Health Equity

Review: Digital health tools can address BP-control inequities


Andis Robeznieks

Senior News Writer

Studies show that targeted digital health interventions can improve blood-pressure control levels among populations experiencing health inequities.

Multicomponent digital health interventions such as remote BP monitoring, text-message reminders, and the use of community health workers or skilled nurses led to greater reductions in systolic BP at six and 12 months compared with standard care alone, according to a systematic review of 28 studies published in JAMA Network Open.

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The interventions were linked to an average 4.24 mm Hg drop in systolic BP at six months and a 4.30 mm Hg reduction at 12 months, researchers found. Three-quarters of the studies included culturally tailored interventions.

“BP reductions were greater in the intervention groups compared with the standard care groups,” the JAMA Network Open study says. “The findings suggest that tailored initiatives that leverage digital health may have the potential to advance equity in hypertension outcomes.”

About half of U.S. adults have hypertension or high blood pressure, a primary or contributing cause of more than 925,000 deaths due to cardiovascular disease annually.

“Racial, ethnic and socioeconomic disparities in hypertension prevalence, awareness, and treatment persist,” the study says. “Notably, population-based studies have shown that Black and Hispanic adults have lower BP awareness and control despite a higher overall burden of hypertension” than white patients.

Prior to the COVID-19 pandemic, data showed inequity in high blood pressure among Black patients. The prevalence of high BP in Black women was nearly 40% higher than white women in the U.S., according to the American Heart Association (AHA).

The AMA and AMA Foundation, in collaboration with the Association of Black Cardiologists, AHA, Minority Health Institute and National Medical Association, have undertaken the “Release the Pressure” campaign to give Black women the resources to identify and track their BP numbers.

“Awareness of the importance of hypertension control for cardiovascular health is achievable through digital campaigns,” said Kate Kirley, MD, MS, a family physician and director of chronic disease prevention and programs at the AMA.

The Release the Pressure campaign “was designed to increase awareness of heart health—including high blood pressure—among Black women,” Dr. Kirley added. “Digital resources include a self-measured blood pressure training video and a pledge to prioritize heart health.”

The campaign aims to help Black women develop a wellness plan with existing personal support systems of family and friends to manage their heart health virtually. To date, the campaign has provided self-measured BP training to more than 144,000 Black women.

The JAMA Network Open study also notes that hypertension management and control are low across all Latino groups, with rates lower than those among white patients and lowest among Hispanic adults without health insurance. The systematic review found evidence validating the use of community health workers as an approach to boosting health care access in this population.

The AMA’s Improving Health Outcomes (IHO) group has produced patient-facing content that will help on this front.

“IHO has recently reviewed and redesigned patient education materials for self-measured blood pressure to ensure health literacy,” said Neha Sachdev, MD, MS, a family physician and IHO director of clinical engagement and equitable care. “The resources have also been translated into 15 different languages to reach a broad patient audience.”

The AMA has developed many other tools and resources using the latest evidence-based information to support physicians and care teams to help manage their patients’ high blood pressure. The AMA MAP™ Hypertension program which helps care teams to improve and sustain blood pressure control with an evidence-based approach, includes peer-to-peer education, practice tools and resources.

To help physicians and care teams better diagnose and manage patients with high BP, the high-impact, three-part quality improvement program offers a path to sustained BP control with guidance on how to:

Another resource is the US Blood Pressure Validated Device Listing (VDL™). The website details which of the thousands of BP-measurement devices for sale in the United States have been validated for clinical accuracy.