New Strategy to Control Blood Pressure: Interactive Mobile Phone Support

Cardiovascular (CV) disease accounts for 30% of all deaths and arterial hypertension remains the number one risk factor for global disease burden.1 It is easily understandable that from an adequate control of blood pressure (BP) in the general population an enormous amount of benefit would be obtained. Many different components play a role in the attainment of adequate BP control, but compliance and long‐term adherence are the most relevant factors needed to obtain BP control.2 However, the maintenance of good compliance and long‐term adherence is a complex issue wherein many components, eg, patients, medical staff, mode of care delivery, and role of caregivers, are interrelated.3 If compliance is inadequate, two main things happen: (1) BP remains elevated, facilitating the progression of visceral damage and the development of CV events, death, and chronic kidney disease (CKD); and (2) the potential effect beyond BP control of certain drugs that has recently been shown to be present in the prevention of some of the vascular consequences of elevated BP are absent, contributing to a further increase in CV and renal risk.4 Any intervention able to improve the active participation of patients in their own BP management is always warranted as a result of the very high prevalence of inadequate compliance and long‐term adherence.

In the present issue of the Journal, Bengtsson 5 performed a longitudinal study where they evaluated the effect of the daily use of a mobile phone–based self‐management support system for hypertension in reducing BP. This is an example of how to improve the mode of care delivery using information and communication technologies.3 The authors concluded that the daily use of the support system significantly reduced systolic BP by 7 mm Hg and diastolic BP by 4.9 mm Hg between baseline and the 8 weeks of study duration. Interestingly, the positive effect was independent of baseline BP provided it was above 140/90 mm Hg.

Home BP monitoring (HBPM) was the methodology used for daily estimation of BP in this study. HBPM contributed to the success of this study in two ways: first because HBPM contributes by itself to improve compliance and long‐term adherence,6 and second because it excludes the presence of white‐coat hypertension (WCH).7 In other words, true BP levels were analyzed in this study, which enhanced the value of the positive data found.

Recently, the advantages of early control of BP within the first 3 months of diagnosis of arterial hypertension has been recognized.8 As recognized by the authors, the system described in this study should be particularly investigated in this early stage of the evolution of atrial hypertension, although it could be applied to any stage of arterial hypertension. In this sense, it could be particularly interesting to investigate its use in true resistant hypertension where recent data have shown that low compliance and long‐term adherence can be particularly low.9, 10

There are several caveats in this study. The first is that the educational level of the patients was elevated, which raises the question of whether people with lower levels of education could accomplish the requirement of this support system. The authors also describe the subdivision of patients according to latent class growth modeling (LCGM) to investigate the trends of change in BP. In our opinion, this subdivision creates groups with very few patients, which complicates the interpretation of the data. Last, the technique used is expensive and casts doubts about the use in daily clinical practice. The question is whether future studies could simplify the methodology, making it available for a much wider range of patients.

In summary, this is an interesting paper that offers a new concept that could contribute to improved compliance and long‐term adherence particularly in the very early stages of hypertension or in difficult to control hypertension characterized by absence of response to triple therapy.11