Enhanced smartphone-based blood pressure monitoring is not superior to standard approaches

By Dr Jonathan Shurlock

In recent years many healthcare providers have explored the role of remote monitoring of patient groups and this idea is widespread in cardiovascular health. A seemingly natural evolution of this is the use of smartphones and other ‘smart’ devices to facilitate patient engagement in their ongoing monitoring and management.

Pletcher et al. have explored a comparison between standard blood pressure monitoring and the use of a device connected to a smartphone application in an attempt to determine which is a more effective blood pressure reduction strategy.

The authors contacted potential participants from PCORnet – a national research network. Inclusion criteria required patients with uncontrolled blood pressure, a desired to lower their blood pressure and regular access to a smartphone.

2,101 patients with uncontrolled blood pressure were randomised into enhanced and standard blood pressure monitoring groups (1,051 enhanced [50.0%] vs 1,050 standard [50.0%]; 1,191 women [56.7%]). The mean age of participants was 58 ±13 years. Follow-up was over 6 months, and the primary outcome measure was reduction in systolic blood pressure.
There was no significant difference in change in systolic blood pressure from baseline with a mean reduction of 10.8 ±18 mmHg vs −10.6 ±18 mmHg (enhanced vs standard: adjusted difference, −0.19 mm Hg; 95% CI, −1.83 to 1.44; P = .81). Despite good engagement with the smartphone application the authors found it to be non-superior for both reduction in blood pressure, and patient satisfaction.

In a release alongside the study, primary author Dr Mark Pletcher explained the potential difficulties with using digital monitoring devices and that “the time and effort involved in connecting them to a smartphone is really not trivial”. This is particularly important in the context of the lack of significant differences in blood pressure.

All healthcare providers and services utilising remote or smartphone based monitoring devices should consider the evidence base behind their use, given the often additional patient energy and engagement required.

Full study:
Pletcher MJ, Fontil V, Modrow MF, 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. Published online August 15, 2022. doi:10.1001/jamainternmed.2022.3355