The Swedish Institute for Health Economics (IHE), Lund.
Blodtrycksdoktorn AB, Stockholm.
Blood Press Monit. 2023 Apr 1;28(2):86-95. doi: 10.1097/MBP.0000000000000633. Epub 2022 Dec 7.
Hypertension is a leading causeof premature death worldwide and a major public health problem. This study investigated the long-term effects (>1 year) of digital hypertension monitoring by home blood pressure (HBP) measurements in combination with individualized remote treatment via a Swedish Digital Therapeutics platform in a large patient population.
The primary endpoint, HBP, and exploratory endpoints, BMI, alcohol consumption, stress level, physical activity, and smoking, were assessed every 3 months for 540 and 360 days, respectively, in 7752 Swedish primary hypertension patients. Patients received individualized medical treatments and lifestyle advice via asynchronous text-based communication in an app. Changes from baseline in endpoints were calculated for the whole population and for subgroups defined by baseline SBP ≥135 (high SBP), 125-135 (suboptimal SBP), 115-125 (optimal SBP), and <115 mmHg (low SBP).
After 360 days of treatment, the whole population showed a significant increase of 57% (from 37 to 58%) in the proportion of patients with controlled SBP (i.e. SBP of 115-135 mmHg). The largest reduction in SBP of 13.8 mmHg was observed for the high SBP subgroup, whereas for the low SBP subgroup, SBP increased by 13.4 mmHg. BP improved most in the first three months, and for both the high and low BP subgroups, the improvement continued during the 540-day study period. Significant beneficial changes were also observed for some exploratory endpoints including BMI and smoking.
In conclusion, the digital therapeutics platform was associated with significant improvement in BP control and associated risk factors, which were maintained over a longer period.
高血压是全球范围内导致过早死亡的主要原因之一，也是一个主要的公共卫生问题。本研究调查了通过家庭血压（HBP）测量结合瑞典数字治疗平台进行的个体化远程治疗对大量患者人群中高血压的长期影响（>1 年）。
主要终点 HBP 和探索性终点 BMI、饮酒量、压力水平、身体活动和吸烟，在 7752 名瑞典原发性高血压患者中分别在 540 天和 360 天内每 3 个月评估一次。患者通过应用程序中的异步基于文本的通信接收个体化的医疗治疗和生活方式建议。计算了整个人群以及根据基线 SBP≥135（高 SBP）、125-135（次优 SBP）、115-125（最佳 SBP）和<115mmHg（低 SBP）定义的亚组中从基线开始的终点变化。
经过 360 天的治疗，整个人群中 SBP 得到控制的患者比例从 37%增加到 58%，增加了 57%（即 SBP 为 115-135mmHg）。高 SBP 亚组的 SBP 降低最大，为 13.8mmHg，而低 SBP 亚组的 SBP 增加了 13.4mmHg。BP 在头三个月内改善最大，对于高和低 BP 亚组，改善在 540 天的研究期间持续。一些探索性终点，包括 BMI 和吸烟，也观察到了显著的有益变化。
总之，数字治疗平台与血压控制和相关危险因素的显著改善相关，这些改善在较长时间内得以维持。
