A mHealth-based care model for improving hypertension control in stroke survivors: Pilot RCT

Abstract

Purpose: Hypertension (HTN) is significantly under-treated in stroke survivors. We examined usability and efficacy of a mHealth -based care model for improving post-stroke HTN control (Funding: AHRQ R21HS021794).

Methods: We used a RCT design. Planned study duration was 90 days. Intervention arm (IA) participants measured their BP daily using a smart phone and wireless BP monitor. This was transmitted automatically to the study database. Investigators (Physician + PharmD) made bi-weekly medication adjustments to achieve the BP goal. Control arm (CA) participants received a digital BP monitor and usual care. We examined Usability (measured with Marshfield System Usability Survey) and HTN control efficacy using an ITT (intent-to-treat) and as-treated (AT) analyses.

Results: Fifty participants (IA = 28; CA = 22) completed the study. The Marshfield survey question, "I thought the system was easy to use" mean score was 4.6, (5 = strongly agree). Mean SBP declined significantly between enrollment and study completion in the IA. In ITT, IA SBP declined 9.88 mm, p = 0.005. In AT, IA SBP declined 10.81 mm, p = 0.0036. CA SBP decline was 5-6 mm Hg (not significant). In the ITT, baseline HTN control (SBP < 140 mm Hg) was 50% in IA and CA. At study completion, HTN was controlled in 82% (23/28) of IA and 64% (14/22) of CA (p = 0.14). In the AT, HTN was controlled in 89% (23/26) of IA and 58% (14/24) of CA, (p = 0.015).

Conclusion: A mHealth-based HTN care model had excellent usability and provided better HTN control than usual care in stroke survivors.

Clinical trial: gov: NCT01875094.

Keywords: Hypertension; MHealth; Self-management; Stroke survivors.

Conflict of interest statement

CONFLICTS OF INTEREST

None

Copyright © 2018 Elsevier Inc. All rights reserved.

Figures

Figure1.

CONSORT Participant Flow Diagram.

Figure 2.

Trajectory of systolic and diastolic blood pressures (SBP, DBP) of a participant in the intervention arm. Seven-day moving averages of blood pressures are shown since medication adjustment was based on 7-day blood pressure readings.