Digitally Based Blood Pressure Self-Monitoring Program That Promotes Hypertension Self-Management and Health Education Among Patients With Low-Income: Usability Study

Background According to evidence-based clinical guidelines, adults with hypertension are advised to self-monitor their blood pressure (BP) twice daily. Self-measured BP monitoring is a recommended strategy for improving hypertension management. Objective We aimed to determine the feasibility and acceptability of a digitally based BP 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 and that at least 50% of the patients would use the monitor at the rate required for the reimbursement of the device’s cost (16 days of measurements in any 30-day period). Methods Withings BPM Connect was deployed to patients at Family Health Centers of San Diego. Program elements included training, SMS text message reminders, and physician communication. Compliance, use, mean BP, and BP control status were calculated. A Kaplan-Meier time-to-event analysis was conducted to compare time to compliance between a strict definition (≥16 days in any rolling 30-day window) and a lenient definition (≥1 day per week for 4 consecutive weeks). A log-rank test was performed to determine whether the difference in time to compliance between the definitions was statistically significant. Mean systolic BP (SBP) and diastolic BP (DBP) before the intervention and after the intervention and mean change in SBP and DBP across patients were calculated. Paired sample t tests (2-tailed) were performed to assess the changes in SBP and DBP from before to after the intervention. Results A total of 179 patients received the monitors. The mean changes in SBP and DBP from before to after the intervention were +2.62 (SE 1.26) mm Hg and +3.31 (SE 0.71) mm Hg, respectively. There was a statistically significant increase in both SBP and DBP after the intervention compared with before the intervention (P=.04 and P<.001). At the first and last measurements, 37.5% (63/168) and 48.8% (82/168) of the patients had controlled BP, respectively. During the observation period, 83.3% (140/168) of the patients had at least 1 controlled BP measurement. Use decreased over time, with 53.6% (90/168) of the patients using their monitor at week 2 and only 25% (42/168) at week 11. Although only 25.6% (43/168) achieved the strict definition of compliance, 42.3% (71/168) achieved the lenient definition of compliance. The median time to compliance was 130 days for the strict definition and 95 days for the lenient definition. The log-rank test showed a statistically significant difference in time to compliance between the compliance definitions (P<.001). Only 26.8% (45/168) complied with the measurement rate that would result in device cost reimbursement. Conclusions Few patients used the monitors at a rate that would result in reimbursement, raising financial feasibility concerns. Plans for sustaining costs among low-income patients need to be further evaluated.


HIGHER THAN 180 and/ or HIGHER THAN 120
Blood pressure is the force of blood pushing against blood vessel walls. It is measured in millimeters of mercury (mm Hg).
High blood pressure (HBP) means the pressure in your arteries is higher than it should be. Another name for high blood pressure is hypertension.
Blood pressure is written as two numbers, such as 112/78 mm Hg. The top (systolic) number is the pressure when the heart beats. The bottom (diastolic) number is the pressure when the heart rests between beats.
Normal blood pressure is below 120/80 mm Hg.
If you're an adult and your systolic pressure is 120 to 129, and your diastolic pressure is less than 80, you have elevated blood pressure. High blood pressure is a systolic pressure of 130 or higher,or a diastolic pressure of 80 or higher, that stays high over time.
High blood pressure usually has no signs or symptoms. That's why it is so dangerous. But it can be managed.
Nearly half of the American population over age 20, has HBP, and many don't even know it.
Not treating high blood pressure is dangerous.
High blood pressure increases the risk of heart attack and stroke.
Make sure you get your blood pressure checked regularly and treat it the way your health care provider advises.
What is High Blood Pressure? (continued)

Am I at higher risk of developing HBP?
There are risk factors that increase your chances of developing HBP. Some you can control, and some you can't.
Those that can be controlled are: • Cigarette smoking and exposure to secondhand smoke

Shelf-Stable Healthy Eating
• Canned, frozen and dried fruits and vegetables (low or no salt and sugar options).
• Canned meats like light tuna or white meat chicken (salt free), packed in water.
• Frozen chicken breast is safe for up to 1-year in a freezer set to zero degrees or below ..(store as air-tightly as possible to preserve maximum freshness).
• Dried beans and legumes (or canned with no salt added).
• Dried whole grains like brown rice and quinoa.
• Dried herbs and spices.
• Shelled eggs are safe 3-5 weeks and unopened egg substitute is safe up to ..1 year in the refrigerator.
Learn more ways to add activity to your routine at heart.org/HealthyForGood © Copyright 2020 American Heart Association, Inc., a 501(c)(3) not-for-pro t. All rights reserved. Healthy for Good is a trademark. Unauthorized use prohibited. 3/20DS15967

TO BUILD YOUR CIRCUIT, CHOOSE 3-4 EXERCISES FROM EACH CATEGORY:
Alternate cardio and strength exercises in short bursts of 30 seconds and 3 minutes, then repeat the circuit two to three times.

EAT SMART MOVE MORE BE WELL
Circuits can be a great way to work out without any special equipment

CHOOSE YOUR OWN WORKOUT
Please consult with your healthcare provider to determine what exercises may be best for you.

Be active every day.
Exercise can relieve mental and physical tension. Find something you think is fun and stick with it.

Give up the bad habits.
Too much alcohol, tobacco or caffeine can increase blood pressure. Cut back or quit to decrease anxiety.

Lean into things you can change.
Make time to learn a new skill, work toward a goal, or to love and help others.

Get Prepared at Home
Make sure you can reach your doctor quickly.
If you live alone, gather a list of support contacts who you might call on if needed.
Take stock of your medications Make sure you have enough for an extended time.
Make sure you have plenty of food, beverage and hygiene supplies for yourself, your family and your pets.

What if you have symptoms of coronavirus?
Common symptoms include fever and cough. Contact your health care provider if you have these symptoms. If you experience shortness of breath or other heart attack or stroke warning signs, call 911. + Make sure appropriate caregivers are available at home.
Ensure there's a separate bedroom where the patient can recover without sharing immediate space with others.
Set up some basic rules for making sure the person being isolated can get food and other necessities with minimal risk.