Effect of Home Blood Pressure Monitoring via a Smartphone Hypertension Coaching Application or Tracking Application on Adults With Uncontrolled Hypertension : A Randomized Clinical Trial

Key Points

Question

Does an artificial intelligence smartphone coaching application (app) improve blood pressure and hypertension-associated behaviors?

Findings

In this randomized clinical trial of 297 adults with uncontrolled hypertension, participants randomized to a smartphone coaching app did not have lower blood pressure at 6 months compared with those receiving a blood pressure tracking app. The study was not large enough to detect small but potentially important intervention effects.

Meaning

Benefits of combining this mobile coaching app with home monitoring were not established in this trial.

Abstract

This randomized clinical trial investigates the effect on blood pressure of an artificial intelligence smartphone coaching application (app) designed to promote home monitoring and behavioral changes vs a blood pressure tracking smartphone app.

Abstract

Importance

Mobile applications (apps) may help improve hypertension self-management.

Objective

To investigate the effect of an artificial intelligence smartphone coaching app to promote home monitoring and hypertension-related behaviors on systolic blood pressure level compared with a blood pressure tracking app.

Design, Setting, and Participants

This was a 2-group, open, randomized clinical trial. Participants with uncontrolled hypertension were recruited in 2016 and 2017 and were followed up for 6 months. Data analysis was performed from April 2019 to December 2019.

Interventions

Intervention group participants received a smartphone coaching app to promote home monitoring and behavioral changes associated with hypertension self-management plus a home blood pressure monitor. Control participants received a blood pressure tracking app plus a home blood pressure monitor.

Main Outcomes and Measures

The primary study outcome was systolic blood pressure at 6 months. Secondary outcomes included self-reported antihypertensive medication adherence, home monitoring and self-management practices, measures of self-efficacy associated with blood pressure, weight, and self-reported health behaviors.

Results

There were 333 participants randomized, and 297 completed the follow-up assessment. Among the participants who completed the study, the mean (SD) age was 58.9 (12.8) years, 182 (61.3%) were women, and 103 (34.7%) were black. Baseline mean (SD) systolic blood pressure was 140.6 (12.2) mm Hg among intervention participants and 141.8 (13.4) mm Hg among control participants. After 6 months, the corresponding mean (SD) systolic blood pressures were 132.3 (15.0) mm Hg and 135.0 (13.9) mm Hg, with a between-group adjusted difference of −2.0 mm Hg (95% CI, −4.9 mm Hg to 0.8 mm Hg; P = .16). At 6 months, self-confidence in controlling blood pressure was greater in the intervention group (0.36 point on a 5-point scale; 95% CI, 0.18 point to 0.54 point; P < .001). There were no significant differences between the 2 groups in other secondary outcomes. The adjusted difference in self-reported physical activity was 26.7 minutes per week (95% CI, −5.4 minutes per week to 58.8 minutes per week; P = .10). Subgroup analysis raised the possibility that intervention effects differed by age.

Conclusions and Relevance

Among individuals with uncontrolled hypertension, those randomized to a smartphone coaching app plus home monitor had similar systolic blood pressure compared with those who received a blood pressure tracking app plus home monitor. Given the direction of the difference in systolic blood pressure between groups and the possibility for differences in treatment effects across subgroups, future studies are warranted.

Trial Registration

ClinicalTrials.gov Identifier: NCT03288142