Introduction: In 2012, there were 39 million physician visits for hypertension (HTN), but only 53% of patients have hypertension under control. Remote management coupled with mobile health platforms may help improve communication, medication titration, care team feedback and patient experience. We conducted an observational study in order to evaluate the performance of mobile app-facilitated, team-based remote HTN management program on HTN control, time to control, and time spent under control.
Methods: The HIPSTER study was an observational study conducted by the UCSF Division of Cardiology and School of Pharmacy in collaboration with Vital Labs Inc. We enrolled 120 consecutive patients from the UCSF Cardiology clinic who were aged ≥18 years with a diagnosis of essential or co-morbid HTN. Participants downloaded the Vital Labs smart phone application (app) and utilized a home blood pressure cuff to measure blood pressure at least once-daily. The app scheduled blood pressure reminders, allowed for virtual communication via direct messaging, and provided access to patient data. Based on the daily, remote BP measurements, pharmacists performed rapid-cycle medication management for patients remotely, in coordination with study cardiologists.
Results: Of 120 patients enrolled, 59% were male, and 10% were between 18-35y, 43% between 36-64y, and 45% >64y. At the time of enrollment, 17.5% of patients were not on any antihypertensive medication. After 6 month follow-up, 84% of patients met their JNC8 goal. Patients took an average of 17 days to achieve BP control, and patients remained under control for 74% of the study duration.
Conclusions: Using a mobile-app facilitated remote HTN management protocol, 84% of patients met their JNC8 BP goal, versus an estimated 53% nationally. Compared to prior reports that cite an average of 3.2 months to reach BP goal in real-world practice-based settings, patients in our study achieved JNC8 BP goal within 17 days from enrollment. A mobile app-facilitated remote HTN management platform, coupled with team-based care, can be used to increase achievement of BP control and decrease the time required to achieve BP control. Future directions include examining the generalizability of these findings through randomized studies.