centre Södra Älvsborg, Research and Development Primary HealthcareRegion Västra GötalandBoråsSweden
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Home blood pressure monitoring schedule: optimal and minimum based on 2122 individual participants' data. J Hypertens 2022; 40:1380-1387. [PMID: 35762478 DOI: 10.1097/hjh.0000000000003157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Home blood pressure (HBP) monitoring has become a primary method for hypertension diagnosis and management. This analysis aimed to investigate the optimal and minimum schedule for HBP monitoring. METHODS A retrospective analysis of cross-sectional data was performed, which involved HBP and 24-h ambulatory blood pressure (ABP) monitoring in adults performed within the context of clinical studies in Finland, Greece and UK. Participants with six to seven HBP monitoring days and at least 12 HBP readings were included. The stability of HBP was assessed by evaluating the average value of an increasing number of readings and its variability (SD). Its association with awake ABP was also assessed. RESULTS Data from 2122 participants were analysed (mean age 53.9 ± 11.3 years, males 53%, treated 34%). A progressive HBP decline was observed in succeeding days, reaching a plateau after day 3. Day 1 HBP was higher than in the next days by about 2.8/1.4 mmHg (systolic/diastolic, P < 0.001). In a 3-day HBP monitoring schedule, the exclusion of day 1 reduced average HBP and SD, with a clinically important HBP decline in 115 participants (5%) and different hypertension diagnosis in 120 participants (6%). For schedules including more than three HBP monitoring days, the exclusion of day 1 had negligible impact. The 3-day average HBP was strongly correlated with awake ABP, with a little improvement thereafter. CONCLUSION These data support the recommendation for 7 days of HBP monitoring with a minimum of 3 days. Readings of the first day should be discarded, particularly when the minimum 3-day monitoring schedule is obtained (average readings of second and third day).
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Yeh PT, Rhee DK, Kennedy CE, Zera CA, Lucido B, Tunçalp Ö, Gomez Ponce de Leon R, Narasimhan M. Self-monitoring of blood pressure among women with hypertensive disorders of pregnancy: a systematic review. BMC Pregnancy Childbirth 2022; 22:454. [PMID: 35641913 PMCID: PMC9152837 DOI: 10.1186/s12884-022-04751-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends self-monitoring of blood pressure (SMBP) for hypertension management. In addition, during the COVID-19 response, WHO guidance also recommends SMBP supported by health workers although more evidence is needed on whether SMBP of pregnant individuals with hypertension (gestational hypertension, chronic hypertension, or pre-eclampsia) may assist in early detection of pre-eclampsia, increase end-user autonomy and empowerment, and reduce health system burden. To expand the evidence base for WHO guideline on self-care interventions, we conducted a systematic review of SMBP during pregnancy on maternal and neonatal outcomes. METHODS We searched for publications that compared SMBP with clinic-based monitoring during antenatal care. We included studies measuring any of the following outcomes: maternal mortality, pre-eclampsia, long-term risk and complications, autonomy, HELLP syndrome, C-section, antenatal hospital admission, adverse pregnancy outcomes, device-related issues, follow-up care with appropriate management, mental health and well-being, social harms, stillbirth or perinatal death, birthweight/size for gestational age, and Apgar score. After abstract screening and full-text review, we extracted data using standardized forms and summarized findings. We also reviewed studies assessing values and preferences as well as costs of SMBP. RESULTS We identified 6 studies meeting inclusion criteria for the effectiveness of SMBP, 6 studies on values and preferences, and 1 study on costs. All were from high-income countries. Overall, when comparing SMBP with clinic-monitoring, there was no difference in the risks for most of the outcomes for which data were available, though there was some evidence of increased risk of C-section among pregnant women with chronic hypertension. Most end-users and providers supported SMBP, motivated by ease of use, convenience, self-empowerment and reduced anxiety. One study found SMBP would lower health sector costs. CONCLUSION Limited evidence suggests that SMBP during pregnancy is feasible and acceptable, and generally associated with maternal and neonatal health outcomes similar to clinic-based monitoring. However, more research is needed in resource-limited settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021233839 .
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Affiliation(s)
- Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dong Keun Rhee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin Elizabeth Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chloe A Zera
- Department of Obstetrics and Gynecology, Harvard Medical Faculty Physicians, Boston, MA, USA
| | - Briana Lucido
- Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction - HRP, 20 Avenue Appia, 1211, Geneva 27, Switzerland
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction - HRP, 20 Avenue Appia, 1211, Geneva 27, Switzerland
| | | | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction - HRP, 20 Avenue Appia, 1211, Geneva 27, Switzerland.
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Groenland EH, Bots ML, Visseren FLJ, McManus RJ, Spiering W. Number of measurement days needed for obtaining a reliable estimate of home blood pressure and hypertension status. Blood Press 2022; 31:100-108. [DOI: 10.1080/08037051.2022.2071674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Eline H. Groenland
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Frank L. J. Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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11
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Blood Pressure Checks for Diagnosing Hypertension: Health Professionals' Knowledge, Beliefs, and Practices. J Am Board Fam Med 2022; 35:310-319. [PMID: 35379718 PMCID: PMC9621313 DOI: 10.3122/jabfm.2022.02.210318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The US Preventive Services Task Force recommends out-of-office blood pressure (BP) measurement before making a new hypertension diagnosis and initiating treatment, using 24-hour ambulatory (ABPM) or home BP monitoring. However, this approach is not common. METHODS e-mail-linked surveys were sent to primary care team members (n = 421) from 10 clinics. The sample included medical assistants, licensed practical nurses, registered nurses, and advanced practice registered nurses (LPN/RN/APRNs), physician assistants (PAs), and physicians. Those licensed to diagnosis hypertension (physician/PA/APRNs) received additional questions. Data were collected from November 2017 to July 2019. RESULTS 2-thirds of invitees responded (163 MA/LPN/RNs, 86 physicians, and 33 PA/APRNs). When making a new hypertension diagnosis, most respondents believed that BP measured manually with a stethoscope (78.6%) or ABPM (84.2%) were very or highly accurate. In contrast, most did not believe that automated clinic BPs, home BP, or kiosk BP measurements were very or highly accurate. Almost all reported always or almost always relying on clinic BP measurements in making a diagnosis (95.7%), but most physician/PA/APRNs (60.5%) would prefer ABPM if it was readily available. Very few physician/PA/APRNs used the guideline-concordant diagnostic threshold (135/85 mmHg) with home monitoring (14.0%) or ABPM (8.4%), with 140/90 mmHg the most commonly reported threshold for home (59.4%) and ABPM (49.6%). DISCUSSION Our study found health care professional knowledge, beliefs, and practices gaps in diagnosing hypertension. These gaps could lead to clinical care that is not aligned with guidelines. CONCLUSION System changes and interventions to increase use of evidence-based practices could improve hypertension diagnosis and outcomes.
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Tran K, Padwal R, Khan N, Wright MD, Chan WS. Home blood pressure monitoring in the diagnosis and treatment of hypertension in pregnancy: a systematic review and meta-analysis. CMAJ Open 2021; 9:E642-E650. [PMID: 34131027 PMCID: PMC8248564 DOI: 10.9778/cmajo.20200099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Home blood pressure monitoring is increasingly used for pregnant individuals; however, there are no guidelines on such monitoring in this population. We assessed current practices in the prescription and use of home blood pressure monitoring in pregnancy. METHODS We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs). We conducted a structured search through the MEDLINE (from 1946), Embase (from 1974) and CENTRAL (from 2018) databases up to Oct. 19, 2020. We included trials comparing office and home blood pressure monitoring in pregnant people. Outcomes included patient education, home blood pressure device, monitoring schedule, adherence, diagnostic thresholds for home blood pressure, and comparison between home and office measurements of blood pressure. RESULTS We included in our review 21 articles on 19 individual studies (1 RCT, 18 observational) that assessed home and office blood pressure in pregnant individuals (n = 2843). We observed variation in practice patterns in terms of how home monitoring was prescribed. Eight (42%) of the studies used validated home blood pressure devices. Across all studies, measurements were taken 3 to 36 times per week. Third-trimester home blood pressure corresponding to office blood pressure of 140/90 mm Hg after application of a conversion factor ranged from 118 to 143 mm Hg (systolic) and from 76 to 92 mm Hg (diastolic), depending on the patient population and methodology. Systolic and diastolic blood pressure values measured at home were lower than office values by 4 (95% confidence interval [CI] -6 to -3) mm Hg and 3 (95% CI -4 to -2) mm Hg, respectively. INTERPRETATION Many issues related to home blood pressure monitoring in pregnancy are currently unresolved, including technique, monitoring schedule and target values. Future studies should prioritize the use of validated home measuring devices and standardized measurement schedules and should establish treatment targets. PROSPERO REGISTRATION CRD42020147352.
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Affiliation(s)
- Karen Tran
- Division of General Internal Medicine (Tran, Khan, Chan), Department of Medicine, University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Tran, Khan); and Apex Information (Wright), Vancouver, BC; Division of General Internal Medicine (Padwal), Department of Medicine, University of Alberta, Edmonton, Alta.
| | - Raj Padwal
- Division of General Internal Medicine (Tran, Khan, Chan), Department of Medicine, University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Tran, Khan); and Apex Information (Wright), Vancouver, BC; Division of General Internal Medicine (Padwal), Department of Medicine, University of Alberta, Edmonton, Alta
| | - Nadia Khan
- Division of General Internal Medicine (Tran, Khan, Chan), Department of Medicine, University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Tran, Khan); and Apex Information (Wright), Vancouver, BC; Division of General Internal Medicine (Padwal), Department of Medicine, University of Alberta, Edmonton, Alta
| | - Mary-Doug Wright
- Division of General Internal Medicine (Tran, Khan, Chan), Department of Medicine, University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Tran, Khan); and Apex Information (Wright), Vancouver, BC; Division of General Internal Medicine (Padwal), Department of Medicine, University of Alberta, Edmonton, Alta
| | - Wee Shian Chan
- Division of General Internal Medicine (Tran, Khan, Chan), Department of Medicine, University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Tran, Khan); and Apex Information (Wright), Vancouver, BC; Division of General Internal Medicine (Padwal), Department of Medicine, University of Alberta, Edmonton, Alta
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Alessa T, S Hawley M, Alsulamy N, de Witte L. Using a Commercially Available App for the Self-Management of Hypertension: Acceptance and Usability Study in Saudi Arabia. JMIR Mhealth Uhealth 2021; 9:e24177. [PMID: 33560237 PMCID: PMC7902196 DOI: 10.2196/24177] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/26/2020] [Accepted: 12/23/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The use of smartphone apps to assist in the self-management of hypertension is becoming increasingly common, but few commercially available apps have the potential to be effective along with adequate security and privacy measures in place. In a previous study, we identified 5 apps that are potentially effective and safe, and based on the preferences of doctors and patients, one (Cora Health) was selected as the most suitable app for use in a Saudi context. However, there is currently no evidence of its usability and acceptance among potential users. Indeed, there has been little research into the usability and acceptance of hypertension apps in general, and less research considers this in the Gulf Region. OBJECTIVE This study aims to evaluate the acceptance and usability of the selected app in the Saudi context. METHODS This study used a mixed methods approach with 2 studies: a usability test involving patients in a controlled setting performing predefined tasks and a real-world usability study where patients used the app for 4 weeks. In the usability test, participants were asked to think aloud while performing the tasks, and an observer recorded the number of tasks they completed. At the end of the real-world pilot study, participants were interviewed, and the mHealth App Usability Questionnaire was completed. Descriptive statistics were used to analyze quantitative data, and thematic analysis was used to analyze qualitative data. RESULTS In total, 10 patients completed study 1. The study found that app usability was moderate and that participants needed some familiarization time before they could use the app proficiently. Some usability issues were revealed, related to app accessibility and navigation, and a few tasks remained uncompleted by most people. A total of 20 patients completed study 2, with a mean age of 51.6 (SD 11.7) years. Study 2 found that the app was generally acceptable and easy to use, with some similar usability issues identified. Participants stressed the importance of practice and training to use it more easily and proficiently. Participants had a good engagement level with 48% retention at the end of study 2, with most participants' engagement being classed as meaningful. The most recorded data were blood pressure, followed by stress and medication, and the most accessed feature was viewing graphs of data trends. CONCLUSIONS This study shows that a commercially available app can be usable and acceptable in the self-management of hypertension but also found a considerable number of possibilities for improvement, which needs to be considered in future app development. The results show that there is potential for a commercially available app to be used in large-scale studies of hypertension self-management if suggestions for improvements are addressed.
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Affiliation(s)
- Tourkiah Alessa
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.,Biomedical Technology Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mark S Hawley
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Nouf Alsulamy
- Public Health, School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom.,College of Business, University of Jeddah, Jeddah, Saudi Arabia
| | - Luc de Witte
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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Armario P, Blanch P, Cortés-Fernández MS, Castellanos P. Simultaneous measurement of blood pressure in both arms. What does it contribute to the management and assessment of vascular risk in the hypertensive patient? CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2020; 32:117-119. [PMID: 32475467 DOI: 10.1016/j.arteri.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Pedro Armario
- Área de Atención Integrada Riesgo Vascular. Servicio de Medicina Interna, Hospital de Sant Joan Despí Moisès Broggi; Universitat de Barcelona.
| | - Pedro Blanch
- Área de Atención Integrada Riesgo Vascular. Servicio de Cardiología, Hospital de Sant Joan Despí Moisès Broggi
| | - Maria S Cortés-Fernández
- Área de Atención Integrada Riesgo Vascular. Servicio de Medicina Interna, Hospital de Sant Joan Despí Moisès Broggi
| | - Pere Castellanos
- Área de Atención Integrada Riesgo Vascular. Servicio de Medicina Interna, Hospital de Sant Joan Despí Moisès Broggi
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