Hypertension is a chronic disease that is considered to be a public health problem and requires efforts by patients to manage themselves. The global growth in the use of mobile phones and tablets has been accompanied by the increased use of health apps. Many of these apps support the self-management of hypertension and, therefore, they have the potential benefits of lowering blood pressure. Despite this, there is currently a lack of evidence for their effectiveness, usability, and patient satisfaction with their use.

A systematic review was conducted to assess the effectiveness of apps in lowering blood pressure, as well as their usability and patients’ satisfaction with their use

We conducted searches in the following databases: MEDLINE (OVID), EMBASE (OVID), PsycINFO (OVID), CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), IEEE Xplore ASSIAN, Google Scholar and the main Arabic databases Al Manhal, AskZad, and Mandumah. We looked for studies that used apps in the self-management of hypertension from 2008-2016. We also checked the reference lists of the review papers and all the primary studies for additional references.

Hypertension, in which the blood pressure (BP) in the arteries is raised, is one of the most common chronic diseases in adults. Patients can be diagnosed with hypertension when their systolic blood pressure (SBP) and diastolic blood pressure (DBP) are above 140/90 mm Hg, respectively. Hypertension has been recognized as a major risk factor for many diseases, such as renal failure, heart disease, and stroke. Despite the effect of lowering BP on reducing the risk of renal and cardiovascular disease, most people with hypertension poorly control their BP. Therefore, it is important to encourage patients’ involvement in controlling their BP.

Self-management is considered an important element of chronic care management. Self-management demands an active role of patients in managing their symptoms, treatment, psychosocial and physical effects, and changing lifestyle. Achieving an optimum level of self-management behavior is difficult and requires considerable effort from patients. Mobile health technology (mHealth), defined as the use of mobile devices to deliver health care, has the potential to facilitate and optimize patients’ selfmanagement. This can be performed by integrating health care with everyday life by delivering and collecting health information and services in a convenient, accessible, and interactive mode. The use of the new generation of these mobile devices, including mobile phone and tablets, has increased rapidly in recent years, and it is estimated that by 2018 mobile phones will be used by one-third of the global population. Mobile phones have become an important platform to deliver health to patients through health apps. The rapid growth in the use of these devices has been accompanied by a huge expansion in health and health-related behavior apps, and more than 100,000 of these are used by millions

of people. Many health apps are targeted to support people with hypertension in their selfmanagement by offering self-monitoring activities, reminders, tailored information, and feedback.

To the best of our knowledge, despite the potential benefits of apps for people with hypertension and the increased use of these apps, a synthesis of studies on their effectiveness in this population has not been conducted. This systematic review will synthesize the existing evidence on the effectiveness of apps in lowering BP, as well as their usability and patients’ satisfaction with their use.

Eligibility Criteria

The inclusion criteria were dependent on PICOS [18] as described below:

The population was people with hypertension (18 years of age and over) and health care professionals (HCPs) supporting people with hypertension in their self-management in any care setting, without limitations on the participants’ gender, age or socio-demographic characteristics. Studies about people with chronic illness including hypertension as one of their inclusion criteria were also included.

The intervention was a mobile phone or a tablet app that collects data, provides feedback, connects with HCPs or informs about hypertension to support the self-management tasks of hypertension. These tasks include self-monitoring of BP and other biometrics, healthy eating and drinking, being physically active, maintaining a healthy weight, adhering to medication, and managing stress and coping. The app should also enable interactions between the user and the device via a set of interfaces (eg, a visual user interface). Studies in which a health app was the only method of delivery or in which it was a component of a blended intervention were also included.

The comparator was either usual care or any other control intervention. Articles with no comparison were also included.

The outcomes of studies that were considered are: levels of BP, SBP, and DBP, as well as usability, attitudes, and satisfaction with mobile apps.

The eligible study designs were all quantitative, qualitative, and mixed-method studies that explore the self-management of hypertension using apps. Pilot studies were included because they might enable us to understand the status of apps.

Exclusion criteria.

They were not aimed at hypertension or studies focusing only on primary prevention of hypertension or hypertension during pregnancy.

1.They examined interventions accessed by a personal digital assistant, desktop computer, laptop, netbook

2.They examined interventions accessed by a mobile phone or traditional tablet that did not permit participants to download or use any app from the app store.

3.They solely used messaging including short message service (SMS) text messaging, multimedia messaging service (MMS), websites, calls, emails or Web-based apps.

4.A mobile device was used to transmit information provided by a blood pressure monitoring device to care providers or clinicians, but in which there was no interaction with the user.

5.They describe only the technological development of a mobile system6

Study Selection

Reference management software (Endnote) was utilized to collect results from databases, and to deduplicate articles. Two reviewers (TA and SA) independently scanned titles against the eligibility criteria and in a second phase the abstracts of selected titles. Cohen kappa was calculated to determine the agreement between the reviewers for each step of selecting titles and abstracts.

Titles and in the second phase abstracts received 2 points if they met the criteria, zero if not and 1 point when there was doubt. If the sum of reviewer scores for a title was 2 or more, the study was included for the next phase. Otherwise, it was excluded. Two reviewers separately reviewed the full articles when the total scores for the abstract equaled 2 points or more. Any disagreements were resolved through a discussion with other researchers (LdW and MSH).

Results

A total of 21 studies with a total of 3112 participants were included in the review. Of the 14 studies that assessed the effectiveness of the apps in lowering blood pressure, 10 (71.4%) studies (6 RCTs and 4 nonrandomized studies) reported that using the apps led to significant decreases in blood pressure and seemed to be effective in the self-management of hypertension. Of these 10, only 2 (20%) RCTs and 3 (30%) nonrandomized studies had a low–moderate risk of bias. The results of this review are inconclusive regarding which combinations of functionalities would be most effective in lowering blood pressure because of variation in the studies’ quality, but the data suggest that apps incorporating more comprehensive functionalities are likely to be more effective. In all the studies that assessed the usability of the apps and users’ acceptance of them, all the apps seemed to be accepted and easy to use.

Conclusions

Most of the studies reported that apps might be effective in lowering blood pressure and are accepted by users. However, these findings should be interpreted with caution, as most of the studies had a high risk of bias. More well-designed, large-scale studies are required to evaluate the real effect of using apps in lowering blood pressure and to identify the most effective functionality combinations for lowering blood pressure.

Source: PubMed