JMIR Publications

ABSTRACT

Background:

According to evidence-based clinical guidelines, adults with hypertension are advised to self-monitor their blood pressure at least twice daily. Self-measured blood pressure monitoring (SMBP), the regular measurement of blood pressure by a patient outside of the clinical setting, is a recommended strategy for improving hypertension management and blood pressure control.

Objective:

To determine the feasibility and acceptability of a digitally-based blood pressure self-monitoring program that promotes hypertension self-management and health education among low-income patients. We hypothesized that the program would be highly feasible and acceptable to patients and that at least 50% of patients would use their blood pressure monitor at the rate required for reimbursement of the device's cost (16 days of measurements in any 30-day period).

Methods:

Cellularly connected blood pressure monitors (Withings BMP Connect) were deployed to patients with hypertension at Family Health Centers of San Diego. Program elements included training on measurement, behavior change, text message reminders, and physician communication. Data was monitored via a remote patient monitoring (RPM) platform provided by Withings (Issy-les-Moulineaux, France). Participants completed a baseline survey and follow-up survey on digital health literacy and device usability. Descriptive statistics were used to analyze survey results. Compliance, utilization, mean blood pressure, and blood pressure control status were calculated.

Results:

Patients who received blood pressure monitors (N=199) had a mean (SD) age of 56.2 (12.0) years and 57.8% were female. Most patients were Hispanic (66.3%), spoke Spanish (56.3%), owned a smartphone (78.8%), and had access to Internet or Wi-Fi at home (73.7%). The mean (SD) SBP was 134.6 mmHg (19.7) and the mean (SD) DBP was 81.5 mmHg (13.6). Forty-two percent of patients were in control at their first measurement and 51% of patients were in control at their last measurement. Eighty-five percent of patients had at least one measurement in control during the observation period. Use of the blood pressure monitor decreased over time, Utilization of BP monitors decreased over time, with 58.5% of patients using their monitor at Week 2 and only 25.0% at week 11. At follow-up, 91.9% of patients said they would recommend the monitor to others and 71.8% said they would continue using the monitor in the future; however, only 26% of patients were able to comply with the measurement rate that would result in device cost reimbursement.

Conclusions:

Providing a simple and low-cost method to monitor blood pressure was acceptable to patients. However, few patients were able to use the monitors at a rate that would result in device cost reimbursement, raising concerns regarding the financial feasibility of such a program at scale. While RPM programs show promise, plans for sustaining costs among low-income patients need to be further evaluated.