by Bimal R. Shah, MD, chief medical officer of the health technology company
Livongo, and assistant consulting professor at Duke University School of
The findings of this pilot study will be
presented at the American College of
Cardiology's 68th Annual Scientific Session.
the Efficacy of Smartphone App in Blood Pressure Control
Earlier studies have shown that making
suitable lifestyle modifications and home
blood pressure monitoring, also known as self-measured blood pressure monitoring can help
improve blood pressure control
. The study team hoped to determine whether the Livongo's smartphone app can help achieve
significant blood pressure control in people with both hypertension and diabetes.
goal was a decrease in systolic blood pressure after six weeks.
The secondary endpoint
measured was a
reduction of diastolic blood pressure in the same period.
- The study enrolled 708 participants at an average age of 54 years, and 53 percent of them were women
- At the onset of the
study, all participants were diagnosed with diabetes, and 63 percent had blood pressure greater than 130/80 mm Hg,
which is the cut-off for the diagnosis of stage 1 hypertension, according to the revised guideline published by ACC and the
American Heart Association (AHA) in 2017
- A small subset of
patients (28.7 percent) had blood pressure readings greater than 140/90 mm
Hg, the cut-off for stage 2 high blood pressure, according to ACC/AHA guidelines
- The study participants were given a blood pressure monitor and cuff that they could connect
wirelessly with Livongo's smartphone app
- When the patients
checked their blood pressure (on an average 4 times per week) with their
smartphones nearby, the recordings were automatically transmitted to
Livongo's computer servers
- After recording
their blood pressure, the participants could open
the app to view the results while they got tips on ways to manage their blood pressure such as better
diet choices, regular exercise, weight management and reminding them to
take their medications
- The app also
enabled them to look at the trend in blood pressure readings over time,
share the results with family members, friends, their doctor and if needed
fix up a call with a health coach
- At the end of the
study in six weeks, almost 40.8 percent
of patients had blood pressure values less than 130/80 mm Hg, while 23.6
percent of participants still had blood pressure more than 140/90 mm Hg
The findings of the study suggest that regular monitoring of blood pressure via the smartphone app and initiating
suitable interventions resulted in significant improvement in blood pressure levels
According to the Shah, patients with higher readings at the start of the study
were more likely to see improvements in both systolic and diastolic blood
"We have shown in
this pilot study that, in a population with both diabetes and high blood
pressure, six weeks of remote blood pressure monitoring--accompanied by
education about high blood pressure management and access to health
coaches--can significantly improve blood pressure control,"
Shah said. "The improvement is comparable to what doctors would expect
to see if a patient had started taking a low to moderate dose of a high blood
A potential limitation of the current
study is that it did not include a control group that received standard care
for hypertension as a comparison.
Shah and his team his colleague plan to
undertake a further randomized trial in
which patients are randomly assigned
to either standard hypertension care
or the smartphone app intervention.
Risks Associated with Concomitant Hypertension and Diabetes
It is estimated that 50
percent of adults in the US have hypertension
and only 54
percent of them have proper control of their blood pressure.
It is common for patients with hypertension to also have concomitant diabetes. Occurrence of these two conditions together
increases the risk of heart disease, kidney disease or stroke by four times
compared to persons with only one of these conditions.
The findings of the study indicate that a
holistic approach combining remote blood pressure monitoring and provision of
health tips can have a significant beneficial
effect on blood pressure control. Hence, t
findings of the study have to be
validated in further trials.
- Remote Monitoring of Blood Pressure in T2D Population Decreases Systolic Blood Pressure at 6 Weeks: A Pilot Study - (https://www.acc.org/education-and-meetings/meetings/meeting-items/2018/03/12/13/48/acc19-68th-annual-scientific-session-and-expo)