The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
JMIR Mhealth Uhealth. 2020 Oct 19;8(10):e21759. doi: 10.2196/21759.
Hypertension is a major cause of cardiovascular disease, which is the leading cause of premature death. People with hypertension who do not comply with recommended treatment strategies have a higher risk of heart attacks and strokes, leading to hospitalization and consequently greater health care costs. The smartphone, which is now ubiquitous, offers a convenient tool to aid in the treatment of hypertension through the use of apps targeting lifestyle management, and such app-based interventions have shown promising results. In particular, recent evidence has shown the feasibility, acceptability, and success of digital interventions in changing the behavior of people with chronic conditions.
The aim of this study was to systematically compile available evidence to determine the overall effect of smartphone apps on blood pressure control, medication adherence, and lifestyle changes for people with hypertension.
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. Databases were searched to identify randomized controlled trials related to the influence of an app-based intervention in people with hypertension. Data extracted from the included studies were subjected to a meta-analysis to compare the effects of the smartphone app intervention to a control.
Eight studies with a total of 1657 participants fulfilled the inclusion criteria. Pooled analysis of 6 studies assessing systolic blood pressure showed a significant overall effect in favor of the smartphone intervention (weighted mean difference -2.28, 95% CI -3.90-0.66). Pooled analysis of studies assessing medication adherence demonstrated a significant effect (P<.001) in favor of the intervention group (standard mean difference 0.38, 95% CI 0.26-0.50) with low heterogeneity (I=0%). No difference between groups was demonstrated with respect to physical activity.
A smartphone intervention leads to a reduction in blood pressure and an increase in medication adherence for people with hypertension. Future research should focus on the effect of behavior coaching apps on medication adherence, lifestyle change, and blood pressure reduction.
高血压是心血管疾病的主要病因，也是导致过早死亡的主要原因。未遵循推荐治疗策略的高血压患者发生心脏病发作和中风的风险更高，导致住院治疗，进而增加医疗保健费用。智能手机现在已经无处不在，它提供了一种方便的工具，可以通过针对生活方式管理的应用程序来辅助治疗高血压，并且此类基于应用程序的干预措施已经显示出了良好的效果。特别是，最近的证据表明，数字干预措施在改变慢性病患者行为方面具有可行性、可接受性和成功性。
本研究旨在系统地收集现有证据，以确定智能手机应用程序对高血压患者血压控制、药物依从性和生活方式改变的总体影响。
本系统评价按照《系统评价和荟萃分析的首选报告项目》（PRISMA）声明指南进行。搜索数据库以确定与基于应用程序的干预对高血压患者影响相关的随机对照试验。从纳入的研究中提取的数据进行荟萃分析，以比较智能手机应用程序干预与对照组的效果。
有 8 项研究共 1657 名参与者符合纳入标准。对 6 项评估收缩压的研究进行汇总分析显示，智能手机干预具有显著的总体效果（加权均数差-2.28，95%置信区间-3.90-0.66）。对评估药物依从性的研究进行汇总分析显示，干预组具有显著效果（P<.001）（标准均数差 0.38，95%置信区间 0.26-0.50），异质性较低（I=0%）。两组间在体力活动方面没有差异。
智能手机干预可降低高血压患者的血压并提高药物依从性。未来的研究应集中在行为辅导应用程序对药物依从性、生活方式改变和血压降低的影响上。
