Hypertension, commonly known as high blood pressure, is a major risk factor for heart disease and affects over 100 million adults in the U.S., according to an American Heart Association report. Black communities often face significant health disparities related to hypertension. Individuals in these communities also are more likely to use emergency departments (ED) for hypertension care, which is linked to poorer blood pressure control, less awareness about hypertension, and a higher risk of cardiovascular problems.
To address these disparities, researchers in Michigan Medicine’s Department of Family Medicine, as well as those from Wayne State University, Brown University and the University of Toronto, recruited Black participants to use MI-BP, a multicomponent intervention that targets multiple behaviors for hypertension via smartphone app, including blood pressure monitoring, physical activity tracking, sodium intake tracking, goal setting, educational and motivational messaging and medication adherence reminders.
They published their findings in the paper, “The Effect of an mHealth Self-Monitoring Intervention (MI-BP) on Blood Pressure Among Black Individuals With Uncontrolled Hypertension: Randomized Controlled Trial” in JMIR mHealth and uHealth.
Researchers recruited participants from emergency departments and community settings within Detroit to determine whether the use of MI-BP could improve blood pressure and other related health behaviors over one year compared to an enhanced care group.
A total of 869 participants were potential study recruits, but only 162 (18.6%) were randomized into the study after researchers ensured they had uncontrolled hypertension and were willing to participate.
All participants received a blood pressure cuff, while 83 patients were randomized into the study arm that required they use the MI-BP app on their smart phones and a Bluetooth pedometer.
Researchers followed participants over 52 weeks, collecting data at four intervals: 13, 26, 39 and 52 weeks and did additional data collection visits during weeks 2 and 8. They measured blood pressure, physical activity, salt consumption, medication adherence, and overall blood pressure control.
After one year, both groups showed significant improvements in blood pressure. The MI-BP group had an average systolic blood pressure decrease of 22.5 mm Hg, while the control group showed a 24.1 mm Hg decrease. However, there were no significant differences between the two groups in any of the measured outcomes. Both groups also showed improved physical activity, decreased sodium intake, greater medication adherence, and better overall blood pressure control.
The researchers acknowledged various challenges they faced in the study. These included the COVID-19 pandemic, which required them to cancel additional participant recruitment and in-clinic information collection. Another hurdle was the high participation dropout rate, with around 60% of participants not completing the study. The authors argue that this high dropout rate is characteristic of other mobile technology-based studies and highlights the difficulties in maintaining engagement, especially in urban, low-income Black populations.
“Our findings ... suggest that these types of mHealth behavior change interventions may not be a complete solution that can promote behavior change and improve health outcomes in this population,” the authors said. “Rather, mHealth may have the greatest potential as part of a suite of approaches available to health care professionals and patients. While differences among the groups were not detected, the results speak to the general benefits of proactive outreach and engagement focused on cardiometabolic risk reduction in urban-dwelling, low-socioeconomic-status Black populations.”
Article citation: Buis LR, Kim J, Sen A, Chen D, Dawood K, Kadri R, Muladore R, Plegue M, Richardson CR, Djuric Z, McNaughton C, Hutton D, Robert LP, Park SY, Levy P. The Effect of an mHealth Self-Monitoring Intervention (MI-BP) on Blood Pressure Among Black Individuals With Uncontrolled Hypertension: Randomized Controlled Trial. JMIR Mhealth Uhealth 2024;12:e57863
doi: 10.2196/57863
