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Effectiveness of Standard vs Enhanced Self-measurement of Blood Pressure Paired With a Connected Smartphone Application: A Randomized Clinical Trial.

Publication ,  Journal Article
Pletcher, MJ; Fontil, V; Modrow, MF; Carton, T; Chamberlain, AM; Todd, J; O'Brien, EC; Sheer, A; Vittinghoff, E; Park, S; Orozco, J; Lin, F ...
Published in: JAMA Intern Med
October 1, 2022

IMPORTANCE: Self-measured blood pressure (SMBP) with commercially available connected smartphone applications may help patients effectively use SMBP measurements. OBJECTIVE: To determine if enhanced SMBP paired with a connected smartphone application was superior to standard SMBP for blood pressure (BP) reduction or patient satisfaction. DESIGN, SETTING, AND PARTICIPANTS: This 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, to December 31, 2020, which was followed by 6 months of follow-up for each patient. Analysis commenced shortly thereafter. INTERVENTIONS: 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. MAIN OUTCOMES AND MEASURES: Reduction in systolic BP, defined as the difference between clinic BP at baseline and the most recent clinic BP extracted from electronic health records at 6 months. RESULTS: Enrolled participants (1051 enhanced [50.0%] vs 1050 standard [50.0%]; 1191 women [56.7%]) were mostly middle-aged or older (mean [SD] age, 58 [13] years), nearly a third were Black or Hispanic (645 [31%]), and most were relatively comfortable using technology (mean [SD], 4.1 [1.1] of 5). The mean (SD) change in systolic BP from baseline to 6 months was -10.8 (18) mm Hg vs -10.6 (18) mm Hg (enhanced vs standard: adjusted difference, -0.19 mm Hg; 95% CI, -1.83 to 1.44; P = .81). Secondary outcomes were mostly null, except for documented attainment of BP control to lower than 140/<90 mm Hg, which occurred in 32% enhanced vs 29% standard groups (odds ratio, 1.15; 95% CI, 1.01-1.34). Most participants were very likely to recommend their SMBP device to a friend (70% vs 69%). CONCLUSIONS AND RELEVANCE: 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. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03796689.

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Published In

JAMA Intern Med

DOI

EISSN

2168-6114

Publication Date

October 1, 2022

Volume

182

Issue

10

Start / End Page

1025 / 1034

Location

United States

Related Subject Headings

  • Smartphone
  • Mobile Applications
  • Middle Aged
  • Hypertension
  • Humans
  • Female
  • Blood Pressure Monitoring, Ambulatory
  • Blood Pressure
  • 4203 Health services and systems
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Pletcher, M. J., Fontil, V., Modrow, M. F., Carton, T., Chamberlain, A. M., Todd, J., … Cooper-DeHoff, R. M. (2022). Effectiveness of Standard vs Enhanced Self-measurement of Blood Pressure Paired With a Connected Smartphone Application: A Randomized Clinical Trial. JAMA Intern Med, 182(10), 1025–1034. https://doi.org/10.1001/jamainternmed.2022.3355
Pletcher, Mark J., Valy Fontil, Madelaine Faulkner Modrow, Thomas Carton, Alanna M. Chamberlain, Jonathan Todd, Emily C. O’Brien, et al. “Effectiveness of Standard vs Enhanced Self-measurement of Blood Pressure Paired With a Connected Smartphone Application: A Randomized Clinical Trial.JAMA Intern Med 182, no. 10 (October 1, 2022): 1025–34. https://doi.org/10.1001/jamainternmed.2022.3355.
Pletcher MJ, Fontil V, Modrow MF, Carton T, Chamberlain AM, Todd J, et al. Effectiveness of Standard vs Enhanced Self-measurement of Blood Pressure Paired With a Connected Smartphone Application: A Randomized Clinical Trial. JAMA Intern Med. 2022 Oct 1;182(10):1025–34.
Pletcher, Mark J., et al. “Effectiveness of Standard vs Enhanced Self-measurement of Blood Pressure Paired With a Connected Smartphone Application: A Randomized Clinical Trial.JAMA Intern Med, vol. 182, no. 10, Oct. 2022, pp. 1025–34. Pubmed, doi:10.1001/jamainternmed.2022.3355.
Pletcher MJ, Fontil V, Modrow MF, Carton T, Chamberlain AM, Todd J, O’Brien EC, Sheer A, Vittinghoff E, Park S, Orozco J, Lin F, Maeztu C, Wozniak G, Rakotz M, Shay CM, Cooper-DeHoff RM. Effectiveness of Standard vs Enhanced Self-measurement of Blood Pressure Paired With a Connected Smartphone Application: A Randomized Clinical Trial. JAMA Intern Med. 2022 Oct 1;182(10):1025–1034.

Published In

JAMA Intern Med

DOI

EISSN

2168-6114

Publication Date

October 1, 2022

Volume

182

Issue

10

Start / End Page

1025 / 1034

Location

United States

Related Subject Headings

  • Smartphone
  • Mobile Applications
  • Middle Aged
  • Hypertension
  • Humans
  • Female
  • Blood Pressure Monitoring, Ambulatory
  • Blood Pressure
  • 4203 Health services and systems
  • 3202 Clinical sciences