Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Center for Primary Care Innovation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
JAMA Netw Open. 2020 Mar 2;3(3):e200255. doi: 10.1001/jamanetworkopen.2020.0255.
Mobile applications (apps) may help improve hypertension self-management.
To investigate the effect of an artificial intelligence smartphone coaching app to promote home monitoring and hypertension-related behaviors on systolic blood pressure level compared with a blood pressure tracking app.
DESIGN, SETTING, AND PARTICIPANTS: This was a 2-group, open, randomized clinical trial. Participants with uncontrolled hypertension were recruited in 2016 and 2017 and were followed up for 6 months. Data analysis was performed from April 2019 to December 2019.
Intervention group participants received a smartphone coaching app to promote home monitoring and behavioral changes associated with hypertension self-management plus a home blood pressure monitor. Control participants received a blood pressure tracking app plus a home blood pressure monitor.
The primary study outcome was systolic blood pressure at 6 months. Secondary outcomes included self-reported antihypertensive medication adherence, home monitoring and self-management practices, measures of self-efficacy associated with blood pressure, weight, and self-reported health behaviors.
There were 333 participants randomized, and 297 completed the follow-up assessment. Among the participants who completed the study, the mean (SD) age was 58.9 (12.8) years, 182 (61.3%) were women, and 103 (34.7%) were black. Baseline mean (SD) systolic blood pressure was 140.6 (12.2) mm Hg among intervention participants and 141.8 (13.4) mm Hg among control participants. After 6 months, the corresponding mean (SD) systolic blood pressures were 132.3 (15.0) mm Hg and 135.0 (13.9) mm Hg, with a between-group adjusted difference of -2.0 mm Hg (95% CI, -4.9 mm Hg to 0.8 mm Hg; P = .16). At 6 months, self-confidence in controlling blood pressure was greater in the intervention group (0.36 point on a 5-point scale; 95% CI, 0.18 point to 0.54 point; P < .001). There were no significant differences between the 2 groups in other secondary outcomes. The adjusted difference in self-reported physical activity was 26.7 minutes per week (95% CI, -5.4 minutes per week to 58.8 minutes per week; P = .10). Subgroup analysis raised the possibility that intervention effects differed by age.
Among individuals with uncontrolled hypertension, those randomized to a smartphone coaching app plus home monitor had similar systolic blood pressure compared with those who received a blood pressure tracking app plus home monitor. Given the direction of the difference in systolic blood pressure between groups and the possibility for differences in treatment effects across subgroups, future studies are warranted.
ClinicalTrials.gov Identifier: NCT03288142.
移动应用程序（apps）可能有助于改善高血压自我管理。
研究人工智能智能手机辅导应用程序在促进家庭监测和与高血压相关行为方面对收缩压水平的影响，与血压跟踪应用程序相比。
设计、设置和参与者：这是一项 2 组、开放、随机临床试验。2016 年和 2017 年招募了血压控制不佳的参与者，并随访了 6 个月。数据分析于 2019 年 4 月至 2019 年 12 月进行。
干预组参与者接受智能手机辅导应用程序以促进家庭监测和与高血压自我管理相关的行为改变，以及家用血压监测器。对照组参与者接受了血压跟踪应用程序和家用血压监测器。
主要研究结果是 6 个月时的收缩压。次要结果包括自我报告的降压药物依从性、家庭监测和自我管理实践、与血压、体重和自我报告的健康行为相关的自我效能感的测量。
共有 333 名参与者随机分组，297 名完成了随访评估。在完成研究的参与者中，平均（SD）年龄为 58.9（12.8）岁，182 名（61.3%）为女性，103 名（34.7%）为黑人。干预组参与者的基线平均（SD）收缩压为 140.6（12.2）mmHg，对照组参与者为 141.8（13.4）mmHg。6 个月后，相应的平均（SD）收缩压分别为 132.3（15.0）mmHg 和 135.0（13.9）mmHg，组间调整差异为-2.0mmHg（95%CI，-4.9mmHg 至 0.8mmHg；P=0.16）。6 个月时，干预组对控制血压的信心更高（5 分制得 0.36 分；95%CI，0.18 分至 0.54 分；P<0.001）。两组在其他次要结局上无显著差异。自我报告的体育活动差异为每周 26.7 分钟（95%CI，每周减少 5.4 分钟至每周增加 58.8 分钟；P=0.10）。亚组分析提示干预效果可能因年龄而异。
在血压控制不佳的个体中，与接受血压跟踪应用程序加家用监测器的个体相比，随机分配到智能手机辅导应用程序加家用监测器的个体收缩压相似。鉴于两组之间收缩压差异的方向以及治疗效果在亚组之间可能存在差异，因此需要进一步研究。
ClinicalTrials.gov 标识符：NCT03288142。
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