Heart Disease and Stroke Prevention: Interactive Digital Interventions for Blood Pressure Self-Management

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends the use of interactive digital interventions to improve blood pressure control in patients with high blood pressure.

The full CPSTF Finding and Rationale Statement and supporting documents for Heart Disease and Stroke Prevention: Interactive Digital Interventions for Blood Pressure Self-Management are available in The Community Guide Collection on CDC Stacks.

Intervention

In these interventions, patients who have high blood pressure use digital devices to receive personalized, automated guidance on blood pressure self-management.

Devices include mobile phones, web-based programs, or telephones. Interactive content does not require direct input from a health professional.

About The Systematic Review

The Community Preventive Services Task Force (CPSTF) uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to cardiovascular disease prevention.

McLean G, Band R, Saunderson K, Hanlon P, Murray E, et al. Digital interventions to promote self-management in adults with hypertension: systematic review and meta-analysis. Journal of Hypertension 2016;34(4):600-12.

The review included seven randomized controlled trials (search period through 2014). The CPSTF finding is based on results from the published review, additional information from the included studies, and expert input from team members and the CPSTF.

Study Characteristics

  • All of the included studies were randomized controlled trials.
  • Studies were conducted in the United States (3 studies), Canada (1 study), Finland (1 study), Korea (1 study), and Honduras and Mexico (1).
  • Patients were recruited in healthcare settings (6 studies) and workplaces (1 study).
  • Two U.S. studies included clinics that served urban, low-income communities. In one of these studies, recruited patients were primarily African-American (72%) or Hispanic (14%).
  • Evaluated interventions were of short duration (median 6 months).
  • Interventions used mobile phones (3 studies), web-based programs (3 studies), or telephones (1 study).
  • While limited information was provided about the digital content, all of the interventions included health education related to blood pressure self-management.
  • Patients interacted with digital components daily (3 studies) or weekly (3 studies); interactions were variable in the remaining study.
  • In five of the studies, digital components were part of self-measured blood pressure monitoring (SMBP) interventions.
  • Three studies offered contact or appropriate follow-up with a health professional or community health worker.

Summary of Results

The systematic review included seven studies.

  • Among recruited patients who had high blood pressure, interventions led to the following outcomes:
    • Systolic blood pressure decreased by a mean of 3.7 mmHg (6 studies)
    • Diastolic blood pressure decreased by a mean of 2.4 mmHg (5 studies)
    • One study reported patients in the intervention group were significantly more likely to have their blood pressure under control after 24 months.

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

While additional research is warranted, the CPSTF finding should be applicable to the use of interactive digital interventions in U.S. healthcare settings for adults who have high blood pressure.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • Are interventions effective in helping patients control their blood pressure over longer periods of time (1-2 years)?
  • Are these interventions effective in reducing morbidity, mortality, and health care utilization associated with hypertension?
  • What factors influence intervention effectiveness?
    • Use with or without self-measured blood pressure monitoring?
    • Use with or without additional counseling or interpersonal contact?
    • Setting (i.e. workplaces or community)?
    • Patients’ race, ethnicity, or socioeconomic status?
    • Length of time since hypertension diagnosis?
    • Level of blood pressure control at enrollment?
    • Use with novel or existing smartphone applications?

Implementation Considerations and Resources

  • The CPSTF recommends self-measured blood pressure (SMBP) monitoring interventions when used alone or with additional support based on evidence of effectiveness for patients with high blood pressure. Interactive digital interventions can be a central component of SMBP monitoring or provide additional support for patients.
  • The Million Hearts Initiative includes tools and resources to help organize health system and public health improvement strategies for blood pressure management. Strategies may include the use of interactive digital interventions:
  • Implementers should understand state policies regarding application of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to electronic communications with patients.
  • Use of digital interventions might reduce the number of in-person clinic visits needed to encourage patient self-management and achieve blood pressure control.

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.