Hypertension Clinical Trial
Official title:
App Documentation of Electronic BP Readings in Hypertension
Background: Hypertension is the leading attributable risk factor for cardiovascular disease
and death globally. In diagnosing and monitoring hypertensive patient population, home blood
pressure monitoring (HBPM) has been shown to be superior to the office-based blood pressure
(BP) measurement as a predictor of cardiovascular disease and total mortality. However, the
conventional method of HBPM utilizing handwritten BP logbooks has known shortcomings, mainly
attributable to inaccuracy and underreporting of data, as well as the failure to bring the
logbooks to the regular outpatient appointments. In recent years, the availability of home BP
devices with Bluetooth® technology on the market, the increasingly widespread use of
smartphones, and the development of mobile applications (apps) that complement Bluetooth®
enabled BP monitors have expanded the potential for an accurate log of BP data to be
accessible to clinicians. Our study's primary aim is to compare the level of HBPM recording
fidelity using smartphone app versus using a handwritten logbook among the multi-ethnic
hypertensive patient population seen in a district polyclinic located in Pasir Ris,
Singapore. Patient acceptability of the two recording modalities and the association between
the home blood pressure recording fidelity and the patients' socio-demographic background,
self-care profile, clinical factors, and level of exposure to technology is also assessed as
exploratory aims. Our main hypothesis is that the level of fidelity in HBPM recording,
defined as the proportion of scheduled number of home blood pressure readings that is
successfully recorded, regimen compliant, and made available at the final follow up visit,
would be higher for patients who use a smartphone app versus those who maintain a handwritten
logbook.
Methods/design: Open, randomized controlled trial of 80 patients seen at Pasir Ris Polyclinic
randomized to either intervention or control arm and assessed after a 3-week follow up period
Intervention arm: Participants randomized to intervention arm follow a 3-week HBPM regimen
and wirelessly record the BP readings onto a smartphone app using Bluetooth® technology.
Control arm: Participants randomized to control arm follow a 3-week HBPM regimen (identical
to intervention arm) and manually record the BP readings onto a handwritten logbook.
Participants: A convenience sample of 80 patients visiting the study polyclinic was obtained
during the recruitment period (15 Mar 2017 - 15 June 2017).
Outcomes: A trained outcomes assessor will assess each participant's home BP record brought
to the final follow up visit at 3 weeks post-randomization. The primary outcome will be HBPM
recording fidelity, defined as the proportion of scheduled number of home blood pressure
readings that is successfully recorded, regimen compliant, and made available at the final
follow up visit. The participants' level of discomfort during the study, their willingness to
incorporate into their healthcare management the modality of HBPM to which they were
assigned, and their overall impression on their study participation will be assessed by a
participant acceptability questionnaire.
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