Early blood pressure assessment after acute myocardial infarction: Insights using digital health technology

Abstract

Objective: There is rising interest in digital health in preventive cardiology, particularly for blood pressure (BP) management. In a digital health study of early BP assessment following acute myocardial infarction (AMI), we sought to examine feasibility and the (1) proportion of post-AMI patients with controlled BP and hypotension, and (2) association between prior cardiovascular disease (CVD) and BP post-AMI.

Methods: In this substudy of the parent Myocardial infarction, COmbined-device, Recovery Enhancement (MiCORE) study, type 1 AMI patients were enrolled between October 2017 and April 2019. Participants self-monitored their BP through 30 days after hospital discharge using an FDA-approved wireless BP monitor connected with a smartphone application. Linear mixed-effects models assessed the association between prior CVD and BP trajectory post-discharge, adjusting for antihypertensive medications and a propensity score inclusive of CVD risk factors.

Results: Sixty-eight AMI patients (mean age 58 ​± ​10 years, 75% male, 68% white race, 68% history of hypertension, 24% prior CVD) provided 2638 measurements over 30 days. The percentage of BP control <130/80 ​mmHg was 59.6% (95% CI: 54.3-64.9%) and <140/90 ​mmHg was 83.7% (95% CI: 80.3-87.2%). The percentage of systolic BP ​<90 ​mmHg was 1.1% (95% CI: 0.17-2.0%) and the percentage of diastolic BP ​<60 ​mmHg was 3.9% (95% CI: 2.6-5.2%). Prior CVD was associated with 12.2 ​mmHg higher mean daily systolic BP during admission (95% CI: 3.5-20.9 ​mmHg), which persisted over follow-up. There was no association between prior CVD and diastolic BP.

Conclusion: The digital health program was feasible and ~40% of post-AMI patients who engaged in it had uncontrolled BP according to recent guideline cutpoints, while hypotension occurred rarely. The gap in BP control was especially large in patients in whom AMI represented recurrent CVD. These data suggest an opportunity for more aggressive secondary prevention early after MI as care models integrate digital health.

Keywords: Blood pressure; Digital health; Myocardial infarction; Secondary prevention; Smartphone.

Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Corrie Health, as described in this work, was developed by FAM, MAL, and SSM . They are also founders of and hold equity in Corrie Health, which intends to further develop the digital platform. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. SSM has served as a consultant to Akcea, Amgen, Astra Zeneca, Esperion, Kaneka, Novo Nordisk, Quest Diagnostics, Sanofi, Regeneron, and REGENXBIO.

© 2020 The Authors.

Figures

Fig. 1

Data flow. MiCORE denotes Myocardial infarction, COmbined-device, Recovery Enhancement (the parent study for this analysis); BP blood pressure; AMI acute myocardial infarction.

Fig. 2

Distribution of time of day of self-selected home blood pressure recording. Total number of recordings ​= ​2488. Time periods are defined as follows: Night/Early Morning (0000–0759), Morning (0800–1159), Noon/Afternoon (1200–1559), Late Afternoon/Evening (1600–1959), and Evening/Night (2000–2359).

Fig. 3

Predicted trajectories of average daily systolic blood pressure (BP) values over 30-day post discharge, by prior cardiovascular disease (CVD) status. Study day 0 represents mean systolic BP during the admission period. Trajectories of mean BP values on each follow-up day were predicted using a linear mixed-effects model, which was adjusted for CVD propensity score, number of antihypertensive medications, and the interaction term between prior CVD and study day. Number of participants ​= ​68; number of observations ​= ​1197.