@Article{info:doi/10.2196/66351, author="Baldridge, S. Abigail and Odukwe, Adaora and Dabiri, Olabisi and Mobisson, Nneka L. and Munnee, Moosa Maria and Ogboye, Ayoposi and Aryee, Korkoi Dorothy Naa and Mwale, Rodrick and Akpakli, Jonas and Orji, A. Ikechukwu and Okoli, B. Rosemary C. and Ripiye, R. Nanna and Ojji, B. Dike and Huffman, D. Mark and Kandula, R. Namratha and Hirschhorn, R. Lisa", title="Implementation of the Extension for Community Healthcare Outcomes Model for Hypertension Education of Frontline Health Care Workers in the Federal Capital Territory, Nigeria: Explanatory Sequential Mixed Methods Evaluation", journal="J Med Internet Res", year="2025", month="Apr", day="24", volume="27", pages="e66351", keywords="hypertension", keywords="implementation", keywords="primary care", keywords="education", keywords="Kirkpatrick model", abstract="Background: The Extension for Community Healthcare Outcomes (ECHO) model was adapted for hypertension education of community health extension workers in the Federal Capital Territory, Nigeria, and delivered as a 7-part series. Objective: This study aims to evaluate implementation outcomes of the hypertension ECHO series mapped to the first 3 levels of the Kirkpatrick model. Outcomes included reach, appropriateness (level 1), effectiveness (level 2), and penetration (level 3). Methods: From August 2022 to April 2023, 7 hypertension ECHO sessions were delivered via Zoom (Zoom Video Communications, Inc) to a health care worker audience including targeted community health extension workers at 12 primary health centers (PHCs) in the Hypertension Treatment in Nigeria Program. Health care workers provided demographic information, engaged in pre- and postsession knowledge quizzes, and shared feedback during live sessions. Surveys were sent to health care workers at 12 PHCs approximately 1 month after each session to ask about the use of the presented material and focus group discussions were performed with these health care workers after the ECHO program concluded. Qualitative and quantitative results were evaluated using an explanatory sequential mixed methods design wherein qualitative data were used to help explain outcomes and variability among participants. Results: Across 7 ECHO sessions, a total of 1407 live participants were documented. Participants largely found the program was acceptable, with more than 97\% of respondents reporting that the session was useful. Postsession knowledge scores increased (range: 2.3\%-10.5\%) relative to presession scores demonstrating moderate effectiveness. Among 12 PHCs, most (more than 70\%) health care workers applied information learned in each session to provide patient care. In 6 focus group discussions, with 31 health care workers (n=15; 48\% community health extension workers), participants reported that network connectivity and clinical demands were barriers to live participation and expressed preferences for blended training and asynchronous resources. Conclusions: Results show that a hypertension ECHO program adapted for community health extension workers effectively increased knowledge among participants and was useful to a majority. Insights gained may inform the scaling of remote hypertension education programs for community health extension workers in similar settings. Trial Registration: ClinicalTrials.gov NCT04158154; https://clinicaltrials.gov/ct2/show/NCT04158154 ", doi="10.2196/66351", url="https://www.jmir.org/2025/1/e66351" } @Article{info:doi/10.2196/57032, author="Decambron, M{\'e}lanie and Tchikladze Merand, Christine", title="Telemedicine Booths for Screening Cardiovascular Risk Factors: Prospective Multicenter Study", journal="JMIR Hum Factors", year="2025", month="Apr", day="22", volume="12", pages="e57032", keywords="cardiovascular disease risk factors", keywords="cardiovascular disease", keywords="CVD", keywords="cardiology", keywords="cardiac", keywords="cardiologists", keywords="health check", keywords="hypertension", keywords="HTN", keywords="hypertensive", keywords="high blood pressure", keywords="blood pressure", keywords="obesity", keywords="screening", keywords="health screening", keywords="telemedicine", keywords="telehealth", keywords="virtual care", keywords="virtual health", keywords="virtual medicine", keywords="COVID-19", keywords="SARS-CoV-2", keywords="Coronavirus", keywords="respiratory", keywords="infectious", keywords="pulmonary", keywords="pandemic", abstract="Background: Cardiovascular risk factors such as hypertension often remain undetected and untreated. This was particularly problematic during the COVID-19 pandemic when there were fewer in-person medical consultations. Objective: This study aimed to determine whether health screening using a telemedicine booth would have an impact on people's medical care during the COVID-19 pandemic. Methods: Health screening was run using a telemedicine booth (the consult station) that was placed in three different vaccination centers in northern France between July 2021 and September 2021. Participants followed a series of instructions to obtain various measures, including their blood pressure, BMI, and heart rate. If any measures were found to be outside of the normal range, participants were advised to consult a doctor. After 3 months, the participants with abnormal readings were contacted by telephone and were asked a series of standardized questions. The primary outcome was the percentage of respondents who reported that they had consulted a doctor since the health check. Results: Approximately 6000 people attended the 3 vaccination centers over the study period. Of these, around 2500 used the consult station. A total of 1333 participants (53.3\%) were found to have abnormal readings, which mostly concerned their blood pressure, heart rate, or BMI. There were 638 participants who responded to the follow-up call, and 234 of these (37\%) reported that they had consulted a doctor since the health check. However, 158 of the 638 respondents (24.8\%) reported that they would have consulted a doctor even without the screening. Conclusions: We succeeded in screening large numbers of people for cardiovascular risk factors during the COVID-19 pandemic by using a telemedicine booth. Although relatively few follow-up call respondents reported that they went on to consult a physician, the screening would nevertheless have raised people's awareness of their cardiovascular risk factors. ", doi="10.2196/57032", url="https://humanfactors.jmir.org/2025/1/e57032" } @Article{info:doi/10.2196/59275, author="Wang, Yi and Tyagi, Shilpa and Ng, Liang David Wei and Teo, Ying Valerie Hui and Kok, David and Foo, Dennis and Koh, Choon-Huat Gerald", title="Primary Technology-Enhanced Care for Hypertension Scaling Program: Trial-Based Economic Evaluation Examining Effectiveness and Cost-Effectiveness Using Real-World Data in Singapore", journal="J Med Internet Res", year="2025", month="Apr", day="15", volume="27", pages="e59275", keywords="telehealth monitoring", keywords="hypertension", keywords="cost-effectiveness analysis", keywords="real-world data", keywords="Singapore", keywords="telehealth", keywords="cost-effectiveness", keywords="blood pressure monitoring", keywords="health care", keywords="teleconsultation", keywords="chatbot", keywords="regression analysis", keywords="medical cost", abstract="Background: Telehealth interventions are effective in hypertension management. However, the cost-effectiveness of using them for managing patients with hypertension remains inconclusive. Further research is required to understand the effectiveness and cost-effectiveness in the real-world setting. Objective: The Primary Technology-Enhanced Care for Hypertension (PTEC-HT) scaling program, a telehealth intervention for hypertension management, is currently being scaled nationwide in Singapore. The program comprises remote blood pressure (BP) monitoring at home, health care team support through teleconsultations, and in-app support with a digital chatbot. This study aimed to evaluate the program's effectiveness and cost-effectiveness. Methods: For patients under the PTEC-HT scaling program, BP readings over 6 months and 12 months, age, and gender were collected within the program. Health care use, health care cost, and patient ethnicity were extracted from the National Healthcare Group Polyclinics. For patients in the usual care group, demographic information, clinical data, health care use, and health care costs were extracted from the national claims records. Comparing the PTEC-HT scaling program with usual care, a trial-based economic evaluation using patient-level data was conducted to examine the effectiveness and cost-effectiveness over time horizons of 6 months and 12 months. The health care system's perspective was adopted. Regression analysis and exact matching were used to control for the differences between the PTEC-HT group and the usual care group. Results: For the 6-month analysis, 427 patients were included in the PTEC-HT group, and 64,679 patients were included in the usual care group. For the 12-month analysis, 338 patients were included in the PTEC-HT group, and 7324 patients were included in the usual care group. Using exact matching plus regression, in the 6-month analysis, the probability of having controlled BP was 13.5\% (95\% CI 6.3\%-20.7\%) higher for the PTEC-HT group compared to the usual care group. In the 12-month analysis, the probability of having controlled BP was 16\% (95\% CI 10.7\%-21.3\%) higher for the PTEC-HT group. Without considering the cost of the BP machine and program maintenance cost, the direct medical cost was S \$57.7 (95\% CI 54.4-61.0; a currency exchange rate of S \$1=US \$0.74 was applicable;) lower per patient for the PTEC-HT group in the 6-month analysis and S \$170.9 (95\% CI 151.9-189.9) lower per patient for the PTEC-HT group in the 12-month analysis. With the cost of the BP machine and program maintenance considered, compared to usual care, the PTEC-HT program reached breakeven at around the sixth month and saved S \$52.6 (95\% CI 33.6-71.6) per patient at the 12th month. Conclusions: Implemented in a real-world setting in Singapore, our study showed that the PTEC-HT scaling program is more effective in controlling BP status with lower cost compared to the usual care over 12 months. ", doi="10.2196/59275", url="https://www.jmir.org/2025/1/e59275" } @Article{info:doi/10.2196/70752, author="Matulis 3rd, Charles John and Greenwood, Jason and Eberle, Michele and Anderson, Benjamin and Blair, David and Chaudhry, Rajeev", title="Implementation of an Integrated, Clinical Decision Support Tool at the Point of Antihypertensive Medication Refill Request to Improve Hypertension Management: Controlled Pre-Post Study", journal="JMIR Med Inform", year="2025", month="Apr", day="11", volume="13", pages="e70752", keywords="clinical decision support systems", keywords="population health", keywords="hypertension", keywords="electronic health records", abstract="Background: Improving processes regarding the management of electronic health record (EHR) requests for chronic antihypertensive medication renewals may represent an opportunity to enhance blood pressure (BP) management at the individual and population level. Objective: This study aimed to evaluate the effectiveness of the eRx HTN Chart Check, an integrated clinical decision support tool available at the point of antihypertensive medication refill request, in facilitating enhanced provider management of chronic hypertension. Methods: The study was conducted at two Mayo Clinic sites---Northwest Wisconsin Family Medicine and Rochester Community Internal Medicine practices---with control groups in comparable Mayo Clinic practices. The intervention integrated structured clinical data, including recent BP readings, laboratory results, and visit dates, into the electronic prescription renewal interface to facilitate prescriber decision-making regarding hypertension management. A difference-in-differences (DID) design compared pre- and postintervention hypertension control rates between the intervention and control groups. Data were collected from the Epic EHR system and analyzed using linear regression models. Results: The baseline BP control rates were slightly higher in intervention clinics. Postimplementation, no significant improvement in population-level hypertension control was observed (DID estimate: 0.07\%, 95\% CI ?4.0\% to 4.1\%; P=.97). Of the 19,968 refill requests processed, 46\% met all monitoring criteria. However, clinician approval rates remained high (90\%), indicating minimal impact on prescribing behavior. Conclusions: Despite successful implementation, the tool did not significantly improve hypertension control, possibly due to competing quality initiatives and high in-basket volumes. Future iterations should focus on enhanced integration with other decision support tools and strategies to improve clinician engagement and patient outcomes. Further research is needed to optimize chronic disease management through EHR-integrated decision support systems. ", doi="10.2196/70752", url="https://medinform.jmir.org/2025/1/e70752" } @Article{info:doi/10.2196/67956, author="Dorsch, P. Michael and Flynn, J. Allen and Greer, M. Kaitlyn and Ganai, Sabah and Barnes, D. Geoffrey and Zikmund-Fisher, Brian", title="A Web-Based Tool to Perform a Values Clarification for Stroke Prevention in Patients With Atrial Fibrillation: Design and Preliminary Testing Study", journal="JMIR Cardio", year="2025", month="Apr", day="11", volume="9", pages="e67956", keywords="digital health", keywords="atrial fibrillation", keywords="stroke prevention", keywords="shared decision-making", keywords="values clarification", abstract="Background: Atrial fibrillation (AF) is associated with an increased risk of stroke. Oral anticoagulation (OAC) is used for stroke prevention in AF, but it also increases bleeding risk. Clinical guidelines do not definitively recommend for or against OAC for patients with borderline stroke risk. Decision-making may benefit from values clarification exercises to communicate risk trade-offs. Objective: This study aimed to evaluate if a visual with a values clarification alters the understanding of the trade-offs of anticoagulation in AF. Methods: Participants aged 45?64 years were recruited across the United States via an online survey. While answering the survey, they were asked to imagine they were newly diagnosed with AF with a CHA2DS2-VASc (congestive heart failure; hypertension; age ?75 years [doubled]; type 2 diabetes; previous stroke, transient ischemic attack, or thromboembolism [doubled]; vascular disease; age 65 to 75 years; and sex category) score of 1 for men and 2 for women. Eligibility criteria included no diagnosis of AF and no prior OAC use. Participants were randomized to one of three conditions: (1) standard text-based information only (n=255), (2) visual aids showing stroke-risk probabilities (n=218), or (3) visual aids plus a values clarification exercise (visual+VC; n=200). Participants were subrandomized within the 2 visual-based groups to view either a gauge display or an icon array representing stroke risk. All participants read a hypothetical scenario of being newly diagnosed with AF and hypertension. The primary outcome was decision confidence as measured by the SURE (Sure of Myself; Understand Information; Risk-Benefit Ratio; Encouragement) test. Secondary measures included participants' perceived stroke risk reduction, worry about stroke or bleeding, and likelihood to choose OAC. Results: A total of 673 participants completed the survey. The overall SURE test was 61.2\% (156/255) for the standard, 66.5\% (145/218) for the visual, and 67\% (134/200) for the visual+VC group (visual vs standard P=.23; visual+VC vs standard P=.20). Participants were less likely to choose OAC in the visual groups (standard: mean 58.3, SD 30; visual: mean 51.4, SD 32; visual+VC: 51.9, SD 28; P=.03). Participants felt the reduction in stroke risk from an OAC was less in the visual groups (standard: mean 63.8, SD 22; visual: mean 54.2, SD 28; visual+VC: mean 58.6, SD 25; P<.001). Visualization methods (gauge vs icon array) showed no significant differences in overall SURE test results. Participants were less likely to choose OAC and perceived a smaller stroke risk reduction with gauge than icon array (OAC choice: gauge 48.8, icon array 55.4; P=.03; stroke risk reduction: gauge 52.1, icon array 60.4; P=.001). Conclusions: Visual aids can modestly affect decision confidence and perceptions regarding the benefits of OAC but do not significantly alter decision certainty in a scenario where the guidelines do not recommend for or against OAC. Future work should determine the role of a gauge versus icon array visual for decision-making in stroke prevention in AF. ", doi="10.2196/67956", url="https://cardio.jmir.org/2025/1/e67956" } @Article{info:doi/10.2196/51434, author="Clements, Frances and Vedam, Hima and Chung, Yewon and Smoleniec, John and Sullivan, Colin and Shanmugalingam, Renuka and Hennessy, Annemarie and Makris, Angela", title="Effect of Continuous Positive Airway Pressure or Positional Therapy Compared to Control for Treatment of Obstructive Sleep Apnea on the Development of Gestational Diabetes Mellitus in Pregnancy: Protocol for Feasibility Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Apr", day="11", volume="14", pages="e51434", keywords="obstructive sleep apnoea", keywords="OSA", keywords="sleep disordered breathing", keywords="pregnancy", keywords="CPAP", keywords="positional therapy", keywords="gestational diabetes", keywords="GDM", keywords="preeclampsia", keywords="fetomaternal", keywords="maternal", keywords="pregnant", keywords="fetus", keywords="fetal", keywords="breathing", keywords="apnoea", keywords="sleep", keywords="respiratory", keywords="eclampsia", keywords="pregnant women", keywords="pregnancy complications", keywords="hypertension", abstract="Background: Obstructive sleep apnea (OSA) is a common sleep disorder, and in pregnancy, it is associated with an increased risk of complications, including gestational diabetes mellitus and preeclampsia. Supine sleep may worsen OSA, and in pregnancy, it is associated with an increased risk of stillbirth due to effects on fetomaternal blood flow. Continuous positive airway pressure (CPAP) therapy is considered the gold-standard treatment for moderate to severe OSA, although compliance is frequently poor; positional therapy (PT) is generally less effective than CPAP in nonpregnant patients but may be better tolerated and more accessible during pregnancy. There is limited data on whether widespread, early screening for sleep disorders in pregnant women with symptoms of sleep-disordered breathing or at high risk of metabolic complications and subsequent early intervention with CPAP or PT attenuates fetomaternal risks. Objective: This study aims to determine the feasibility of conducting a randomized controlled trial to assess improved fetomaternal outcomes in a high-risk pregnant population with OSA, using CPAP or PT, initiated by the 16th week of gestation. Methods: This study is a randomized, controlled, open-label feasibility study in which pregnant women with an apnea-hypopnea index (AHI) or respiratory disturbance index (RDI) ?5 are treated with CPAP (auto-titrating and fixed pressure) or positional therapy from early gestation (by 16 weeks) until delivery. The primary outcome is the feasibility of the study protocol and the development of gestational diabetes mellitus by the 28-week gestation period. Secondary outcomes include the development of hypertensive disorders of pregnancy (HDP), maternal weight gain, uterine artery blood flow, glycemic control during pregnancy (in participants who develop gestational diabetes), changes in maternal circulating biomarkers, and neonatal birthweight complications. Polysomnography at 28- to 32-week gestation period, postpartum polysomnography, therapy compliance, and patient acceptability are also assessed. Results: The trial commenced on September 30, 2019. The trial is ongoing as of August 6, 2024. Conclusions: The trial intends to contribute to the growing evidence base to support the need for the identification and treatment of OSA occurring during pregnancy and to assess the feasibility of the study protocol. This will be the first trial to compare the early initiation of CPAP (auto-titrating and fixed pressure) and positional therapy in pregnant women from early gestation, providing alternative therapies for the treatment of OSA in this important population. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001530112; https://tinyurl.com/yctdzs4u International Registered Report Identifier (IRRID): DERR1-10.2196/51434 ", doi="10.2196/51434", url="https://www.researchprotocols.org/2025/1/e51434", url="http://www.ncbi.nlm.nih.gov/pubmed/40215099" } @Article{info:doi/10.2196/55248, author="Clapham, Eleanor and Picone, Dean and Carmichael, Samuel and Bonner, Carissa and Chapman, Niamh", title="Appropriateness of Web-Based Resources for Home Blood Pressure Measurement and Their Alignment With Guideline Recommendations, Readability, and End User Involvement: Environmental Scan of Web-Based Resources", journal="JMIR Infodemiology", year="2025", month="Apr", day="3", volume="5", pages="e55248", keywords="readability", keywords="online resources", keywords="blood pressure guidelines", keywords="end user", keywords="home blood pressure measurement", keywords="patient education", keywords="educational resource", keywords="self-education", keywords="hypertension", abstract="Background: High blood pressure (?140/90 mm Hg) is the most prominent mortality risk factor worldwide. Home blood pressure measurement (HBPM) is recommended for blood pressure (BP) management. HBPM is most effective to improve BP management when delivered with patient education. It is unknown whether web-based resources are appropriate for patient education for HBPM. Patient education should provide accurate, evidence-based information, communicate at an eighth grade reading level, and involve end users in development to meet the needs of adults of all health literacy levels. Using these criteria, this study aimed to determine the appropriateness of web-based HBPM resources. Objective: This study aimed to determine whether web-based resources are appropriate for HBPM education based on three research questions: (1) Do web-based resources provide evidence-based information that aligns with guideline recommendations? (2) Do they communicate at an appropriate reading level? (3) Do they involve end users in their development? Methods: An environmental scan of web-based resources for HBPM was conducted on Google (October 2022) using search terms developed with consumers (n=6). Resources were included if they were identified on the first page of the search findings, not paywalled, and in English. Resource appropriateness was appraised based on three criteria: (1) alignment of resource content to 23 recommendations for HBPM from 6 international guidelines, (2) being at an appropriate grade reading level as determined by a health literacy assessment software, and (3) having evidence of end user involvement in resource development. Results: None of the identified resources (n=24) aligned with all 23 of the guideline recommendations. All resources aligned with the recommendation to measure BP when seated, while few aligned with the recommendation to use a validated BP device (n=9, 38\%). All resources exceeded the recommended eighth grade reading level (mean 11.8, range 8.8-17.0) and none reported evidence of patient end user involvement in development. Conclusions: None of the web-based resources met the criteria for appropriate education to support adults to measure BP at home. Resources should be developed with end users using health literacy tools and multimodal communication methods to ensure they are appropriate to meet the needs of patients. ", doi="10.2196/55248", url="https://infodemiology.jmir.org/2025/1/e55248" } @Article{info:doi/10.2196/56666, author="May, Susann and Seifert, Frances and Bruch, Dunja and Heinze, Martin and Spethmann, Sebastian and Muehlensiepen, Felix", title="Insights Into How mHealth Applications Could Be Introduced Into Standard Hypertension Care in Germany: Qualitative Study With German Cardiologists and General Practitioners", journal="JMIR Mhealth Uhealth", year="2025", month="Mar", day="28", volume="13", pages="e56666", keywords="hypertension", keywords="mHealth apps", keywords="physicians", keywords="qualitative study", keywords="digitalization", keywords="app", keywords="application", keywords="Germany", keywords="blood pressure", keywords="cardiologists", keywords="thematic analysis", keywords="general practitioner", keywords="mobile phone", abstract="Background: Mobile health (mHealth) apps provide innovative solutions for improving treatment adherence, facilitating lifestyle modifications, and optimizing blood pressure control in patients with hypertension. Despite their potential benefits, the adoption and recommendation of mHealth apps by physicians in Germany remain limited. This reluctance may be due to a lack of understanding of the factors influencing physicians' willingness to incorporate these digital tools into routine clinical practice. Understanding these factors is crucial for fostering greater integration of mHealth apps in hypertension care. Objective: The aim of this study was to explore the relationship between physicians' information needs and acceptance factors, and how these elements can support the effective integration of mHealth apps into daily medical routines. Methods: We conducted a qualitative study involving 24 semistructured telephone interviews with physicians, including 14 cardiologists and 10 general practitioners, who are involved in the treatment of hypertensive patients. Participants were selected through purposive sampling to ensure a diverse range of perspectives. Thematic analysis was conducted using MAXQDA software (Verbi GmbH) to identify key themes and subthemes related to the acceptance and use of mHealth apps. Results: The analysis revealed significant variability in physicians' information needs regarding mHealth apps, particularly concerning their functionalities, clinical benefits, and potential impact on patient outcomes. These informational gaps play a critical role in determining whether physicians are willing to recommend mHealth apps to their patients. Key determinants influencing acceptance were identified, including the availability of robust knowledge about the apps, high-quality and reliable data, generational shifts within the medical profession, solid evidence supporting the effectiveness of the mHealth apps, and clearly defined areas of application and responsibilities within the physician-patient relationship. The study found that acceptance of mHealth apps could be significantly increased through targeted educational initiatives, enhanced data quality, and better integration of these tools into existing clinical workflows. Furthermore, younger physicians, more familiar with digital technologies, demonstrated greater openness to using mHealth apps, suggesting that generational changes may drive future increases in adoption. Conclusions: The successful integration of mHealth apps into hypertension management requires a multifaceted approach that addresses both the informational and practical concerns of physicians. By disseminating comprehensive knowledge about the variety, functionality, and proven efficacy of hypertension-related mHealth apps, health care providers can be better equipped to use these tools effectively. This approach necessitates the implementation of various knowledge transfer strategies, such as targeted training programs, peer learning opportunities, and active engagement with digital health technologies. As physicians become more informed and confident in the use of mHealth apps, their acceptance and recommendation of these tools are likely to increase, leading to more widespread adoption. Overcoming current barriers related to information deficits and data quality is essential for ensuring that mHealth apps are optimally used in routine hypertension care, ultimately improving patient outcomes and enhancing the overall quality of care. Trial Registration: German Clinical Trials Register DRKS00029761; https://drks.de/search/de/trial/DRKS00029761 International Registered Report Identifier (IRRID): RR2-10.3389/fcvm.2022.1089968 ", doi="10.2196/56666", url="https://mhealth.jmir.org/2025/1/e56666" } @Article{info:doi/10.2196/60092, author="Wang, Naibo and Wang, Chen and Zhang, Puhong and Li, Yinghua and He, J. Feng and Li, Li and Li, Yuan and Luo, Rong and Wan, Dezhi and Xu, Lewei and Deng, Lifang and Wu, Lei", title="Effectiveness of an mHealth- and School-Based Health Education Program for Salt Reduction (EduSaltS) in China: Cluster Randomized Controlled Trial Within Scale-Up", journal="J Med Internet Res", year="2025", month="Mar", day="27", volume="27", pages="e60092", keywords="school-based health education", keywords="EduSaltS", keywords="mobile health", keywords="salt reduction", keywords="cluster randomized trial", abstract="Background: Globally, cardiovascular diseases are leading causes of mortality and disability, with hypertension being a major risk factor. Reducing salt intake and blood pressure are among the most cost-effective health promotion strategies. While mobile health (mHealth)-- and school-based salt reduction interventions have proven effective in trials, their impact when scaled up in real-world contexts remains uncertain. Objective: We evaluated the effectiveness of the real-world implementation of an mHealth- and school-based health education scale-up program to reduce salt intake (EduSaltS [mHealth and school-based education program to reduce salt intake scaling up in China]). Methods: A parallel cluster randomized controlled trial was conducted from April 2022 to July 2023 across 20 schools in 2 districts and 2 counties within Ganzhou City, Jiangxi Province, China. Schools were randomized 1:1 to intervention or control groups within each district or county. One third-grade class per school and 26 students per class were randomly sampled. One parent, or alternative family member (aged 18-75 years, residing with the student), of each student was invited to join. The EduSaltS intervention, spanning over 1 academic year, incorporated both app-based health education courses and offline salt reduction activities, with participation monitored through the backend management system. The intervention's effectiveness was assessed by comparing changes in salt intake and blood pressure between groups from baseline to 1-year follow-up using surveys, physical examination, and 24-hour urine tests. Results: Of 524 children (boys: n=288, 54.96\%; age: mean 9.16, SD 0.35 years) and 524 adults (men: n=194, 37.02\%; age: mean 40.99, SD 11.04 years) who completed the baseline assessments in 10 intervention and 10 control schools, 13 (2.48\%) children and 47 (8.97\%) adults were lost to follow-up. All schools and participants showed satisfactory intervention adherence. Measured differences in schoolchildren's salt intake, systolic blood pressure, and diastolic blood pressure, between the intervention and control schools, were --0.24 g/day (95\% CI --0.82 to 0.33), --0.68 mm Hg (95\% CI --2.32 to 0.95), and --1.37 mm Hg (95\% CI --2.79 to 0.06), respectively. For adults, the intervention group's salt intake decreased from 9.0 (SE 0.2) g/day to 8.3 (SE 0.2) g/day post intervention. Adjusted changes in the intervention (vs control) group in salt intake, systolic blood pressure, and diastolic blood pressure were --1.06 g/day (95\% CI --1.81 to --0.30), --2.26 mm Hg (95\% CI --4.26 to --0.26), and --2.33 mm Hg (95\% CI --3.84 to --0.82), respectively. Conclusions: The EduSaltS program, delivered through primary schools with a child-to-parent approach, was effective in reducing salt intake and controlling blood pressure in adults, but its effects on children were not significant. While promising for nationwide scaling, further improvements are needed to ensure its effectiveness in reducing salt intake among schoolchildren. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400079893; https://tinyurl.com/4maz7dyv (retrospectively registered); Chinese Clinical Trial Registry ChiCTR2000039767; https://tinyurl.com/5n6hc4s2 ", doi="10.2196/60092", url="https://www.jmir.org/2025/1/e60092", url="http://www.ncbi.nlm.nih.gov/pubmed/40017342" } @Article{info:doi/10.2196/66975, author="Wright, D. Kathy and Richards Adams, K. Ingrid and Helsabeck, P. Nathan and Rose, M. Karen and Moss, O. Karen and Nemati, Donya and Palmer, Navia and Kim, Bohyun and Pokhrel Bhattarai, Sunita and Nguyen, Christopher and Addison, Daniel and Klatt, D. Maryanna", title="Stress and Hypertension Among African American Female Family Caregivers of Persons Living With Alzheimer Disease and Related Dementias: Protocol for a Pilot Internet-Based Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Mar", day="27", volume="14", pages="e66975", keywords="African American women", keywords="high blood pressure", keywords="stress reactivity and resilience", keywords="caregiving", keywords="hypertension", keywords="stress", keywords="Alzheimer disease", keywords="dementia", keywords="lifestyle and healthy self-care behaviors", abstract="Background: Caregivers of persons with Alzheimer disease and related dementias (ADRD) neglect their health, including by ignoring stress levels. African American women are vulnerable and susceptible to hypertension. Chronic caregiving stress and hypertension place them at high risk for cardiovascular disease. Addressing stress reactivity or resilience is vital in lessening their caregiving stress, enhancing their quality of life (QOL), and fostering healthy blood pressure (BP) self-care behaviors. Objective: This pilot study aims to investigate the feasibility and acceptability of implementing the Mindfulness in Motion (MIM) plus the Dietary Approaches to Stop Hypertension (DASH) intervention in this population and to evaluate its effect on ADRD caregivers' stress and QOL. Additionally, it explores the mediation of stress reactivity or resilience between interventions and self-care behaviors. Methods: A small randomized controlled trial pilot study will recruit 28 African American or Black female caregivers aged 40 years diagnosed with hypertension and on an antihypertensive medication. Participants will be randomly assigned to either the MIM DASH or the Alzheimer's Association caregiver training group (attention control). Trained facilitators will deliver both interventions over 8 weeks through 1-hour, group, internet-based sessions, via video or telephone. After completion, both groups will receive coaching calls over 9 months, beginning with 8 weekly calls followed by 4 monthly calls to encourage use of the educational materials. Primary outcome measures include feasibility (recruitment and retention) and acceptability (attendance). Secondary measures assess caregiver stress (Perceived Stress Scale), QOL, and self-care behaviors (Food Frequency Questionnaire and self-reported physical activity). Data collection occurs at baseline, 3 months, and 9 months. Quantitative data will be analyzed using descriptive statistics, CIs, and mediation models. Results: This study was approved by the institutional review board in April 2022 and funded in May 2022. The first data were collected in January 2023, and the last data were collected in September 2024. The completion of all aims' data analysis is anticipated in spring 2025. The participants' mean age was 62.4 (SD 7.98) years, with a mean baseline systolic BP of 128 (SD 19) mm Hg and diastolic BP of 79 (SD 10) mm Hg. Participants reported that MIM DASH was acceptable (at a mean score of 59.08, SD 7.38, compared to 60.83, SD 5.56 for caregiver training). Regarding feasibility, as reflected in attendance, MIM DASH participants had a mean attendance of 6.3 (SD 2.3) sessions, and the caregiver training group had 4.9 (SD 2.9) sessions. Conclusions: This study's findings demonstrate the feasibility of conducting an internet-based intervention (MIM DASH) for African American women with hypertension who also care for families living with ADRD. These results will inform the design of a larger randomized controlled trial to evaluate the intervention's efficacy and scalability further. Trial Registration: ClinicalTrials.gov NCT05721482; https://clinicaltrials.gov/study/NCT05721482 International Registered Report Identifier (IRRID): DERR1-10.2196/66975 ", doi="10.2196/66975", url="https://www.researchprotocols.org/2025/1/e66975" } @Article{info:doi/10.2196/64933, author="Wu, J. Jennifer and Graham, Ross and {\c{C}}elebi, Julie and Fraser, Kevin and Gin, T. Geneen and Dang, Laurel and Hatamy, Esmatullah and Walker, Amanda and Barbato, Courtney and Lunde, Ottar and Coles, Lisa and Agnihotri, Parag and Morn, Cassandra and Tai-Seale, Ming", title="Factors Influencing Primary Care Physicians' Intent to Refer Patients With Hypertension to a Digital Remote Blood Pressure Monitoring Program: Mixed Methods Study", journal="J Med Internet Res", year="2025", month="Mar", day="24", volume="27", pages="e64933", keywords="digital health", keywords="primary care", keywords="electronic health records", keywords="referral", keywords="hypertension", keywords="remote monitoring", keywords="remote blood pressure", keywords="digital technology", keywords="mobile phone", keywords="mixed method", keywords="quantitative analysis", keywords="linear regression", keywords="clinical information", abstract="Background: Primary care physicians' (PCP) referral rates to digital health programs are highly variable. This study explores whether knowledge of the digital remote blood pressure monitoring (RBPM) program and information on referral patterns influence PCPs' intention to refer patients. Objective: This study aims to examine the relationship between PCPs' knowledge of the digital RBPM program and information on their own prior referral rates versus their own with their peers' referral rates and their likelihood to refer patients to the digital RBPM program. Methods: This is a mixed methods study integrating quantitative analysis of electronic health record data regarding the frequency of PCPs' referrals of patients with hypertension to a digital health program and quantitative and qualitative analyses of survey data about PCPs' knowledge of the program and their intention to refer patients. PCPs responded to a clinical vignette featuring an eligible patient. They were randomized to either receive their own referral rate or their own plus their peers' referral rate. They were assessed on their intent to refer eligible future patients. Descriptive and multivariable linear regression analyses examined participant characteristics and the factors associated with their intent to refer patients. Narrative reasons for their intention to refer were thematically analyzed. Results: Of the 242 eligible PCPs invited to participate, 31\% (n=70) responded to the survey. From electronic health record data, the mean referral rate of patients per PCP was 11.80\% (SD 13.30\%). The mean self-reported knowledge of the digital health program was 6.47 (SD 1.81). The mean likelihood of referring an eligible patient (on a scale of 0 to 10, with 0 being not at all, and 10 being definitely) based on a vignette was 8.54 (SD 2.12). The own referral data group's mean likelihood to refer was 8.91 (SD 1.28), whereas the own plus peer prior referral data group was 8.35 (SD 2.19). Regression analyses suggested the intention to refer the vignette patient was significantly associated with their knowledge (coefficient 0.46, 95\% CI 0.20-0.73; P<.001), whereas the intention to refer future patients was significantly associated with their intent to refer the patient in the vignette (coefficient 0.62, 95\% CI 0.46-0.78; P<.001). No evidence of association was found on receiving own plus peer referral data compared with own referral data and intent to refer future patients (coefficient 0.23, 95\% CI --0.43 to 0.89; P=.48). Conclusions: Physicians' intention to refer patients to a novel digital health program can be extrapolated by examining their intention to refer an eligible patient portrayed in a vignette, which was found to be significantly influenced by their knowledge of the program. Future efforts should engage PCPs to better inform them so that more patients can benefit from the digital health program. ", doi="10.2196/64933", url="https://www.jmir.org/2025/1/e64933", url="http://www.ncbi.nlm.nih.gov/pubmed/40126550" } @Article{info:doi/10.2196/68442, author="Cheng, Yinlin and Gu, Kuiying and Ji, Weidong and Hu, Zhensheng and Yang, Yining and Zhou, Yi", title="Two-Year Hypertension Incidence Risk Prediction in Populations in the Desert Regions of Northwest China: Prospective Cohort Study", journal="J Med Internet Res", year="2025", month="Mar", day="12", volume="27", pages="e68442", keywords="hypertension", keywords="desert", keywords="machine learning", keywords="deep learning", keywords="prevention", keywords="clinical applicability", abstract="Background: Hypertension is a major global health issue and a significant modifiable risk factor for cardiovascular diseases, contributing to a substantial socioeconomic burden due to its high prevalence. In China, particularly among populations living near desert regions, hypertension is even more prevalent due to unique environmental and lifestyle conditions, exacerbating the disease burden in these areas, underscoring the urgent need for effective early detection and intervention strategies. Objective: This study aims to develop, calibrate, and prospectively validate a 2-year hypertension risk prediction model by using large-scale health examination data collected from populations residing in 4 regions surrounding the Taklamakan Desert of northwest China. Methods: We retrospectively analyzed the health examination data of 1,038,170 adults (2019-2021) and prospectively validated our findings in a separate cohort of 961,519 adults (2021-2023). Data included demographics, lifestyle factors, physical examinations, and laboratory measurements. Feature selection was performed using light gradient-boosting machine--based recursive feature elimination with cross-validation and Least Absolute Shrinkage and Selection Operator, yielding 24 key predictors. Multiple machine learning (logistic regression, random forest, extreme gradient boosting, light gradient-boosting machine) and deep learning (Feature Tokenizer + Transformer, SAINT) models were trained with Bayesian hyperparameter optimization. Results: Over a 2-year follow-up, 15.20\% (157,766/1,038,170) of the participants in the retrospective cohort and 10.50\% (101,077/961,519) in the prospective cohort developed hypertension. Among the models developed, the CatBoost model demonstrated the best performance, achieving area under the curve (AUC) values of 0.888 (95\% CI 0.886-0.889) in the retrospective cohort and 0.803 (95\% CI 0.801-0.804) in the prospective cohort. Calibration via isotonic regression improved the model's probability estimates, with Brier scores of 0.090 (95\% CI 0.089-0.091) and 0.102 (95\% CI 0.101-0.103) in the internal validation and prospective cohorts, respectively. Participants were ranked by the positive predictive value calculated using the calibrated model and stratified into 4 risk categories (low, medium, high, and very high), with the very high group exhibiting a 41.08\% (5741/13,975) hypertension incidence over 2 years. Age, BMI, and socioeconomic factors were identified as significant predictors of hypertension. Conclusions: Our machine learning model effectively predicted the 2-year risk of hypertension, making it particularly suitable for preventive health care management in high-risk populations residing in the desert regions of China. Our model exhibited excellent predictive performance and has potential for clinical application. A web-based application was developed based on our predictive model, which further enhanced the accessibility for clinical and public health use, aiding in reducing the burden of hypertension through timely prevention strategies. ", doi="10.2196/68442", url="https://www.jmir.org/2025/1/e68442", url="http://www.ncbi.nlm.nih.gov/pubmed/40072485" } @Article{info:doi/10.2196/52544, author="May, Susann and Muehlensiepen, Felix and Wengemuth, Eileen and Seifert, Frances and Heinze, Martin and Bruch, Dunja and Spethmann, Sebastian", title="Benefits and Barriers to mHealth in Hypertension Care: Qualitative Study With German Health Care Professionals", journal="JMIR Hum Factors", year="2025", month="Mar", day="10", volume="12", pages="e52544", keywords="hypertension", keywords="mHealth apps", keywords="digital health", keywords="physicians", keywords="nurses", keywords="HCP", keywords="qualitative interviews", keywords="health care professional", keywords="cardiologists", keywords="mHealth", keywords="Germany", keywords="general practitioners", keywords="blood pressure monitoring", keywords="qualitative study", keywords="qualitative content analysis", abstract="Background: Digital health technologies, particularly mobile health (mHealth) apps and wearable devices, have emerged as crucial assets in the battle against hypertension. By enabling lifestyle modifications, facilitating home blood pressure monitoring, and promoting treatment adherence, these technologies have significantly enhanced hypertension treatment. Objective: This study aims to explore the perspectives of health care professionals (HCPs) regarding the perceived benefits and barriers associated with the integration of mHealth apps into routine hypertension care. Additionally, strategies for overcoming these barriers will be identified. Methods: Through qualitative analysis via semistructured interviews, general practitioners (n=10), cardiologists (n=14), and nurses (n=3) were purposefully selected between October 2022 and March 2023. Verbatim transcripts were analyzed using qualitative content analysis. Results: The results unveiled 3 overarching themes highlighting the benefits of mHealth apps in hypertension care from the perspective of HCPs. First, these technologies possess the potential to enhance patient safety by facilitating continuous monitoring and early detection of abnormalities. Second, they can empower patients, fostering autonomy in managing their health conditions, thereby promoting active participation in their care. Lastly, mHealth apps may provide valuable support to medical care by offering real-time data that aids in decision-making and treatment adjustments. Despite these benefits, the study identified several barriers hindering the seamless integration of mHealth apps into hypertension care. Challenges predominantly revolved around data management, communication contexts, daily routines, and system handling. HCPs underscored the necessity for structural and procedural modifications in their daily practices to effectively address these challenges. Conclusions: In conclusion, the effective usage of digital tools such as mHealth apps necessitates overcoming various obstacles. This entails meeting the information needs of both HCPs and patients, tackling interoperability issues to ensure seamless data exchange between different systems, clarifying uncertainties surrounding reimbursement policies, and establishing the specific clinical benefits of these technologies. Active engagement of users throughout the design and implementation phases is crucial for ensuring the usability and acceptance of mHealth apps. Moreover, enhancing knowledge accessibility through the provision of easily understandable information about mHealth apps is essential for eliminating barriers and fostering their widespread adoption in hypertension care. Trial Registration: German Clinical Trials Register DRKS00029761; https://drks.de/search/de/trial/DRKS00029761 International Registered Report Identifier (IRRID): RR2-10.3389/fcvm.2022.1089968 ", doi="10.2196/52544", url="https://humanfactors.jmir.org/2025/1/e52544" } @Article{info:doi/10.2196/59841, author="Clifford, Namuun and Tunis, Rachel and Ariyo, Adetimilehin and Yu, Haoxiang and Rhee, Hyekyun and Radhakrishnan, Kavita", title="Trends and Gaps in Digital Precision Hypertension Management: Scoping Review", journal="J Med Internet Res", year="2025", month="Feb", day="10", volume="27", pages="e59841", keywords="precision health", keywords="hypertension", keywords="digital health", keywords="prediction models", keywords="personalization", keywords="phenotyping", keywords="machine learning", keywords="algorithms", keywords="mobile apps", keywords="mobile health", abstract="Background: Hypertension (HTN) is the leading cause of cardiovascular disease morbidity and mortality worldwide. Despite effective treatments, most people with HTN do not have their blood pressure under control. Precision health strategies emphasizing predictive, preventive, and personalized care through digital tools offer notable opportunities to optimize the management of HTN. Objective: This scoping review aimed to fill a research gap in understanding the current state of precision health research using digital tools for the management of HTN in adults. Methods: This study used a scoping review framework to systematically search for articles in 5 databases published between 2013 and 2023. The included articles were thematically analyzed based on their precision health focus: personalized interventions, prediction models, and phenotyping. Data were extracted and summarized for study and sample characteristics, precision health focus, digital health technology, disciplines involved, and characteristics of personalized interventions. Results: After screening 883 articles, 46 were included; most studies had a precision health focus on personalized digital interventions (34/46, 74\%), followed by prediction models (8/46, 17\%) and phenotyping (4/46, 9\%). Most studies (38/46, 82\%) were conducted in or used data from North America or Europe, and 63\% (29/46) of the studies came exclusively from the medical and health sciences, with 33\% (15/46) of studies involving 2 or more disciplines. The most commonly used digital technologies were mobile phones (33/46, 72\%), blood pressure monitors (18/46, 39\%), and machine learning algorithms (11/46, 24\%). In total, 45\% (21/46) of the studies either did not report race or ethnicity data (14/46, 30\%) or partially reported this information (7/46, 15\%). For personalized intervention studies, nearly half (14/30, 47\%) used 2 or less types of data for personalization, with only 7\% (2/30) of the studies using social determinants of health data and no studies using physical environment or digital literacy data. Personalization characteristics of studies varied, with 43\% (13/30) of studies using fully automated personalization approaches, 33\% (10/30) using human-driven personalization, and 23\% (7/30) using a hybrid approach. Conclusions: This scoping review provides a comprehensive mapping of the literature on the current trends and gaps in digital precision health research for the management of HTN in adults. Personalized digital interventions were the primary focus of most studies; however, the review highlighted the need for more precise definitions of personalization and the integration of more diverse data sources to improve the tailoring of interventions and promotion of health equity. In addition, there were significant gaps in the reporting of race and ethnicity data of participants, underuse of wearable devices for passive data collection, and the need for greater interdisciplinary collaboration to advance precision health research in digital HTN management. Trial Registration: OSF Registries osf.io/yuzf8; https://osf.io/yuzf8 ", doi="10.2196/59841", url="https://www.jmir.org/2025/1/e59841" } @Article{info:doi/10.2196/65548, author="He, Jinyu and Li, Yanjun and Zeng, Huatang and Sun, Haoran and Wu, Liqun and Zhu, Zhenzhen and Zhang, Ning and Liang, Wannian", title="Health Equity of Hypertension Management Between Local Residents and Internal Migrants in Shenzhen, China: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2025", month="Feb", day="10", volume="11", pages="e65548", keywords="health equity", keywords="hypertension management", keywords="immigrant population", keywords="hypertension", keywords="China", keywords="global health", keywords="public health", keywords="health disparities", keywords="medical record", keywords="community health care", keywords="native population", keywords="immigrant", keywords="socioeconomic", keywords="disease burden", keywords="well-being", keywords="chronic disease", keywords="community health center", abstract="Background: With hypertension emerging as a global public health concern, taking measures to alleviate its burden is urgently needed. The hypertension management program (HMP) in China is a standardized policy to help people with hypertension to improve their health levels and reduce health inequalities. However, studies focusing on details regarding participation in this program remain scarce. Objective: This study aims to investigate the participation rates in HMPs in China and examine the health disparities in hypertension management between local residents and internal migrants in Shenzhen. Methods: This study used the medical record of Shenzhen, Guangdong, China. We included adults with new-onset diagnosis of hypertension after 2017 and focused on patients who have a record in the community health center. We described the basic characteristics of people diagnosed with hypertension, including age, gender, marital status, occupation, education level, and health insurance type. Enrolled rate, follow-up rate, and adherence rate were used to measure the engagement with this program at the city, district, and community levels. Results: Of the 1,160,214 hypertensive patients, 29.70\% (344,526/1,160,214) were local residents, while 70.3\% (815,688/1,160,214) were internal migrants. In addition, 55.36\% (642,250/1,160,214) were enrolled in the HMP. Of those, 57.52\% (369,439/642,25) were followed up. In addition, 62.59\% (231,217/369,439) of followed up individuals were adherents. Internal migrants demonstrated a significantly higher participation in the HMP, especially for the enrolled rate (local residents: 156,085/344,526, 45.30\% vs internal migrants: 486,165/815,688, 59.60\%) and adherence rate (local residents: 44,044/84,635, 52.04\% vs internal migrants: 187,173/284,804, 65.72\%). Apart from that, local, single, and younger individuals had lower rates compared to their counterparts. There also existed within-district and within-community variation among enrolled, follow-up, and adherence rates. Conclusions: Based on our research, individuals with different demographic and socioeconomic characteristics and in different regions had different enrolled, follow-up, and adherence rates. Internal migrants in Shenzhen showed a significantly higher participation in the HMP. Given these findings, there exists the potential to enhance the outreach and engagement of local, single, and younger populations through targeted promotional strategies. ", doi="10.2196/65548", url="https://publichealth.jmir.org/2025/1/e65548" } @Article{info:doi/10.2196/65783, author="Wei, Feiran and Ge, You and Li, Han and Liu, Yuan", title="Impact of the National Essential Public Health Service Package on Blood Pressure Control in Chinese People With Hypertension: Retrospective Population-Based Longitudinal Study", journal="JMIR Public Health Surveill", year="2025", month="Feb", day="6", volume="11", pages="e65783", keywords="hypertension", keywords="primary care", keywords="public health", keywords="blood pressure control", keywords="cardiovascular disease", abstract="Background: The National Essential Public Health Service Package (NEPHSP) was launched in 2009 to tackle poor blood pressure control in Chinese people with hypertension; however, it's effect is still unclear. Objective: In a retrospective population-based longitudinal study, we aimed to evaluate effect of the NEPHSP on blood pressure control. Methods: A total of 516,777 patients registered in the NEPHSP were included. The blood pressure control data were assessed based on the Residence Health Record System dataset. We longitudinally evaluated the effects of the NEPHSP on blood pressure control by analyzing changes in blood pressure at quarterly follow-ups. Both the degree and trend of the blood pressure changes were analyzed. We conducted stratified analysis to explore effects of the NEPHSP on blood pressure control among subgroups of participants with specific characteristics. Results: The mean baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 147.12 (SD 19.88) mm Hg and 85.11 (SD 11.79) mm Hg, respectively. The control rates of baseline SBP and DBP were 39.79\% (205,630/516,777) and 69.21\% (357,685/516,777). Compared to baseline, the mean SBP decreased in each quarter by 5.06 mm Hg (95\% CI ?5.11 to ?5.00; P<.001), 6.69 mm Hg (95\% CI; ?6.74 to ?6.63; P<.001), 10.30 mm Hg (95\% CI ?10.34 to ?10.23; P<.001), and 6.63 mm Hg (95\% CI ?6.68 to ?6.57; P<.001). The SBP control rates increased in each quarter to 53.12\% (274,493/516,777; $\beta$ coefficient=0.60, 95\% CI 0.59-0.61; P<.001), 56.61\% (292,537/516,777; $\beta$ coefficient=0.76, 95\% CI 0.75-0.77; P<.001), 63.4\% (327,648/516,777; $\beta$ coefficient=1.08, 95\% CI 1.07-1.09; P<.001), and 55.09\% (284,711/516,777; $\beta$ coefficient=0.69, 95\% CI 0.68-0.70; P<.001). Compared to baseline, the mean DBP decreased in each quarter by 1.75 mm Hg (95\% CI ?1.79 to ?1.72; P<.001), 2.64 mm Hg (95\% CI ?2.68 to ?2.61; P<.001), 4.20 mm Hg (95\% CI ?4.23 to ?4.16; P<.001), and 2.64 mm Hg (95\% CI ?2.68 to ?2.61; P<.001). DBP control rates increased in each quarter to 78.11\% (403,641/516,777; $\beta$ coefficient=0.52, 95\% CI 0.51-0.53; P<.001), 80.32\% (415,062/516,777; $\beta$ coefficient=0.67, 95\% CI 0.66-0.68; P<.001), 83.17\% (429,829/516,777; $\beta$ coefficient=0.89, 95\% CI 0.88-0.90; P<.001), and 79.47\% (410,662/516,777; $\beta$ coefficient=0.61, 95\% CI 0.60-0.62; P<.001). The older age group had a larger decrease in their mean SBP ($\beta$ coefficient=0.87, 95\% CI 0.85-0.90; P<.001) and a larger increase in SBP control rates ($\beta$ coefficient=0.054, 95\% CI 0.051-0.058; P<.001). The participants with cardiovascular disease (CVD) had a smaller decrease in their mean SBP ($\beta$ coefficient=?0.38, 95\% CI ?0.41 to ?0.35; P<.001) and smaller increase in SBP control rates ($\beta$ coefficient=?0.041, 95\% CI ?0.045 to ?0.037; P<.001) compared to the blood pressure of participants without CVD. Conclusions: The NEPHSP was effective in improving blood pressure control of Chinese people with hypertension. Blood pressure control of older individuals and those with CVD need to be intensified. ", doi="10.2196/65783", url="https://publichealth.jmir.org/2025/1/e65783" } @Article{info:doi/10.2196/39950, author="Joshi, Ashish and Surapaneni, Mohan Krishna and Grover, Ashoo and Kaur, Harpreet and Saggu, Rani Sofia and Oliveira, Doilyn", title="Swasthya Pahal (Health for All) Using a Sustainable, Multisector, Accessible, Affordable, Reimbursable, and Tailored Informatics Framework in Rural and Urban Areas of Chennai, Tamil Nadu: Protocol for a Quantitative Study", journal="JMIR Res Protoc", year="2025", month="Feb", day="6", volume="14", pages="e39950", keywords="interventions", keywords="Swasthya Pahal", keywords="acceptance", keywords="health behavior", keywords="NCDs risks", keywords="self-management", keywords="healthcare", keywords="noncommunicable disease", abstract="Background: Noncommunicable diseases (NCDs) require a longer period of care, for which health care systems must acquire technologically advanced solutions to enhance patient care. Swasthya Pahal (health for all) is an innovative, interactive, multilingual, stand-alone, internet-enabled computer-based program that aims to improve the self-management of NCDs. Objective: This study aims to enhance the self-management of chronic NCDs (diabetes, hypertension, high cholesterol, and obesity) by determining the usefulness, acceptance, and effectiveness of the Swasthya Pahal program in hospital and community settings in both rural and urban areas of Chennai, Tamil Nadu. This objective can be met by generating risk factor profiles of individuals enrolled and enhancing their self-management of NCDs using a portable health information kiosk that uses the Sustainable, Multisector, Accessible, Affordable, Reimbursable, and Tailored (SMAART) model. Methods: A quantitative study will be conducted on a convenient sample of 2800 individuals from selected hospital and community settings in rural (n=1400) and urban areas (n=1400) in Chennai, Tamil Nadu. Data will be collected on sociodemographics, health behaviors, and clinical status, as well as knowledge, attitudes, and practices. Objective assessments such as weight, blood pressure, and random blood sugar levels will be measured. In addition, the usefulness, acceptance, and effectiveness of the Swasthya Pahal program will be determined. Results: Results will be summarized using descriptive analysis. Appropriate bivariate and multivariate regression analysis will be performed to determine the predictors of the outcome variables of usefulness, acceptance, and effectiveness of Swasthya Pahal in wider settings. All analyses will be performed using SAS (version 9.1; SAS Institute), and the results will be reported as 95\% CI values and P<.05. Conclusions: The study proposes to enhance the self-management of NCDs in both rural and urban community settings through the implementation of the Swasthya Pahal program based on the SMAART informatics framework. The study aims to understand the implementation, acceptability, and usability of Swasthya Pahal among a diverse sample of people in urban and rural settings. International Registered Report Identifier (IRRID): PRR1-10.2196/39950 ", doi="10.2196/39950", url="https://www.researchprotocols.org/2025/1/e39950" } @Article{info:doi/10.2196/60238, author="Gong, Ke and Chen, Yifan and Song, Xinyue and Fu, Zhizhong and Ding, Xiaorong", title="Causal Inference for Hypertension Prediction With Wearable Electrocardiogram and Photoplethysmogram Signals: Feasibility Study", journal="JMIR Cardio", year="2025", month="Jan", day="23", volume="9", pages="e60238", keywords="hypertension", keywords="causal inference", keywords="wearable physiological signals", keywords="electrocardiogram", keywords="photoplethysmogram", abstract="Background: Hypertension is a leading cause of cardiovascular disease and premature death worldwide, and it puts a heavy burden on the health care system. Therefore, it is very important to detect and evaluate hypertension and related cardiovascular events to enable early prevention, detection, and management. Hypertension can be detected in a timely manner with cardiac signals, such as through an electrocardiogram (ECG) and photoplethysmogram (PPG), which can be observed via wearable sensors. Most previous studies predicted hypertension from ECG and PPG signals with extracted features that are correlated with hypertension. However, correlation is sometimes unreliable and may be affected by confounding factors. Objective: The aim of this study was to investigate the feasibility of predicting the risk of hypertension by exploring features that are causally related to hypertension via causal inference methods. Additionally, we paid special attention to and verified the reliability and effectiveness of causality compared to correlation. Methods: We used a large public dataset from the Aurora Project, which was conducted by Microsoft Research. The dataset included diverse individuals who were balanced in terms of gender, age, and the condition of hypertension, with their ECG and PPG signals simultaneously acquired with wrist-worn wearable devices. We first extracted 205 features from the ECG and PPG signals, calculated 6 statistical metrics for these 205 features, and selected some valuable features out of the 205 features under each statistical metric. Then, 6 causal graphs of the selected features for each kind of statistical metric and hypertension were constructed with the equivalent greedy search algorithm. We further fused the 6 causal graphs into 1 causal graph and identified features that were causally related to hypertension from the causal graph. Finally, we used these features to detect hypertension via machine learning algorithms. Results: We validated the proposed method on 405 subjects. We identified 24 causal features that were associated with hypertension. The causal features could detect hypertension with an accuracy of 89\%, precision of 92\%, and recall of 82\%, which outperformed detection with correlation features (accuracy of 85\%, precision of 88\%, and recall of 77\%). Conclusions: The results indicated that the causal inference--based approach can potentially clarify the mechanism of hypertension detection with noninvasive signals and effectively detect hypertension. It also revealed that causality can be more reliable and effective than correlation for hypertension detection and other application scenarios. ", doi="10.2196/60238", url="https://cardio.jmir.org/2025/1/e60238" } @Article{info:doi/10.2196/60326, author="Kirkham, M. Aidan and Fergusson, A. Dean and Presseau, Justin and McIsaac, I. Daniel and Shorr, Risa and Roberts, J. Derek", title="Strategies to Improve Health Care Provider Prescription of and Patient Adherence to Guideline-Recommended Cardiovascular Medications for Atherosclerotic Occlusive Disease: Protocol for Two Systematic Reviews and Meta-Analyses of Randomized Controlled Trials", journal="JMIR Res Protoc", year="2025", month="Jan", day="16", volume="14", pages="e60326", keywords="coronary artery disease", keywords="cerebrovascular disease", keywords="peripheral artery disease", keywords="polyvascular disease", keywords="underprescription", keywords="nonadherence", keywords="implementation strategy", keywords="adherence-supporting strategy", keywords="statins", keywords="antiplatelets", keywords="antihypertensives", keywords="guideline-recommended medications", keywords="implementation", keywords="atherosclerosis", keywords="patient adherence", keywords="RCT", keywords="randomized controlled trials", keywords="PRISMA", abstract="Background: In patients with atherosclerotic occlusive diseases, systematic reviews and meta-analyses of randomized controlled trials (RCTs) report that antiplatelets, statins, and antihypertensives reduce the risk of major adverse cardiac events, need for revascularization procedures, mortality, and health care resource use. However, evidence suggests that these patients are not prescribed these medications adequately or do not adhere to them once prescribed. Objective: We aim to systematically review and meta-analyze RCTs examining the effectiveness of implementation or adherence-supporting strategies for improving health care provider prescription of, or patient adherence to, guideline-recommended cardiovascular medications in patients with atherosclerotic occlusive disease. Methods: We designed and reported the protocol according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis-Protocols) statement. We will search MEDLINE, Embase, The Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL from their inception. RCTs examining implementation or adherence-supporting strategies for improving prescription of, or adherence to, guideline-recommended cardiovascular medications in adults with cerebrovascular disease, coronary artery disease, peripheral artery disease, or polyvascular disease (>1 of these diseases) will be included. Two investigators will independently review identified titles/abstracts and full-text studies, extract data, assess the risk of bias (using the Cochrane tool), and classify implementation or adherence-supporting strategies using the refined Cochrane Effective Practice and Organization of Care (EPOC) taxonomy (for strategies aimed at improving prescription) and Behavior Change Wheel (BCW; for adherence-supporting strategies). We will narratively synthesize data describing which implementation or adherence-supporting strategies have been evaluated across RCTs, and their reported effectiveness at improving prescription of, or adherence to, guideline-recommended cardiovascular medications (primary outcomes) and patient-important outcomes and health care resource use (secondary outcomes) within refined EPOC taxonomy levels and BCW interventions and policies. Where limited clinical heterogeneity exists between RCTs, estimates describing the effectiveness of implementation or adherence-supporting strategies within different refined EPOC taxonomy levels and BCW interventions and policies will be pooled using random-effects models. Stratified meta-analyses and meta-regressions will assess if strategy effectiveness varies by recruited patient populations, prescriber types, clinical practice settings, and study design characteristics. GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) will be used to communicate evidence certainty. Results: The search was completed on June 6, 2023. Database searches and the PubMed ``related articles'' feature identified 4319 unique citations for title/abstract screening. We are currently screening titles/abstracts. Conclusions: These studies will identify which implementation and adherence-supporting strategies are being used (and in which combinations) across RCTs for improving the prescription of, or adherence to, guideline-recommended cardiovascular medications in adults with atherosclerotic occlusive diseases. They will also determine the effectiveness of currently trialed implementation and adherence-supporting strategies, and whether effectiveness varies by patient, prescriber, or clinical practice setting traits. Trial Registration: PROSPERO CRD42023461317; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=461317; PROSPERO CRD42023461299; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=461299 ", doi="10.2196/60326", url="https://www.researchprotocols.org/2025/1/e60326" } @Article{info:doi/10.2196/65981, author="Sakairi, Mizuki and Miyagami, Taiju and Tabata, Hiroki and Yanagisawa, Naotake and Saita, Mizue and Suzuki, Mai and Fujibayashi, Kazutoshi and Fukuda, Hiroshi and Naito, Toshio", title="Efficacy of Unsupervised YouTube Dance Exercise for Patients With Hypertension: Randomized Controlled Trial", journal="JMIR Cardio", year="2025", month="Jan", day="9", volume="9", pages="e65981", keywords="dance", keywords="video", keywords="exercise therapy", keywords="hypertension", keywords="blood pressure therapy", keywords="YouTube", keywords="mHealth", abstract="Background: High blood pressure (BP) is linked to unhealthy lifestyles, and its treatment includes medications and exercise therapy. Many previous studies have evaluated the effects of exercise on BP improvement; however, exercise requires securing a location, time, and staff, which can be challenging in clinical settings. The antihypertensive effects of dance exercise for patients with hypertension have already been verified, and it has been found that adherence and dropout rates are better compared to other forms of exercise. If the burden of providing dance instruction is reduced, dance exercise will become a highly useful intervention for hypertension treatment. Objective: This study aims to investigate the effects of regular exercise therapy using dance videos on the BP of patients with hypertension, with the goal of providing a reference for prescribing exercise therapy that is highly feasible in clinical settings. Methods: This nonblind, double-arm, randomized controlled trial was conducted at Juntendo University, Tokyo, from April to December 2023. A total of 40 patients with hypertension were randomly assigned to either an intervention group (dance) or a control group (self-selected exercise), with each group comprising 20 participants. The intervention group performed daily dance exercises using street dance videos (10 min per video) uploaded to YouTube. The control group was instructed to choose any exercise other than dance and perform it for 10 minutes each day. The activity levels of the participants were monitored using a triaxial accelerometer. BP and body composition were measured on the day of participation and after 2 months. During the intervention period, we did not provide exercise instruction or supervise participants' activities. Results: A total of 34 patients were included in the study (16 in the intervention group and 18 in the control group). The exclusion criteria were the absence of BP data, medication changes, or withdrawal from the study. The mean age was 56 (SD 9.8) years, and 18 (53\%) of the patients were female. The mean BMI was 28.0 (SD 6.3) m/kg2, and systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 139.5 (SD 17.1) mm Hg and 85.8 (SD 9.1) mm Hg, respectively. The basic characteristics did not differ between the two groups. In the multivariate analysis, SBP and DBP improved significantly in the intervention group compared to the control group (mean SBP --12.8, SD 6.1 mm Hg; P=.047; mean DBP --9.7, SD 3.3 mm Hg; P=.006). Conclusions: This study evaluated the effects of dance exercise on patients with hypertension, as previously verified, under the additional condition of using dance videos without direct staff instruction or supervision. The results showed that dance videos were more effective in lowering BP than conventional exercise prescriptions. Trial Registration: University Hospital Medical Information Network UMIN 000051251; https://center6.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000058446 ", doi="10.2196/65981", url="https://cardio.jmir.org/2025/1/e65981" } @Article{info:doi/10.2196/65611, author="Borrowman, D. Jaclyn and Carr, J. Lucas and Pierce, L. Gary and Story, T. William and Gibbs, Barone Bethany and Whitaker, M. Kara", title="Postpartum Remote Health Coaching Intervention for Individuals With a Hypertensive Disorder of Pregnancy: Proof-of-Concept Study", journal="JMIR Form Res", year="2025", month="Jan", day="8", volume="9", pages="e65611", keywords="cardiovascular disease", keywords="postpartum", keywords="hypertensive disorders of pregnancy", keywords="intervention", keywords="physical activity intervention", keywords="proof-of-concept", keywords="cardiovascular health", keywords="CVD risk", keywords="cardiovascular disease risk", keywords="feasibility", keywords="acceptability", keywords="health coaching", keywords="women's health", keywords="postnatal", abstract="Background: Cardiovascular disease (CVD) is the leading cause of death among women in America. Hypertensive disorders of pregnancy (HDP) negatively impact acute and long-term cardiovascular health, with approximately 16\% of all pregnancies affected. With CVD 2?4 times more likely after HDP compared to normotensive pregnancies, effective interventions to promote cardiovascular health are imperative. Objective: With postpartum physical activity (PA) interventions after HDP as an underexplored preventative strategy, we aimed in this study to assess (1) the feasibility and acceptability of a remotely delivered PA intervention for individuals with HDP 3?6 months postpartum and (2) changes in average steps per day, skills related to PA behavior, and postpartum blood pressure (BP). Methods: A remotely delivered 14-week health coaching intervention was designed based on prior formative work. The health coaching intervention called the Hypertensive Disorders of Pregnancy Postpartum Exercise (HyPE) intervention was tested for feasibility and acceptability with a single-arm proof-of-concept study design. A total of 19 women who were 3?6 months postpartum HDP; currently inactive; 18 years of age or older; resided in Iowa; and without diabetes, kidney disease, and CVD were enrolled. Feasibility was assessed by the number of sessions attended and acceptability by self-reported satisfaction with the program. Changes in steps achieved per day were measured with an activPAL4 micro, PA behavior skills via validated surveys online, and BP was assessed remotely with a research-grade Omron Series 5 (Omron Corporation) BP monitor. Results: Participants at enrollment were on average 30.3 years of age, 4.1 months postpartum, self-identified as non-Hispanic White (14/17, 82\%), in a committed relationship (16/17, 94\%), and had a bachelor's degree (9/17, 53\%). A total of 140 of 152 possible health coaching sessions were attended by those who started the intervention (n=19, 92\%). Intervention completers (n=17) indicated they were satisfied with the program (n=17, 100\%) and would recommend it to others (n=17, 100\%). No significant changes in activPAL measured steps were observed from pre- to posttesting (mean 138.40, SD 129.40 steps/day; P=.75). Significant improvements were observed in PA behavior skills including planning (mean 5.35, SD 4.97 vs mean 15.06, SD 3.09; P<.001) and monitoring of PA levels (mean 7.29, SD 3.44 vs mean 13.00, SD 2.45; P<.001). No significant decreases were observed for systolic (mean --1.28, SD 3.59 mm Hg; Hedges g=--0.26; P=.16) and diastolic BP (mean --1.80, SD 5.03 mm Hg; Hedges g=--0.44; P=.12). Conclusions: While PA behaviors did not change, the intervention was found to be feasible and acceptable among this sample of at-risk women. After additional refinement, the intervention should be retested among a larger, more diverse, and less physically active sample. Trial Registration: ClinicalTrials.gov NCT06019715; https://clinicaltrials.gov/study/NCT06019715 ", doi="10.2196/65611", url="https://formative.jmir.org/2025/1/e65611" } @Article{info:doi/10.2196/50627, author="Lolak, Sermkiat and Attia, John and McKay, J. Gareth and Thakkinstian, Ammarin", title="Application of Dragonnet and Conformal Inference for Estimating Individualized Treatment Effects for Personalized Stroke Prevention: Retrospective Cohort Study", journal="JMIR Cardio", year="2025", month="Jan", day="8", volume="9", pages="e50627", keywords="stroke", keywords="causal effect", keywords="ITE", keywords="individual treatment effect", keywords="Dragonnet", keywords="conformal inference", keywords="mortality", keywords="hospital records", keywords="hypertension", keywords="risk factor", keywords="diabetes", keywords="dyslipidemia", keywords="atrial fibrillation", keywords="machine learning", keywords="treatment", abstract="Background: Stroke is a major cause of death and disability worldwide. Identifying individuals who would benefit most from preventative interventions, such as antiplatelet therapy, is critical for personalized stroke prevention. However, traditional methods for estimating treatment effects often focus on the average effect across a population and do not account for individual variations in risk and treatment response. Objective: This study aimed to estimate the individualized treatment effects (ITEs) for stroke prevention using a novel combination of Dragonnet, a causal neural network, and conformal inference. The study also aimed to determine and validate the causal effects of known stroke risk factors---hypertension (HT), diabetes mellitus (DM), dyslipidemia (DLP), and atrial fibrillation (AF)---using both a conventional causal model and machine learning models. Methods: A retrospective cohort study was conducted using data from 275,247 high-risk patients treated at Ramathibodi Hospital, Thailand, between 2010 and 2020. Patients aged >18 years with HT, DM, DLP, or AF were eligible. The main outcome was ischemic or hemorrhagic stroke, identified using International Classification of Diseases, 10th Revision (ICD-10) codes. Causal effects of the risk factors were estimated using a range of methods, including: (1) propensity score--based methods, such as stratified propensity scores, inverse probability weighting, and doubly robust estimation; (2) structural causal models; (3) double machine learning; and (4) Dragonnet, a causal neural network, which was used together with weighted split-conformal quantile regression to estimate ITEs. Results: AF, HT, and DM were identified as significant stroke risk factors. Average causal risk effect estimates for these risk factors ranged from 0.075 to 0.097 for AF, 0.017 to 0.025 for HT, and 0.006 to 0.010 for DM, depending on the method used. Dragonnet yielded causal risk ratios of 4.56 for AF, 2.44 for HT, and 1.41 for DM, which is comparable to other causal models and the standard epidemiological case-control study. Mean ITE analysis indicated that several patients with DM or DM with HT, who were not receiving antiplatelet treatment at the time of data collection, showed reductions in total risk of ?0.015 and ?0.016, respectively. Conclusions: This study provides a comprehensive evaluation of stroke risk factors and demonstrates the feasibility of using Dragonnet and conformal inference to estimate ITEs of antiplatelet therapy for stroke prevention. The mean ITE analysis suggested that those with DM or DM with HT, who were not receiving antiplatelet treatment at the time of data collection, could potentially benefit from this therapy. The findings highlight the potential of these advanced techniques to inform personalized treatment strategies for stroke, enabling clinicians to identify individuals who are most likely to benefit from specific interventions. ", doi="10.2196/50627", url="https://cardio.jmir.org/2025/1/e50627" } @Article{info:doi/10.2196/58686, author="Qin, Chenlong and Peng, Li and Liu, Yun and Zhang, Xiaoliang and Miao, Shumei and Wei, Zhiyuan and Feng, Wei and Zhang, Hongjian and Wan, Cheng and Yu, Yun and Lu, Shan and Huang, Ruochen and Zhang, Xin", title="Development and Validation of a Nomogram-Based Model to Predict Primary Hypertension Within the Next Year in Children and Adolescents: Retrospective Cohort Study", journal="J Med Internet Res", year="2024", month="Dec", day="30", volume="26", pages="e58686", keywords="independent risk factors", keywords="prediction model", keywords="primary hypertension", keywords="clinical applicability", keywords="development", keywords="validation", keywords="pediatrics", keywords="electronic health records", abstract="Background: Primary hypertension (PH) poses significant risks to children and adolescents. Few prediction models for the risk of PH in children and adolescents currently exist, posing a challenge for doctors in making informed clinical decisions. Objective: This study aimed to investigate the incidence and risk factors of PH in Chinese children and adolescents. It also aimed to establish and validate a nomogram-based model for predicting the next year's PH risk. Methods: A training cohort (n=3938, between January 1, 2008, and December 31, 2020) and a validation cohort (n=1269, between January 1, 2021, and July 1, 2023) were established for model training and validation. An independent cohort of 576 individuals was established for external validation of the model. The result of the least absolute shrinkage and selection operator regression technique was used to select the optimal predictive features, and multivariate logistic regression to construct the nomogram. The performance of the nomogram underwent assessment and validation through the area under the receiver operating characteristic curve, concordance index, calibration curves, decision curve analysis, clinical impact curves, and sensitivity analysis. Results: The PH risk factors that we have ultimately identified include gender (odds ratio [OR] 3.34, 95\% CI 2.88 to 3.86; P<.001), age (OR 1.11, 95\% CI 1.08 to 1.14; P<.001), family history of hypertension (OR 42.74, 95\% CI 23.07 to 79.19; P<.001), fasting blood glucose (OR 6.07, 95\% CI 4.74 to 7.78; P<.001), low-density lipoprotein cholesterol (OR 2.03, 95\% CI 1.60 to 2.57; P<.001), and uric acid (OR 1.01, 95\% CI 1.01 to 1.01; P<.001), while factor breastfeeding (OR 0.04, 95\% CI 0.03 to 0.05; P<.001) has been identified as a protective factor. Subsequently, a nomogram has been constructed incorporating these factors. Areas under the receiver operating characteristic curves of the nomogram were 0.892 in the training cohort, 0.808 in the validation cohort, and 0.790 in the external validation cohort. Concordance indexes of the nomogram were 0.892 in the training cohort, 0.808 in the validation cohort, and 0.790 in the external validation cohort. The nomogram has been proven to have good clinical benefits and stability in calibration curves, decision curve analysis, clinical impact curves, and sensitivity analysis. Finally, we observed noteworthy differences in uric acid levels and family history of hypertension among various subgroups, demonstrating a high correlation with PH. Moreover, the web-based calculator of the nomogram was built online. Conclusions: We have developed and validated a stable and reliable nomogram that can accurately predict PH risk within the next year among children and adolescents in primary care and offer effective and cost-efficient support for clinical decisions for the risk prediction of PH. ", doi="10.2196/58686", url="https://www.jmir.org/2024/1/e58686" } @Article{info:doi/10.2196/56954, author="Eze, E. Chinwe and Dorsch, P. Michael and Coe, B. Antoinette and Lester, A. Corey and Buis, R. Lorraine and Farris, B. Karen", title="Behavioral Factors Related to Participation in Remote Blood Pressure Monitoring Among Adults With Hypertension: Cross-Sectional Study", journal="JMIR Form Res", year="2024", month="Dec", day="23", volume="8", pages="e56954", keywords="remote blood pressure monitoring", keywords="telemonitoring", keywords="hypertension", keywords="blood pressure", keywords="technology", keywords="health behaviors", keywords="quantitative", keywords="cross-sectional study", keywords="United States", keywords="lack of awareness", keywords="health information", keywords="health provider", keywords="electronic communication channels", keywords="adult", keywords="aging", keywords="mobile phone", abstract="Background: Remote blood pressure (BP) monitoring (RBPM) or BP telemonitoring is beneficial in hypertension management. People with hypertension involved in telemonitoring of BP often have better BP control than those in usual care. However, most reports on RBPM are from intervention studies. Objective: This study aimed to assess participant characteristics and technology health behaviors associated with RBPM participation in a wider population with hypertension. This study will help us understand the predictors of RBPM participation and consider how to increase it. Methods: This was a quantitative, cross-sectional survey study of people with hypertension in the United States. The inclusion criteria included people aged ?18 years with a hypertension diagnosis or who self-reported they have hypertension, had a prescription of at least one hypertension medication, understood the English language, and were willing to participate. The survey included demographics, technology health behaviors, and RBPM participation questions. The survey was self-administered on the Qualtrics platform and followed the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) checklist. The primary dependent variable was participation in RBPM. Results: In total, 507 people with hypertension participated in the survey. The mean age for all respondents was 60 (SD 14.7) years. The respondents were mostly female (306/507, 60.4\%), non-Hispanic (483/507, 95.3\%), and White (429/507, 84.6\%). A little over half of the respondents reported having had hypertension for 5 years or more (287/507, 56.6\%). About one-third of participants were aware of RBPM (165/507, 32.5\%), and 11.8\% (60/507) were enrolled in RBPM. The mean age of those engaging in RBPM and non-RBPM was 46.2 (SD 14.7) and 62 (SD 13.7) years, respectively. The most common reasons for not participating in RBPM were because their health provider did not ask the participant to participate (247/447, 55.3\%) and their lack of awareness of RBPM (190/447, 42.5\%). Most respondents in the RBPM group measure their BP at home (55/60, 91.7\%), and 61.7\% (37/60) engage in daily BP measurement, compared with 62.6\% (280/447) and 25.1\% (112/447), respectively, among the non-RBPM group. A greater number of those in the RBPM group reported tracking their BP measurements with mobile health (mHealth; 37/60, 61.7\%) than those in the non-RBPM group (70/447, 15.6\%). The electronic health records or patient portal was the most common channel of RBPM communication between the respondents and their health care providers. The significant predictors of participation in RBPM were RBPM awareness (adjusted odds ratio [AOR] 34.65, 95\% CI 11.35?150.31; P<.001) and sharing health information electronically with a health provider (AOR 4.90, 95\% CI 1.39?21.64; P=.01) among all participants. However, the significant predictor of participation in RBPM among participants who were aware of RBPM was sharing health information electronically with a health provider (AOR 6.99, 95\% CI 1.62?47.44; P=.007). Conclusions: Participation in RBPM is likely to increase with increased awareness, health providers' recommendations, and tailoring RBPM services to patients' preferred electronic communication channels. ", doi="10.2196/56954", url="https://formative.jmir.org/2024/1/e56954" } @Article{info:doi/10.2196/63685, author="Foti, Kathryn and Hubbard, Demetria and Smith, A. Kimberly and Hearld, Larry and Richman, Joshua and Horton, Trudi and Parker, Sharon and Roughton, Dodey and Craft, Macie and Clarkson, A. Stephen and Jackson, A. Elizabeth and Cherrington, L. Andrea", title="Improving Blood Pressure Control and Tobacco Use Cessation Intervention In Primary Care: Protocol for the Alabama Cardiovascular Cooperative Heart Health Improvement Project", journal="JMIR Res Protoc", year="2024", month="Dec", day="20", volume="13", pages="e63685", keywords="hypertension", keywords="primary care", keywords="quality improvement", keywords="tobacco use", keywords="smoking cessation", keywords="healthcare quality", keywords="quality of care", keywords="risk modification", keywords="cardiovascular disease prevention", abstract="Background: Alabama has the second highest rate of cardiovascular disease (CVD) mortality of any US state and a high prevalence of CVD risk factors such as hypertension, diabetes, obesity, and smoking. Within the state, there are disparities in CVD outcomes and risk factors by race or ethnicity and geography. Many primary care practices do not have the capacity for full-scale quality improvement (QI) initiatives. The Alabama Cardiovascular Cooperative (ALCC), which includes academic and community stakeholders, was formed to support primary care practices to implement QI initiatives to improve cardiovascular health. The ALCC is implementing a Heart Health Improvement Project (HHIP) in primary care practices with suboptimal rates of blood pressure (BP) control and tobacco use screening. Objective: The study aimed to support primary care practices to increase BP control among adults with hypertension and increase rates of tobacco use screening and cessation intervention. Methods: We are using a type 1 hybrid design to test the effects of the HHIP on BP control among adults with hypertension and tobacco use screening and cessation intervention, while collecting information on implementation. Primary care practices were recruited through existing practice networks and additional electronic and in-person outreach. To ensure participation from a broad range of clinics, we required at least 50\% of practices to be Federally Qualified Health Centers or look-alikes and to include representation from practices in rural areas. At baseline, we collected information about practice characteristics and preintervention rates of BP control and tobacco use screening and cessation intervention. The QI intervention includes quarterly activities conducted over a 12-month period. The HHIP uses a multipronged approach to QI, including practice facilitation and technical assistance, on-site and e-learning, and improvement through data transparency. We will conduct a pre-post analysis to estimate the effects of the HHIP and whether there is an enduring change in outcomes after the 12 months of HHIP activities beyond what would be expected due to secular trends. Results: Practice recruitment took place between April 2021 and October 2022. After contacting 417 primary care practices, 51 were enrolled, including 28 Federally Qualified Health Centers or look-alikes; 47 practices implemented the HHIP. Among 45 practices that completed the baseline survey, 11 (24\%) were solo practices, while 28 (62\%) had 1-5 clinicians, and 6 (13\%) had 6 or more clinicians. The median number of patient visits per year was 5819 (IQR 3707.3-8630.5). Practices had been in operation for a mean of 19.2 (SD 13.0) years. At baseline, the mean BP control rate was 49.6\% and the rate of tobacco use screening and cessation intervention was 67.4\%. Conclusions: If successful, the ALCC and HHIP may improve the implementation of evidence-based guidelines in primary care and, subsequently, cardiovascular health and health equity in the state of Alabama. International Registered Report Identifier (IRRID): DERR1-10.2196/63685 ", doi="10.2196/63685", url="https://www.researchprotocols.org/2024/1/e63685" } @Article{info:doi/10.2196/53430, author="Richardson, Leanne and Noori, Nihal and Fantham, Jack and Timlin, Gregor and Siddle, James and Godec, Thomas and Taylor, Mike and Baum, Charles", title="Personalized Smartphone-Enabled Assessment of Blood Pressure and Its Treatment During the SARS-CoV-2 COVID-19 Pandemic in Patients From the CURE-19 Study: Longitudinal Observational Study", journal="JMIR Mhealth Uhealth", year="2024", month="Dec", day="3", volume="12", pages="e53430", keywords="digital diary", keywords="hypertension", keywords="blood pressure", keywords="remote monitoring", keywords="smartphone app", keywords="mobile phone", keywords="app", keywords="monitoring", keywords="COVID-19", keywords="SARS-CoV-2", keywords="digital intervention", keywords="management", keywords="observational study", keywords="deployment", keywords="feasibility", keywords="use", keywords="safety", keywords="medication", keywords="symptoms", keywords="community", keywords="systolic", keywords="diastolic", keywords="utilization", abstract="Background: The use of digital interventions by patients for remote monitoring and management of health and disease is increasing. This observational study examined the feasibility, use, and safety of a digital smartphone app for routine monitoring of blood pressure (BP), medication, and symptoms of COVID-19 during the COVID-19 pandemic. Objective: The objective of this study was to deploy and test electronic data recording using a smartphone app developed for routine monitoring of BP in patients with primary hypertension. We tested the app for ease of data entry in BP management and tracking symptoms of new-onset COVID-19 to determine if participants found this app approach useful and sustainable. Methods: This remote, decentralized, 12-week, prospective, observational study was conducted in a community setting within the United States. Participants were approached and recruited from affiliated sites where they were enrolled in an ongoing remote decentralized study (CURE-19) of participants experiencing the COVID-19 pandemic. Potential participants were asked to complete a digital screener to determine eligibility and given informed consent forms to read and consent to using the Curebase digital platform. Following enrollment, participants downloaded the digital app to their smartphones for all data collection. Participants recorded daily BP, associated medication use, and emergent symptoms associated with SARS-CoV-2 infection. In addition, usability (adherence, acceptability, and user experience) was assessed using standard survey questions. Adverse events were collected based on participant self-report. Compliance and engagement were determined from user data entry rates. Feasibility and participant feedback were assessed upon study completion using the User Experience Questionnaire. Results: Of the 389 participants who enrolled in and completed the study, 380 (98\%) participants downloaded and entered BP routines in week 1. App engagement remained high; 239 (62.9\%) of the 380 participants remained in the study for the full 12-week observation period, and 201 (84.1\%) of the 239 participants entered full BP routines into the digital app 80\% or more of the time. The smartphone app scored an overall positive evaluation as assessed by the User Experience Questionnaire and was benchmarked as ``excellent'' for domains of perspicuity, efficiency, and dependability and ``above average'' for domains of attractiveness and stimulation. Highly adherent participants with hypertension demonstrated well-controlled BP, with no significant changes in average systolic or diastolic BP between week 1 and week 12 (all P>.05). Participants were able to record BP medications and symptoms of SARS-CoV-2 infection. No adverse events attributable to the use of the smartphone app were reported during the observational period. Conclusions: The high retention, engagement and acceptability and positive feedback in this study demonstrates that routine monitoring of BP and medications using a smartphone app is feasible for patients with hypertension in a community setting. Remote monitoring of BP and data collection could be coupled with hypertensive medication in a combination product (drug+digital) for precision management of hypertension. ", doi="10.2196/53430", url="https://mhealth.jmir.org/2024/1/e53430" } @Article{info:doi/10.2196/54127, author="Nong, Thu Trang Thi and Nguyen, Hoang Giang and Lepe, Alexander and Tran, Bich Thuy and Nguyen, Phuong Lan Thi and Koot, R. Jaap A.", title="Challenges and Opportunities in Digital Screening for Hypertension and Diabetes Among Community Groups of Older Adults in Vietnam: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Dec", day="2", volume="26", pages="e54127", keywords="NCD screening", keywords="DHIS2 tracker", keywords="District Health Information Software, version 2 tracker", keywords="digital application", keywords="ISHC health volunteers", keywords="non-communicable diseases", keywords="prevention", keywords="Vietnam", keywords="mobile phone", abstract="Background: The project of scaling up noncommunicable disease (NCD) interventions in Southeast Asia aimed to strengthen the prevention and control of hypertension and diabetes, focusing on primary health care and community levels. In Vietnam, health volunteers who were members of the Intergenerational Self-Help Clubs (ISHCs) implemented community-based NCD screening and health promotion activities in communities. The ISHC health volunteers used an app based on District Health Information Software, version 2 (DHIS2) tracker (Society for Health Information Systems Programmes, India) to record details of participants during screening and other health activities. Objective: This study aimed to assess the strengths, barriers, and limitations of the NCD screening app used by the ISHC health volunteers on tablets and to provide recommendations for further scaling up. Methods: A mixed methods observational study with a convergent parallel design was performed. For the quantitative data analysis, 2 rounds of screening data collected from all 59 ISHCs were analyzed on completeness and quality. For the qualitative analysis, 2 rounds of evaluation of the screening app were completed. Focus group discussions with ISHC health volunteers and club management boards and in-depth interviews with members of the Association of the Elderly and Commune Health Station staff were performed. Results: In the quantitative analysis, data completeness of all 6704 screenings (n=3485 individuals) was very high. For anthropomorphic measurements, such as blood pressure, body weight, and abdominal circumference, less than 1\% errors were found. The data on NCD risk factors were not adequately recorded in 1908 (29.5\%) of the screenings. From the qualitative analysis, the NCD screening app was appreciated by ISHC health volunteers and supervisors, as an easier and more efficient way to report to higher levels, secure data, and strengthen relationships with relevant stakeholders, using tablets to connect to the internet and internet-based platforms to access information for self-learning and sharing to promote a healthy lifestyle as the strengths. The barriers and limitations reported by the respondents were a non--age-friendly app, incomplete translation of parts of the app into Vietnamese, some issues with the tablet's display, lack of sharing of responsibilities among the health volunteers, and suboptimal involvement of the health sector; limited digital literacy among ISHC health volunteers. Recommendations are continuous capacity building, improving app issues, improving tablet issues, and involving relevant stakeholders or younger members in technology adoption to support older people. Conclusions: The implementation of the NCD screening app by ISHC volunteers can be an effective way to improve community-led NCD screening and increase the uptake of NCD prevention and management services at the primary health care level. However, our study has shown that some barriers need to be addressed to maximize the efficient use of the app by ISHC health volunteers to record, report, and manage the screening data. ", doi="10.2196/54127", url="https://www.jmir.org/2024/1/e54127" } @Article{info:doi/10.2196/52266, author="Matsumura, Koichiro and Nakagomi, Atsushi and Yagi, Eijiro and Yamada, Nobuhiro and Funauchi, Yohei and Kakehi, Kazuyoshi and Yoshida, Ayano and Kawamura, Takayuki and Ueno, Masafumi and Nakazawa, Gaku and Tabuchi, Takahiro", title="Impact of an mHealth App (Kencom) on Patients With Untreated Hypertension Initiating Antihypertensive Medications: Real-World Cohort Study", journal="JMIR Cardio", year="2024", month="Nov", day="26", volume="8", pages="e52266", keywords="untreated hypertension", keywords="mobile health app", keywords="antihypertensive medication", keywords="cardiovascular disease", keywords="mHealth", abstract="Background: To prevent the further development of cardiovascular diseases, it is a growing global priority to detect untreated hypertension in patients and ensure adequate blood pressure control via drug therapy. However, few effective tools that facilitate the initiation of antihypertensive medications among such patients have been identified. Objective: We aimed to determine whether a mobile health (mHealth) app facilitates the initiation of antihypertensive medications among patients with untreated hypertension. Methods: We analyzed a large longitudinal integrated database mainly comprised of data from middle-aged, employed people and their families. The database contained data from health checkups, health insurance claims, and the mHealth app kencom. kencom is used to manage daily life logs (eg, weight, number of steps) and to provide health information tailored to customers. Patients with untreated hypertension were identified using the baseline health checkup data, and follow-up health checkups were conducted to identify the rate of initiation of antihypertensive medications between mHealth app users and nonusers. Antihypertensive medication status was confirmed via a questionnaire administered during the medical checkup as well as a review of the health insurance claims database. We conducted a modified Poisson regression analysis, weighted by inverse probability of treatment weighting, to examine the effect of mHealth app usage on the initiation of antihypertensive medications. Additionally, data from four lifestyle questionnaires from the baseline and follow-up health checkups were collected to evaluate lifestyle modifications that could be attributed to the mHealth app. Results: Data were collected from 50,803 eligible patients (mean age 49, SD 9 years; men n=39,412, 77.6\%; women n=11,391, 22.4\%) with a median follow-up period of 3.0 (IQR 2.3?3.1) years. The rate of initiation of antihypertensive medications was significantly higher in the mHealth app user group than in the nonuser group: 23.4\% (3482/14,879) versus 18.5\% (6646/35,924; P<.001), respectively. The risk ratio of mHealth app usage for initiated antihypertensive medications was 1.28 (95\% CI 1.23?1.33). Among those who did not intend to improve their lifestyle habits such as exercise and diet at baseline, the rate of lifestyle improvement at follow-up was compared between mHealth app users and nonusers, using data from the questionnaires; mHealth app users demonstrated a significantly higher rate of lifestyle changes than nonusers. Conclusions: For patients with untreated hypertension, the use of the mHealth app kencom, which was not dedicated to hypertension treatment, was associated with a higher initiation of antihypertensive medications. ", doi="10.2196/52266", url="https://cardio.jmir.org/2024/1/e52266" } @Article{info:doi/10.2196/54357, author="Cavero-Redondo, Iv{\'a}n and Martinez-Rodrigo, Arturo and Saz-Lara, Alicia and Moreno-Herraiz, Nerea and Casado-Vicente, Veronica and Gomez-Sanchez, Leticia and Garcia-Ortiz, Luis and Gomez-Marcos, A. Manuel and ", title="Antihypertensive Drug Recommendations for Reducing Arterial Stiffness in Patients With Hypertension: Machine Learning--Based Multicohort (RIGIPREV) Study", journal="J Med Internet Res", year="2024", month="Nov", day="25", volume="26", pages="e54357", keywords="antihypertensive", keywords="drugs", keywords="models", keywords="patients", keywords="pulse wave velocity", keywords="recommendations", keywords="hypertension", keywords="machine learning", keywords="drug recommendations", keywords="arterial stiffness", keywords="RIGIPREV", abstract="Background: High systolic blood pressure is one of the leading global risk factors for mortality, contributing significantly to cardiovascular diseases. Despite advances in treatment, a large proportion of patients with hypertension do not achieve optimal blood pressure control. Arterial stiffness (AS), measured by pulse wave velocity (PWV), is an independent predictor of cardiovascular events and overall mortality. Various antihypertensive drugs exhibit differential effects on PWV, but the extent to which these effects vary depending on individual patient characteristics is not well understood. Given the complexity of selecting the most appropriate antihypertensive medication for reducing PWV, machine learning (ML) techniques offer an opportunity to improve personalized treatment recommendations. Objective: This study aims to develop an ML model that provides personalized recommendations for antihypertensive medications aimed at reducing PWV. The model considers individual patient characteristics, such as demographic factors, clinical data, and cardiovascular measurements, to identify the most suitable antihypertensive agent for improving AS. Methods: This study, known as the RIGIPREV study, used data from the EVA, LOD-DIABETES, and EVIDENT studies involving individuals with hypertension with baseline and follow-up measurements. Antihypertensive drugs were grouped into classes such as angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), $\beta$-blockers, diuretics, and combinations of diuretics with ACEIs or ARBs. The primary outcomes were carotid-femoral and brachial-ankle PWV, while the secondary outcomes included various cardiovascular, anthropometric, and biochemical parameters. A multioutput regressor using 6 random forest models was used to predict the impact of each antihypertensive class on PWV reduction. Model performance was evaluated using the coefficient of determination (R2) and mean squared error. Results: The random forest models exhibited strong predictive capabilities, with internal validation yielding R2 values between 0.61 and 0.74, while external validation showed a range of 0.26 to 0.46. The mean squared values ranged from 0.08 to 0.22 for internal validation and from 0.29 to 0.45 for external validation. Variable importance analysis revealed that glycated hemoglobin and weight were the most critical predictors for ACEIs, while carotid-femoral PWV and total cholesterol were key variables for ARBs. The decision tree model achieved an accuracy of 84.02\% in identifying the most suitable antihypertensive drug based on individual patient characteristics. Furthermore, the system's recommendations for ARBs matched 55.3\% of patients' original prescriptions. Conclusions: This study demonstrates the utility of ML techniques in providing personalized treatment recommendations for antihypertensive therapy. By accounting for individual patient characteristics, the model improves the selection of drugs that control blood pressure and reduce AS. These findings could significantly aid clinicians in optimizing hypertension management and reducing cardiovascular risk. However, further studies with larger and more diverse populations are necessary to validate these results and extend the model's applicability. ", doi="10.2196/54357", url="https://www.jmir.org/2024/1/e54357", url="http://www.ncbi.nlm.nih.gov/pubmed/39585738" } @Article{info:doi/10.2196/63144, author="Zhang, Xiaoyun and Wang, Siyu and Yang, Qianqian and Zheng, Ruizhi and Wang, Long and Lin, Hong and Wang, Shuangyuan and Li, Mian and Wang, Tiange and Zhao, Zhiyun and Lu, Jieli and Xu, Min and Chen, Yuhong and Zheng, Jie and Dai, Meng and Zhang, Di and Wang, Weiqing and Ning, Guang and Bi, Yufang and Xu, Yu", title="Sex Difference and Socioeconomic Inequity in Chinese People With Hypertension: National Cross-Sectional Survey Study", journal="JMIR Public Health Surveill", year="2024", month="Nov", day="20", volume="10", pages="e63144", keywords="sex difference", keywords="socioeconomic inequity", keywords="blood pressure", keywords="hypertension", keywords="cross-sectional survey", abstract="Background: Sex differences in blood pressure (BP) levels and hypertension are important and the role of socioeconomic status (SES) in sex differences in hypertension remains unclear. Objective: This study aimed to evaluate the impact of SES on sex differences of hypertension in a nationally representative survey study. Methods: A total of 98,658 participants aged ?18 years who have lived in their current residence for ?6 months were recruited from 162 study sites across mainland China. Sex was self-reported. Individual-level SES included the highest level of education and annual household income. Area-level SES included economic development status, urban/rural residency, and north/south location. Outcomes included levels of systolic and diastolic BP, and hypertension. Linear and Cox regression models were used to examine the associations between sex (women vs men) and BP characteristics stratified by individual or combined SES indicators. Results: Systolic and diastolic BP levels and the prevalence of hypertension were higher in men than in women. This sex difference was found across categories of SES with widened sex disparities in participants having more favorable SES. Significant multiplicative interaction effects of SES on the association of sex with BP characteristics were found. Women with improving SES were associated with lower BP and hypertension prevalence compared to men. For combined SES, a 9\% (prevalence ratio 0.91, 95\% CI 0.83-0.98) and a 30\% lower probability (prevalence ratio 0.70, 95\% CI 0.63-0.78) of having hypertension were found in women with an overall intermediate SES and high SES, respectively, compared to those with low SES, while no significant reduction was found in men. Conclusions: There are significant sex differences in BP characteristics and SES has a potent impact on the disparities. Sex-specific public health policies to alleviate socioeconomic inequalities, especially in women are important for the prevention of hypertension. ", doi="10.2196/63144", url="https://publichealth.jmir.org/2024/1/e63144" } @Article{info:doi/10.2196/60037, author="Alnooh, Ghadah and AlTamimi, Z. Jozaa and Williams, A. Elizabeth and Hawley, S. Mark", title="An Investigation of the Feasibility and Acceptability of Using a Commercial DASH (Dietary Approaches to Stop Hypertension) App in People With High Blood Pressure: Mixed Methods Study", journal="JMIR Form Res", year="2024", month="Nov", day="19", volume="8", pages="e60037", keywords="hypertension", keywords="blood pressure", keywords="Dietary Approaches to Stop Hypertension", keywords="DASH diet", keywords="self-efficacy", keywords="mobile health", keywords="mHealth", keywords="Saudi Arabia", keywords="mobile phone", abstract="Background: The use of smartphone apps for dietary self-management among patients with high blood pressure is becoming increasingly common. Few commercially available DASH (Dietary Approaches to Stop Hypertension) diet apps have the potential to be effective, and only a few of these have adequate security and privacy measures. In previous studies, we identified 2 high-quality apps that are likely effective and safe. One of these, the Noom app, was selected as the most suitable app for use in the Saudi Arabian context based on health care professionals' and patients' preferences. Objective: This study aims to determine the feasibility and acceptability of using the Noom app to support DASH diet self-management among people with high blood pressure in Saudi Arabia. Methods: This mixed methods study evaluated the feasibility and acceptability of using the Noom app among people with high blood pressure in Riyadh, Saudi Arabia. Fourteen participants with high blood pressure were recruited and asked to use the app for 8 weeks. The quantitative outcome measures were DASH diet adherence and self-efficacy. Feasibility and acceptability were assessed during and after the intervention via the Noom diet-tracking engagement questionnaire, the System Usability Scale, and semistructured interviews. Results: Most participants (8/13, 62\%) logged their meals for 3 to 5 days a week; the frequency of logging increased over time. Snacks were the foods they most often forgot to log. The interviews revealed four main themes: (1) acceptance, (2) app usability, (3) technical issues, and (4) suggestions for improvement. Most participants found the Noom app acceptable, and most had no difficulties integrating it into their daily routines. The results of this feasibility study provided insights into the app's educational content, some of which was deemed unsuitable for Saudi Arabian users. App usability was identified as a critical theme: the app and its database were easy to use, convenient, and valuable to most of the participants. Despite this, some of the participants reported difficulties in identifying some foods because of a lack of local options on the app. Technical issues included the app freezing or responding slowly. Most participants also?suggested developing an Arabic version of the app and simplifying the method of food logging.?The participants showed some improvement in self-efficacy and adherence to the DASH diet, although these improvements were not statistically significant. The mean self-efficacy score increased from 18 (SD 4.7) to 20 (SD 6.3), and the mean DASH diet score increased from 3.4 (SD 1.4) to 4.3 (SD 1.1). Conclusions: The app was feasible and acceptable among the participants who completed the study. Further studies are needed to examine the potential of smartphone apps in promoting adherence to the DASH diet and their impact on blood pressure among individuals with hypertension in Saudi Arabia. ", doi="10.2196/60037", url="https://formative.jmir.org/2024/1/e60037" } @Article{info:doi/10.2196/57931, author="Sattora, Emily and Teelin, Karen and Prendergast, Christopher and Smith, Abigail and Evans, James and Imdad, Aamer", title="Clinical and Biochemical Outcomes in Transgender Individuals Undergoing Hormone Therapy: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2024", month="Nov", day="12", volume="13", pages="e57931", keywords="transgender", keywords="lipid levels", keywords="hormone therapy", keywords="biochemical outcomes", keywords="clinical outcomes", keywords="comprehensive data", keywords="systematic review", keywords="meta-analysis", keywords="adolescent", keywords="adults", keywords="electronic databases", keywords="testosterone", keywords="estrogen", abstract="Background: Monitoring of various clinical outcomes and parameters, such as lipid levels, is recommended in transgender individuals undergoing hormone therapies. However, comprehensive data to inform these recommendations is scarce. Objective: This study aims to conduct a systematic review and meta-analysis to synthesize evidence from existing literature on the effect of exogenous hormone therapy on clinical and biochemical outcomes for transgender adolescents and adults. Methods: We will search multiple electronic databases and will include prospective and retrospective observational studies with and without a control group. The study population will include transgender individuals undergoing hormone therapy with testosterone or estrogen. Comparisons will include age-matched, cisgender individuals and changes from baseline. Primary outcomes include changes in or the development of abnormal lipid parameters. Secondary outcomes include BMI, weight, height, and blood pressure for age, serum testosterone or estrogen levels, and development of disease including hypertension, diabetes, fatty liver disease, obesity, adverse cardiac events, as well as all-cause mortality. The meta-analysis will pool the studies where applicable, and meta-regressions will be conducted to evaluate effect modifiers. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach will be used to evaluate the overall certainty of evidence. Results: We will summarize the selection of the eligible studies using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The results will be presented in a table summarizing the evidence. Data collection is ongoing, and the paper is expected to be published in Spring 2025. Conclusions: This systematic review will summarize and evaluate the evidence of the clinical and biochemical outcomes associated with hormone therapies for transgender individuals. Trial Registration: PROSPERO CRD42024483138; https://tinyurl.com/yc4sfvnb International Registered Report Identifier (IRRID): PRR1-10.2196/57931 ", doi="10.2196/57931", url="https://www.researchprotocols.org/2024/1/e57931" } @Article{info:doi/10.2196/52794, author="Hwang, Ha Seung and Lee, Hayeon and Lee, Hyuk Jun and Lee, Myeongcheol and Koyanagi, Ai and Smith, Lee and Rhee, Youl Sang and Yon, Keon Dong and Lee, Jinseok", title="Machine Learning--Based Prediction for Incident Hypertension Based on Regular Health Checkup Data: Derivation and Validation in 2 Independent Nationwide Cohorts in South Korea and Japan", journal="J Med Internet Res", year="2024", month="Nov", day="5", volume="26", pages="e52794", keywords="machine learning", keywords="hypertension", keywords="cardiovascular disease", keywords="artificial intelligence", keywords="cause of death", keywords="cardiovascular risk", keywords="predictive analytics", abstract="Background: Worldwide, cardiovascular diseases are the primary cause of death, with hypertension as a key contributor. In 2019, cardiovascular diseases led to 17.9 million deaths, predicted to reach 23 million by 2030. Objective: This study presents a new method to predict hypertension using demographic data, using 6 machine learning models for enhanced reliability and applicability. The goal is to harness artificial intelligence for early and accurate hypertension diagnosis across diverse populations. Methods: Data from 2 national cohort studies, National Health Insurance Service-National Sample Cohort (South Korea, n=244,814), conducted between 2002 and 2013 were used to train and test machine learning models designed to anticipate incident hypertension within 5 years of a health checkup involving those aged ?20 years, and Japanese Medical Data Center cohort (Japan, n=1,296,649) were used for extra validation. An ensemble from 6 diverse machine learning models was used to identify the 5 most salient features contributing to hypertension by presenting a feature importance analysis to confirm the contribution of each future. Results: The Adaptive Boosting and logistic regression ensemble showed superior balanced accuracy (0.812, sensitivity 0.806, specificity 0.818, and area under the receiver operating characteristic curve 0.901). The 5 key hypertension indicators were age, diastolic blood pressure, BMI, systolic blood pressure, and fasting blood glucose. The Japanese Medical Data Center cohort dataset (extra validation set) corroborated these findings (balanced accuracy 0.741 and area under the receiver operating characteristic curve 0.824). The ensemble model was integrated into a public web portal for predicting hypertension onset based on health checkup data. Conclusions: Comparative evaluation of our machine learning models against classical statistical models across 2 distinct studies emphasized the former's enhanced stability, generalizability, and reproducibility in predicting hypertension onset. ", doi="10.2196/52794", url="https://www.jmir.org/2024/1/e52794" } @Article{info:doi/10.2196/56869, author="Farapti, Farapti and Putri, Amara Sheila and Furqonia, Wulida Annisaa and Rejeki, Sri Purwo and Miftahussurur, Muhammad", title="High Potassium Diet Rich in Spices and Herbs-Salt Substitution (HPSH-SS) for Blood Pressure Reduction in Older Adults: Protocol for Diet Concept and Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Oct", day="29", volume="13", pages="e56869", keywords="sodium", keywords="potassium", keywords="spices and herbs", keywords="blood pressure", keywords="hypertension", keywords="elderly", keywords="vascular", keywords="kidney", keywords="gerontology", keywords="aging", keywords="protocol study", keywords="dietary", keywords="phytochemical", keywords="anti-hypertensive", keywords="Indonesia", keywords="molecular mechanism", keywords="control group", keywords="oxidative stress", abstract="Background: Hypertension increases with age, often due to high sodium (Na) and low potassium (K) intake. Reducing salt and increasing K intake is challenging, especially for older adults due to taste preferences. Culinary herbs and spices, rich in K, offer a potential solution. The High Potassium Diet Rich in Spices and Herbs-Salt Substitution (HPSH-SS) diet has not yet been studied for its effectiveness in lowering blood pressure. Objective: This study aims to create an HPSH-SS diet, analyze its effects on blood pressure in older adults, and study the molecular mechanism occurring in the kidneys and blood vessels influenced by this diet. Methods: This study consists of 2 phases. The first phase involved formulating and assessing the HPSH-SS diet tailored for older adults. The intervention group (IG) received a diet of 1800 kcal/day, with 3500 mg K and 1500 mg Na, while the control group (CG) received 1500 mg K and 2000 mg Na. The diet was administered for 14 days and standardized using the NutriSurvey program and biochemistry analysis by atomic absorbance spectrophotometry (AAS). The second phase was a 14-day parallel randomized controlled trial (RCT) with the older adult participants divided into IG and CG. Primary outcomes included blood pressure; serum potassium; aldosterone; F2 isoprostane; nitric oxide plasma levels; and urine analysis of Na, K, and the Na/K ratio. Confounding variables were controlled through randomization and stratified analysis. Results: The menu formulation and organoleptic assessment of the HPSH-SS diet began in mid-2022 and was approved by the Ethics Committee of the Faculty of Public Health at Universitas Airlangga (78/EA/KEPK/2022) on May 11, 2022. The diet was standardized to achieve daily nutritional values of 1800 kcal energy, 3500 mg K, and 1500 mg Na. K and Na contents were analyzed using AAS from several participants' spice diet menus. Recruitment for the RCT started in March 2023, with approval from the Health Research Ethics Committee Universitas Airlangga School of Medicine, Surabaya (35/EC/KEPK/FKUA/2023). The study was registered from February 9, 2023, to February 9, 2024. Between March and June 2023, 64 participants were recruited, with 32 participants in the IG and CG. The intervention and data collection will take place over 1 year. Data management is in progress, and data analysis is yet to be performed. Conclusions: This RCT protocol hypothesizes that the diet will increase serum K, plasma aldosterone, and nitric oxide levels; decrease plasma F2 isoprostane; increase urinary Na and K levels; lower the urinary Na/K ratio; and reduce systolic and diastolic blood pressure. If effective, it will offer valuable insights into dietary strategies for blood pressure regulation in older adults. International Registered Report Identifier (IRRID): DERR1-10.2196/56869 ", doi="10.2196/56869", url="https://www.researchprotocols.org/2024/1/e56869", url="http://www.ncbi.nlm.nih.gov/pubmed/39470696" } @Article{info:doi/10.2196/58732, author="Nguyen, Minh Hieu and Anderson, William and Chou, Shih-Hsiung and McWilliams, Andrew and Zhao, Jing and Pajewski, Nicholas and Taylor, Yhenneko", title="Predictive Models for Sustained, Uncontrolled Hypertension and Hypertensive Crisis Based on Electronic Health Record Data: Algorithm Development and Validation", journal="JMIR Med Inform", year="2024", month="Oct", day="28", volume="12", pages="e58732", keywords="machine learning", keywords="risk prediction", keywords="predictive model", keywords="decision support", keywords="blood pressure", keywords="cardiovascular", keywords="electronic health record", abstract="Background: Assessing disease progression among patients with uncontrolled hypertension is important for identifying opportunities for intervention. Objective: We aim to develop and validate 2 models, one to predict sustained, uncontrolled hypertension (?2 blood pressure [BP] readings ?140/90 mm Hg or ?1 BP reading ?180/120 mm Hg) and one to predict hypertensive crisis (?1 BP reading ?180/120 mm Hg) within 1 year of an index visit (outpatient or ambulatory encounter in which an uncontrolled BP reading was recorded). Methods: Data from 142,897 patients with uncontrolled hypertension within Atrium Health Greater Charlotte in 2018 were used. Electronic health record--based predictors were based on the 1-year period before a patient's index visit. The dataset was randomly split (80:20) into a training set and a validation set. In total, 4 machine learning frameworks were considered: L2-regularized logistic regression, multilayer perceptron, gradient boosting machines, and random forest. Model selection was performed with 10-fold cross-validation. The final models were assessed on discrimination (C-statistic), calibration (eg, integrated calibration index), and net benefit (with decision curve analysis). Additionally, internal-external cross-validation was performed at the county level to assess performance with new populations and summarized using random-effect meta-analyses. Results: In internal validation, the C-statistic and integrated calibration index were 0.72 (95\% CI 0.71?0.72) and 0.015 (95\% CI 0.012?0.020) for the sustained, uncontrolled hypertension model, and 0.81 (95\% CI 0.79?0.82) and 0.009 (95\% CI 0.007?0.011) for the hypertensive crisis model. The models had higher net benefit than the default policies (ie, treat-all and treat-none) across different decision thresholds. In internal-external cross-validation, the pooled performance was consistent with internal validation results; in particular, the pooled C-statistics were 0.70 (95\% CI 0.69?0.71) and 0.79 (95\% CI 0.78?0.81) for the sustained, uncontrolled hypertension model and hypertensive crisis model, respectively. Conclusions: An electronic health record--based model predicted hypertensive crisis reasonably well in internal and internal-external validations. The model can potentially be used to support population health surveillance and hypertension management. Further studies are needed to improve the ability to predict sustained, uncontrolled hypertension. ", doi="10.2196/58732", url="https://medinform.jmir.org/2024/1/e58732" } @Article{info:doi/10.2196/54978, author="Zhou, You and Li, Si-Jia and Huang, Ren-Qian and Ma, Hao-Ming and Wang, Ao-Qi and Tang, Xing-Yi and Pei, Run-Yuan and Piao, Mei-Hua", title="Behavior Change Techniques Used in Self-Management Interventions Based on mHealth Apps for Adults With Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials", journal="J Med Internet Res", year="2024", month="Oct", day="22", volume="26", pages="e54978", keywords="hypertension", keywords="mHealth", keywords="app", keywords="behavior change technique", keywords="systematic review", keywords="meta-analysis", keywords="mobile phone", abstract="Background: Hypertension has become an important global public health challenge. Mobile health (mHealth) intervention is a viable strategy to improve outcomes for patients with hypertension. However, evidence on the effect of mHealth app interventions on self-management in patients with hypertension is yet to be updated, and the active ingredients promoting behavior change in interventions remain unclear. Objective: We aimed to evaluate the effect of mHealth app self-management interventions on blood pressure (BP) management and investigate the use of behavior change techniques (BCTs) in mHealth app interventions. Methods: We conducted a literature search in 6 electronic databases from January 2009 to October 2023 for studies reporting the application of mHealth apps in self-management interventions. The Cochrane Risk of Bias (version 2) tool for randomized controlled trials was used to assess the quality of the studies. BCTs were coded according to the Taxonomy of BCTs (version 1). The extracted data were analyzed using RevMan5.4 software (Cochrane Collaboration). Results: We reviewed 20 studies, of which 16 were included in the meta-analysis. In total, 21 different BCTs (mean 8.7, SD 3.8 BCTs) from 12 BCT categories were reported in mHealth app interventions. The most common BCTs were self-monitoring of outcomes of behavior, feedback on outcomes of behavior, instruction on how to perform the behavior, and pharmacological support. The mHealth app interventions resulted in a --5.78 mm Hg (95\% CI --7.97 mm Hg to --3.59 mm Hg; P<.001) reduction in systolic BP and a --3.28 mm Hg (95\% CI --4.39 mm Hg to --2.17 mm Hg; P<.001) reduction in diastolic BP. The effect of interventions on BP reduction was associated with risk factors, such as hypertension, that were addressed by the mHealth app intervention (multiple risk factors vs a single risk factor: --6.50 mm Hg, 95\% CI --9.00 mm Hg to --3.99 mm Hg vs --1.54 mm Hg, 95\% CI --4.15 mm Hg to 1.06 mm Hg; P=.007); the presence of a theoretical foundation (with vs without behavior change theory: --10.06 mm Hg, 95\% CI --16.42 mm Hg to --3.70 mm Hg vs --4.13 mm Hg, 95\% CI --5.50 to --2.75 mm Hg; P=.07); intervention duration (3 vs ?6 months: --8.87 mm Hg, 95\% CI --10.90 mm Hg to --6.83 mm Hg vs --5.76 mm Hg, 95\% CI --8.74 mm Hg to --2.77 mm Hg; P=.09); and the number of BCTs (?11 vs <11 BCTs: --9.68 mm Hg, 95\% CI --13.49 mm Hg to --5.87 mm Hg vs --2.88 mm Hg, 95\% CI --3.90 mm Hg to --1.86 mm Hg; P<.001). Conclusions: The self-management interventions based on mHealth apps were effective strategies for lowering BP in patients with hypertension. The effect of interventions was influenced by factors related to the study's intervention design and BCT. ", doi="10.2196/54978", url="https://www.jmir.org/2024/1/e54978" } @Article{info:doi/10.2196/56162, author="Muehlensiepen, Felix and Bruch, Dunja and Seifert, Frances and Wengemuth, Eileen and Heinze, Martin and Spethmann, Sebastian and May, Susann", title="mHealth Apps for Hypertension Self-Management: Interview Study Among Patient-Users", journal="JMIR Form Res", year="2024", month="Sep", day="27", volume="8", pages="e56162", keywords="hypertension", keywords="mobile health", keywords="mHealth apps", keywords="digital health", keywords="patient perspective", keywords="qualitative study", keywords="cardiology", abstract="Background: Hypertension is a major risk factor for cardiovascular disease, affecting over a billion people worldwide. Mobile health (mHealth) apps have emerged as effective tools for managing hypertension, offering capabilities for monitoring blood pressure, fostering lifestyle changes, and improving treatment adherence. Objective: This study aimed to explore patient-users' perspectives on the hypertension care mHealth app Hypertension.APP, focusing on its accessibility, expected benefits, potential risks, and role in hypertension management in Germany. Methods: A qualitative study was conducted involving semistructured interviews with 20 patient-users of a hypertension care mHealth app, Hypertension.APP. Participants were recruited between January and June 2023 using purposive sampling. Verbatim transcripts were analyzed using qualitative content analysis. Results: Participants primarily discovered the app independently, driven by recent hypertension diagnoses and insufficient information from health care professionals regarding effective self-management strategies for their blood pressure. They valued the app for its continuous monitoring and feedback capabilities, aiding in understanding their condition and making lifestyle adjustments. Risks were perceived as minimal, mainly concerning data privacy and potential overreliance on the app. The app became integral to patient-users' hypertension management by offering consistent information and support. The integration into formal health care was limited, as patient-users felt that health care professionals did not accept the use of the technology or might have even felt intimidated to use it. Conclusions: Among the sample studied, mHealth apps like Hypertension.APP were valued for their continuous monitoring and educational content, aiding in hypertension management. The findings suggest potential benefits of mHealth apps for effective hypertension care among patients who are health- and digitally literate as well as self-effective. There is a critical need for better integration of these apps into routine health care practices, as perceived by the app users. Given the small and specific sample of this qualitative study, further quantitative research with a broader and more varied participant group is necessary to validate these findings. Trial Registration: Deutsches Register Klinischer Studien DRKS00029761; https://tinyurl.com/r33ru22s ", doi="10.2196/56162", url="https://formative.jmir.org/2024/1/e56162" } @Article{info:doi/10.2196/55261, author="Johar, Hamimatunnisa and Ang, Way Chiew and Ismail, Roshidi and Kassim, Zaid and Su, Tin Tin", title="Changes in 10-Year Predicted Cardiovascular Disease Risk for a Multiethnic Semirural Population in South East Asia: Prospective Study", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="26", volume="10", pages="e55261", keywords="cardiovascular risk trajectory", keywords="Framingham risk score", keywords="population-based study", keywords="low- and middle-income countries", abstract="Background: Cardiovascular disease (CVD) risk factors tend to cluster and interact multiplicatively and have been incorporated into risk equations such as the Framingham risk score, which can reasonably predict CVD over short- and long-term periods. Beyond risk factor levels at a single time point, recent evidence demonstrated that risk trajectories are differentially related to CVD risk. However, factors associated with suboptimal control or unstable CVD risk trajectories are not yet established. Objective: This study aims to examine factors associated with CVD risk trajectories in a semirural, multiethnic community-dwelling population. Methods: Data on demographic, socioeconomic, lifestyle, mental health, and cardiovascular factors were measured at baseline (2013) and during follow-up (2018) of the South East Asia Community Observatory cohort. The 10-year CVD risk change transition was computed. The trajectory patterns identified were improved; remained unchanged in low, moderate, or high CVD risk clusters; and worsened CVD risk trajectories. Multivariable regression analyses were used to examine the association between risk factors and changes in Framingham risk score and predicted CVD risk trajectory patterns with adjustments for concurrent risk factors. Results: Of the 6599 multiethnic community-dwelling individuals (n=3954, 59.92\% female participants and n=2645, 40.08\% male participants; mean age 55.3, SD 10.6 years), CVD risk increased over time in 33.37\% (n=2202) of the sample population, while 24.38\% (n=1609 remained in the high-risk trajectory pattern, which was reflected by the increased prevalence of all major CVD risk factors over the 5-year follow-up. Meanwhile, sex-specific prevalence data indicate that 21.44\% (n=567) of male and 41.35\% (n=1635) of female participants experienced an increase in CVD risk. However, a stark sex difference was observed in those remaining in the high CVD risk cluster, with 45.1\% (n=1193) male participants and 10.52\% (n=416) female participants. Regarding specific CVD risk factors, male participants exhibited a higher percentage increase in the prevalence of hypertension, antihypertensive medication use, smoking, and obesity, while female participants showed a higher prevalence of diabetes. Further regression analyses identified that Malay compared to Chinese (P<.001) and Indian (P=.04) ethnicity, nonmarried status (P<.001), full-time employment (P<.001), and depressive symptoms (P=.04) were all significantly associated with increased CVD risk scores. In addition, lower educational levels and frequently having meals from outside were significantly associated to higher odds of both worsening and remaining in high CVD risk trajectories. Conclusions: Sociodemographics and mental health were found to be differently associated with CVD risk trajectories, warranting future research to disentangle the role of psychosocial disparities in CVD. Our findings carry public health implications, suggesting that the rise in major risk factors along with psychosocial disparities could potentially elevate CVD risk among individuals in underserved settings. More prevention efforts that continuously monitor CVD risk and consider changes in risk factors among vulnerable populations should be emphasized. ", doi="10.2196/55261", url="https://publichealth.jmir.org/2024/1/e55261" } @Article{info:doi/10.2196/59243, author="Kalinowski, Jolaade and Bhusal, Sandesh and Pagoto, L. Sherry and Newton Jr, Robert and Waring, E. Molly", title="Smart Device Ownership and Use of Social Media, Wearable Trackers, and Health Apps Among Black Women With Hypertension in the United States: National Survey Study", journal="JMIR Cardio", year="2024", month="Sep", day="9", volume="8", pages="e59243", keywords="Black women", keywords="Black", keywords="women", keywords="tracker", keywords="trackers", keywords="wearable", keywords="wearables", keywords="hypertension", keywords="hypertensive", keywords="cardiology", keywords="cardiovascular", keywords="blood pressure", keywords="social media", keywords="technology", keywords="usage", keywords="digital health", keywords="eHealth", keywords="tablet", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="applications", keywords="survey", keywords="surveys", keywords="questionnaire", keywords="questionnaires", keywords="Health Information National Trends Survey", keywords="HINTS", doi="10.2196/59243", url="https://cardio.jmir.org/2024/1/e59243" } @Article{info:doi/10.2196/54909, author="Heinert, W. Sara and Guzman-Baez, Kelvin and Aamir, Affan and Penugonda, Ananya and Crabtree, F. Benjamin and Greene, Kathryn and Heckman, J. Carolyn and Levy, Phillip and Strickland, Ohman Pamela and Hudson, V. Shawna", title="Developing a Youth-Led Digital Hypertension Education Intervention for Adults With Hypertension: Qualitative Study on Refinement and Acceptability", journal="JMIR Form Res", year="2024", month="Sep", day="6", volume="8", pages="e54909", keywords="hypertension", keywords="adolescents", keywords="adults", keywords="emergency department", keywords="digital health intervention", keywords="dyad intervention", keywords="intervention development", keywords="qualitative research", keywords="youth", keywords="adolescent", keywords="teen", keywords="teens", keywords="teenager", keywords="teenagers", keywords="adult", keywords="youth-led", keywords="digital health", keywords="health education", keywords="refinement", keywords="acceptability", keywords="USA", keywords="United States", keywords="care navigation", keywords="effectiveness", keywords="formative study", keywords="prototype", keywords="self-guided", keywords="online module", keywords="online modules", keywords="engagement", keywords="blood pressure", keywords="health knowledge", keywords="health promotion", keywords="nutrition education", keywords="support intervention", keywords="support", keywords="supports", abstract="Background: Hypertension affects one-third of adults in the United States and is the leading risk factor for death. Underserved populations are seen disproportionately in the emergency department (ED) and tend to have worse blood pressure (BP) control. For adults, a lack of hypertension knowledge is a common barrier to hypertension control, while social support is a strong facilitator, and providing information that is culturally sensitive and relevant is especially important in this context. The youth experience increased confidence when given the responsibility to provide health education and care navigation to others. As such, we planned a randomized controlled trial (RCT) for the effectiveness of a digital youth-led hypertension education intervention for adult patients in the ED with hypertension, focusing on change in BP and hypertension knowledge. Objective: In preparation for an RCT, we conducted a formative study to determine acceptable and easily comprehensible ways to present hypertension information to adults with hypertension and optimal ways to engage youth to support adults on how to achieve better hypertension control. Methods: After creating an intervention prototype with 6 weekly self-guided hypertension online modules, we recruited 12 youth (adolescents, aged 15-18 years) for 3 focus groups and 10 adult ED patients with hypertension for individual online interviews to garner feedback on the prototype. After completing a brief questionnaire, participants were asked about experiences with hypertension, preferences for a hypertension education intervention, and acceptability, feasibility, obstacles, and solutions for intervention implementation with youth and adults. The moderator described and showed participants the prototyped intervention process and materials and asked for feedback. Questionnaire data were descriptively summarized, and qualitative data were analyzed using the template organizing style of analysis by 3 study team members. Results: Participants showed great interest in the intervention prototype, thought their peers would find it acceptable, and appreciated its involvement of youth. Youth with family members with hypertension reported that their family members need more support for their hypertension. Youth suggested adding more nutrition education activities to the intervention, such as a sodium tracker and examples of high-sodium foods. Adults discussed the need for a hypertension support intervention for themselves and the expected benefits to youth. They mentioned the overwhelming amount of hypertension information available and appreciated the intervention's concise content presentation. They suggested adding more mental health and smoking cessation resources, information about specific hypertension medications, and adding active links for health care information. Conclusions: Based on focus groups and interviews with participants, a youth-led digital hypertension intervention is an acceptable strategy to engage both adults with hypertension and youth. Incorporating participant suggestions into the intervention may improve its clarity, engagement, and impact when used in a subsequent RCT. ", doi="10.2196/54909", url="https://formative.jmir.org/2024/1/e54909", url="http://www.ncbi.nlm.nih.gov/pubmed/39240662" } @Article{info:doi/10.2196/60773, author="He, Yunfan and Chen, Han and Xiang, Peng and Zhao, Min and Li, Yingjun and Liu, Yongcheng and Wang, Tong and Liang, Jun and Lei, Jianbo", title="Establishing an Evaluation Indicator System for User Satisfaction With Hypertension Management Apps: Combining User-Generated Content and Analytic Hierarchy Process", journal="J Med Internet Res", year="2024", month="Sep", day="3", volume="26", pages="e60773", keywords="hypertension management", keywords="mobile health", keywords="user satisfaction", keywords="evaluation indicator system", keywords="analytic hierarchy process", abstract="Background: Hypertension management apps (HMAs) can be effective in controlling blood pressure, but their actual impact is often suboptimal. Establishing a user satisfaction evaluation indicator system for HMAs can assist app developers in enhancing app design and functionality, while also helping users identify apps that best meet their needs. This approach aims to improve the overall effectiveness of app usage. Objective: This study aims to systematically collect data on HMAs and their user reviews in the United States and China. It analyzes app usage patterns and functional characteristics, identifies factors influencing user satisfaction from existing research, and develops a satisfaction evaluation indicator system to provide more accurate recommendations for improving user satisfaction. Methods: We conducted a descriptive statistical analysis to assess the development status of HMAs in both countries and applied the task-technology fit model to evaluate whether the app functionalities align with business needs. We separately summarized the factors influencing user satisfaction in both countries from previous research, utilized the analytic hierarchy process to develop an evaluation indicator system for HMA user satisfaction, and calculated satisfaction levels. Based on these findings, we propose improvements to enhance app functionality and user satisfaction. Results: In terms of current development status, there were fewer HMAs and user reviews in China compared with the United States. Regarding app functional availability, fewer than 5\% (4/91) of the apps achieved a demand fulfillment rate exceeding 80\% (8/10). Overall, user satisfaction in both countries was low. Conclusions: In the United States, user satisfaction was lowest for advertising distribution, data synchronization, and reliability. By contrast, Chinese apps need improvements in cost efficiency and compatibility. ", doi="10.2196/60773", url="https://www.jmir.org/2024/1/e60773", url="http://www.ncbi.nlm.nih.gov/pubmed/39226103" } @Article{info:doi/10.2196/50075, author="Xiao, Han and Zhou, Zechen and Ma, Yujia and Li, Xiaoyi and Ding, Kexin and Dai, Xiaotong and Chen, Dafang", title="Association of Wearable Device--Measured Step Volume and Variability With Blood Pressure in Older Chinese Adults: Mobile-Based Longitudinal Observational Study", journal="J Med Internet Res", year="2024", month="Aug", day="14", volume="26", pages="e50075", keywords="older adults", keywords="physical activity", keywords="step volume", keywords="step variability", keywords="blood pressure", keywords="wearable devices", keywords="mHealth apps", keywords="mobile health apps", keywords="mobile phone", abstract="Background: The paucity of evidence on longitudinal and consecutive recordings of physical activity (PA) and blood pressure (BP) under real-life conditions and their relationships is a vital research gap that needs to be addressed. Objective: This study aims to (1) investigate the short-term relationship between device-measured step volume and BP; (2) explore the joint effects of step volume and variability on BP; and (3) examine whether the association patterns between PA and BP varied across sex, hypertension status, and chronic condition status. Methods: This study used PA data of a prospective cohort of 3070 community-dwelling older adults derived from a mobile health app. Daily step counts, as a proxy of step volume, were derived from wearable devices between 2018 and 2022 and categorized into tertiles (low, medium, and high). Step variability was assessed using the SD of daily step counts. Consecutive daily step count recordings within 0 to 6 days preceding each BP measurement were analyzed. Generalized estimation equation models were used to estimate the individual and joint associations of daily step volume and variability with BP. Stratified analyses by sex, the presence of hypertension, and the number of morbidities were further conducted. Results: A total of 3070 participants, with a median age of 72 (IQR 67-77) years and 71.37\% (2191/3070) women, were included. Participants walked a median of 7580 (IQR 4972-10,653) steps and 5523 (IQR 3590-7820) meters per day for a total of 592,597 person-days of PA monitoring. Our results showed that higher levels of daily step volume were associated with lower BP (systolic BP, diastolic BP, mean arterial pressure, and pulse pressure). Compared with participants with low step volume (daily step counts <6000/d) and irregular steps, participants with high step volume (?9500/d) and regular steps showed the strongest decrease in systolic BP (--1.69 mm Hg, 95\% CI --2.2 to --1.18), while participants with medium step volume (6000/d to <9500/d) and regular steps were associated with the lowest diastolic BP (--1.067 mm Hg, 95\% CI --1.379 to --0.755). Subgroup analyses indicated generally greater effects on women, individuals with normal BP, and those with only 1 chronic disease, but the effect pattern was varied and heterogeneous between participants with different characteristics. Conclusions: Increased step volume demonstrated a substantial protective effect on BP among older adults with chronic conditions. Furthermore, the beneficial association between step volume and BP was enhanced by regular steps, suggesting potential synergistic protective effects of both increased step volume and step regularity. Targeting both step volume and variability through PA interventions may yield greater benefits in BP control, particularly among participants with hypertension and a higher chronic disease burden. ", doi="10.2196/50075", url="https://www.jmir.org/2024/1/e50075" } @Article{info:doi/10.2196/53355, author="Chen, Tingting and Zhao, Wenbo and Pei, Qianqian and Chen, Yanru and Yin, Jinmei and Zhang, Min and Wang, Cheng and Zheng, Jing", title="Efficacy of a Web-Based Home Blood Pressure Monitoring Program in Improving Predialysis Blood Pressure Control Among Patients Undergoing Hemodialysis: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Aug", day="9", volume="12", pages="e53355", keywords="hemodialysis", keywords="hypertension", keywords="home blood pressure monitoring", keywords="eHealth", keywords="randomized controlled trial", abstract="Background: Hypertension is highly prevalent among patients undergoing hemodialysis, with a significant proportion experiencing poorly controlled blood pressure (BP). Digital BP management in this population has been underused. Objective: This study aimed to explore the efficacy of a web-based home BP monitoring (HBPM) program in improving predialysis BP control and enhancing knowledge, perception, and adherence to HBPM among patients with hypertension undergoing hemodialysis. Methods: A multicenter, open-label, randomized controlled trial was conducted at 2 hemodialysis units. Patients were randomly allocated in a 1:1 ratio to either the web-based HBPM program as the intervention group or to usual care as the control group over a 6-month period. The primary outcomes were the predialysis BP control rate, defined as less than 140/90 mm Hg, and the predialysis systolic and diastolic BP, assessed from baseline to the 6-month follow-up. Secondary outcomes included patient knowledge, perception, and adherence to HBPM, evaluated using the HBPM Knowledge Questionnaire, HBPM Perception Scale, and HBPM Adherence Scale, respectively. A generalized estimating equations analysis was used to analyze the primary outcomes in the intention-to-treat analysis. Results: Of the 165 patients enrolled in the program (n=84, 50.9\% in the web-based HBPM group and n=81, 49.1\% in the control group), 145 (87.9\%) completed the follow-up assessment. During the follow-up period, 11 instances of hypotension occurred in 9 patients in the web-based HBPM group, compared to 15 instances in 14 patients in the control group. The predialysis BP control rate increased from 30\% (25/84) to 48\% (40/84) in the web-based HBPM group after the 6-month intervention, whereas in the control group, it decreased from 37\% (30/81) to 25\% (20/81; $\chi$22=16.82, P<.001; odds ratio 5.11, 95\% CI 2.14-12.23, P<.001). The web-based HBPM group demonstrated a significant reduction after the 6-month intervention in the predialysis systolic BP (t163=2.46, P=.02; $\beta$=?6.09, 95 \% CI ?10.94 to ?1.24, P=.01) and the predialysis diastolic BP (t163=3.20, P=.002; $\beta$=?4.93, 95\% CI ?7.93 to ?1.93, P=.001). Scores on the HBPM Knowledge Questionnaire (t163=?9.18, P<.001), HBPM Perception Scale (t163=?10.65, P<.001), and HBPM Adherence Scale (t163=?8.04, P<.001) were significantly higher after 6 months of intervention. Conclusions: The implementation of a web-based HBPM program can enhance predialysis BP control and the knowledge, perception, and adherence to HBPM among patients undergoing hemodialysis. This web-based HBPM program should be promoted in appropriate clinical settings. Trial Registration: China Clinical Trial Registration Center ChiCTR2100051535; https://www.chictr.org.cn/showproj.html?proj=133286 ", doi="10.2196/53355", url="https://mhealth.jmir.org/2024/1/e53355" } @Article{info:doi/10.2196/57241, author="Kapoor, Melissa and Holman, Blair and Cohen, Carolyn", title="Contactless and Calibration-Free Blood Pressure and Pulse Rate Monitor for Screening and Monitoring of Hypertension: Cross-Sectional Validation Study", journal="JMIR Cardio", year="2024", month="Aug", day="5", volume="8", pages="e57241", keywords="remote photoplethysmography", keywords="vital signs", keywords="calibration-free blood pressure monitor", keywords="medical device", keywords="hypertension screening", keywords="home blood pressure monitoring", keywords="vital", keywords="vitals", keywords="device", keywords="devices", keywords="hypertension", keywords="hypertensive", keywords="cardiovascular", keywords="cardiology", keywords="heart", keywords="blood pressure", keywords="monitoring", keywords="monitor", keywords="mHealth", keywords="mobile health", keywords="validation", abstract="Background: The key to reducing the immense morbidity and mortality burdens of cardiovascular diseases is to help people keep their blood pressure (BP) at safe levels. This requires that more people with hypertension be identified, diagnosed, and given tools to lower their BP. BP monitors are critical to hypertension diagnosis and management. However, there are characteristics of conventional BP monitors (oscillometric cuff sphygmomanometers) that hinder rapid and effective hypertension diagnosis and management. Calibration-free, software-only BP monitors that operate on ubiquitous mobile devices can enable on-demand BP monitoring, overcoming the hardware barriers of conventional BP monitors. Objective: This study aims to investigate the accuracy of a contactless BP monitor software app for classifying the full range of clinically relevant BPs as hypertensive or nonhypertensive and to evaluate its accuracy for measuring the pulse rate (PR) and BP of people with BPs relevant to stage-1 hypertension. Methods: The software app, known commercially as Lifelight, was investigated following the data collection and data analysis methodology outlined in International Organization for Standardization (ISO) 81060-2:2018/AMD 1:2020 ``Non-invasive Sphygmomanometers---Part 2: Clinical investigation of automated measurement type.'' This validation study was conducted by the independent laboratory Element Materials Technology Boulder (formerly Clinimark). The study generated data from 85 people aged 18-85 years with a wide-ranging distribution of BPs specified in ISO 81060-2:2018/AMD 1:2020. At least 20\% were required to have Fitzpatrick scale skin tones of 5 or 6 (ie, dark skin tones). The accuracy of the app's BP measurements was assessed by comparing its BP measurements with measurements made by dual-observer manual auscultation using the same-arm sequential method specified in ISO 81060-2:2018/AMD 1:2020. The accuracy of the app's PR measurements was assessed by comparing its measurements with concurrent electroencephalography-derived heart rate values. Results: The app measured PR with an accuracy root-mean-square of 1.3 beats per minute and mean absolute error of 1.1 (SD 0.8) beats per minute. The sensitivity and specificity with which it determined that BPs exceeded the in-clinic systolic threshold for hypertension diagnosis were 70.1\% and 71.7\%, respectively. These rates are consistent with those reported for conventional BP monitors in a literature review by The National Institute for Health and Care Excellence. The app's mean error for measuring BP in the range of normotension and stage-1 hypertension (ie, 65/85, 76\% of participants) was 6.5 (SD 12.9) mm Hg for systolic BP and 0.4 (SD 10.6) mm Hg for diastolic BP. Mean absolute error was 11.3 (SD 10.0) mm Hg and 8.6 (SD 6.8) mm Hg, respectively. Conclusions: A calibration-free, software-only medical device was independently tested against ISO 81060-2:2018/AMD 1:2020. The safety and performance demonstrated in this study suggest that this technique could be a potential solution for rapid and scalable screening and management of hypertension. ", doi="10.2196/57241", url="https://cardio.jmir.org/2024/1/e57241", url="http://www.ncbi.nlm.nih.gov/pubmed/39102277" } @Article{info:doi/10.2196/52536, author="Yuan, Lei and Jiang, Qinqin and Liu, Yuqing and Liu, Yijun and Du, Maolin and Sun, Jinhai and Li, Meina", title="Decomposition Analysis of Depressive Symptom Differences Among Older Adults With Hypertension Between Urban and Rural Areas: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="1", volume="10", pages="e52536", keywords="depression", keywords="older", keywords="hypertension", keywords="Fairlie decomposition", keywords="China", keywords="older adult", keywords="elderly", abstract="Background: Hypertension is the most prevalent chronic disease among China's older population, which comprises a growing proportion of the overall demographic. Older individuals with chronic diseases have a higher risk of developing depressive symptoms than their healthy counterparts, as evidenced in China's older population, where patients with hypertension exhibit varying rates of depression depending on residing in urban or rural areas. Objective: This study aimed to investigate factors influencing and contributing to the disparities in depressive symptoms among older urban and rural patients with hypertension in China. Methods: We used a cross-sectional study design and derived data from the 8th Chinese Longitudinal Health Longevity Survey of 2018. The Fairlie model was applied to analyze the factors contributing to disparities in depressive symptoms between urban and rural older populations with hypertension. Results: The sample size for this study was 5210, and 12.8\% (n=669) of participants exhibited depressive symptoms. The proportions of depressive symptoms in rural and urban areas were 14.1\% (n=468) and 10.7\% (n=201), respectively. In rural areas, years of education (1-6 years: odds ratio [OR] 0.68, 95\% CI 1.10-1.21; ?7 years: OR 0.47, 95\% CI 0.24-0.94), alcohol consumption (yes: OR 0.52, 95\% CI 0.29-0.93), exercise (yes: OR 0.78, 95\% CI 0.56-1.08), and sleep duration (6.0-7.9 hours: OR 0.29, 95\% CI 0.17-0.52; 8.0-9.9 hours: OR 0.24, 95\% CI 0.13-0.43; ?10.0 hours: OR 0.22, 95\% CI 0.11-0.41) were protective factors against depressive symptoms in older adults with hypertension, while gender (female: OR 1.94, 95\% CI 1.33-2.81), self-reported income status (poor: OR 3.07, 95\% CI 2.16-4.37), and activities of daily living (ADL) dysfunction (mild: OR 1.69, 95\% CI 1.11-2.58; severe: OR 3.03, 95\% CI 1.46-6.32) were risk factors. In urban areas, age (90-99 years: OR 0.37, 95\% CI 0.16-0.81; ?100 years: OR 0.19, 95\% CI 0.06-0.66), exercise (yes: OR 0.33, 95\% CI 0.22-0.51), and sleep duration (6.0-7.9 hours: OR 0.27, 95\% CI 0.10-0.71; 8.0-9.9 hours: OR 0.16, 95\% CI 0.06-0.44; ?10.0 hours: OR 0.18, 95\% CI 0.06-0.57) were protective factors, while years of education (1-6 years: OR 1.91, 95\% CI 1.05-3.49), self-reported income status (poor: OR 2.94, 95\% CI 1.43-6.08), and ADL dysfunction (mild: OR 2.38, 95\% CI 1.39-4.06; severe: OR 3.26, 95\% CI 1.21-8.76) were risk factors. The Fairlie model revealed that 91.61\% of differences in depressive symptoms could be explained by covariates, including years of education (contribution 63.1\%), self-reported income status (contribution 13.2\%), exercise (contribution 45.7\%), sleep duration (contribution 20.8\%), ADL dysfunction (contribution ?9.6\%), and comorbidities (contribution ?22.9\%). Conclusions: Older patients with hypertension in rural areas had more depressive symptoms than their counterparts residing in urban areas, which could be explained by years of education, self-reported income status, exercise, sleep duration, ADL dysfunction, and comorbidities. Factors influencing depressive symptoms had similarities regarding exercise, sleep duration, self-reported income status, and ADL dysfunction as well as differences regarding age, gender, years of education, and alcohol consumption. ", doi="10.2196/52536", url="https://publichealth.jmir.org/2024/1/e52536" } @Article{info:doi/10.2196/51891, author="Lee, Hyeri and Kim, Minji and Woo, Selin and Park, Jaeyu and Kim, Jin Hyeon and Kwon, Rosie and Koyanagi, Ai and Smith, Lee and Kim, Seo Min and L{\'o}pez S{\'a}nchez, F. Guillermo and Dragioti, Elena and Lee, Jinseok and Lee, Hayeon and Rahmati, Masoud and Rhee, Youl Sang and Lee, Hyuk Jun and Woo, Geol Ho and Yon, Keon Dong", title="National and Regional Trends in the Prevalence of Hypertension in South Korea Amid the Pandemic, 2009-2022: Nationwide Study of Over 3 Million Individuals", journal="JMIR Public Health Surveill", year="2024", month="Jul", day="30", volume="10", pages="e51891", keywords="COVID-19", keywords="pandemic", keywords="Korea", keywords="hypertension", keywords="HPN", keywords="high blood pressure", keywords="prevalence", keywords="national trends", keywords="regional trends", keywords="nationwide study", keywords="socioeconomic", keywords="trends", keywords="participant", keywords="population based", keywords="cross-sectional study", keywords="treatment", abstract="Background: Understanding the association between hypertension prevalence and socioeconomic and behavioral variables during a pandemic is essential, and this analysis should extend beyond short-term trends. Objective: This study aims to examine long-term trends in the prevalence of participants diagnosed with and receiving treatment for hypertension, using data collected by a nationally representative survey from 2009 to 2022, which includes the COVID-19 pandemic era. Methods: A nationwide, population-based, cross-sectional study used data collected from the South Korea Community Health Survey between 2009 and 2022. The study sample comprised 3,208,710 Korean adults over a period of 14 years. We aimed to assess trends in the prevalence of participants diagnosed with and receiving treatment for hypertension in the national population from 2009 to 2022, with a specific focus on the COVID-19 pandemic, using weighted linear regression models. Results: Among the included 3,072,546 Korean adults, 794,239 (25.85\%) were aged 19-39 years, 1,179,388 (38.38\%) were aged 40-59 years; 948,097 (30.86\%) were aged 60-79 years, and 150,822 (4.91\%) were aged 80 years or older. A total of 1,426,379 (46.42\%) were men; 761,896 (24.80\%) and 712,264 (23.18\%) were diagnosed with and received treatment for hypertension, respectively. Although the overall prevalence over the 14-year period increased, the upward trends of patients diagnosed with and receiving treatment for hypertension decreased during the COVID-19 pandemic era compared with the prepandemic era ($\beta$ difference for trend during vs before the pandemic --.101, 95\% CI --0.107 to --0.094 vs --.133, 95\% CI --0.140 to --0.127). Notably, the trends in prevalence during the pandemic were less pronounced in subgroups of older adults (?60 years old) and individuals with higher alcohol consumption (?5 days/month). Conclusions: This nationwide representative study found that the national prevalence of participants diagnosed with and receiving treatment for hypertension increased during the prepandemic era. However, there was a marked decrease in these trends during the prepandemic era, compared with the pandemic era, particularly among specific subgroups at increased risk of negative outcomes. Future studies are needed to evaluate the factors associated with changes in the prevalence of hypertension during the COVID-19 pandemic. ", doi="10.2196/51891", url="https://publichealth.jmir.org/2024/1/e51891", url="http://www.ncbi.nlm.nih.gov/pubmed/39078683" } @Article{info:doi/10.2196/55617, author="Charifson, Mia and Wen, Timothy and Zell, Bonnie and Vaidya, Priyanka and Rios, I. Cynthia and Fagbohun, Funsho C. and Fulcher, Isabel", title="Impact of Remote Blood Pressure Monitoring Device Connectivity on Engagement Among Pregnant Individuals Enrolled in the Delfina Care Platform: Observational Study", journal="JMIR Mhealth Uhealth", year="2024", month="Jul", day="12", volume="12", pages="e55617", keywords="blood pressure", keywords="hypertension", keywords="remote patient monitoring", keywords="pregnancy", keywords="digital health", keywords="remote monitoring", keywords="user engagement", keywords="users", keywords="connected", keywords="unconnected", keywords="comparison", keywords="patient engagement", keywords="prospective pregnancy cohort", keywords="device", keywords="devices", keywords="female", keywords="females", keywords="women", keywords="logistic regression", keywords="Poisson", doi="10.2196/55617", url="https://mhealth.jmir.org/2024/1/e55617" } @Article{info:doi/10.2196/57863, author="Buis, R. Lorraine and Kim, Junhan and Sen, Ananda and Chen, Dongru and Dawood, Katee and Kadri, Reema and Muladore, Rachelle and Plegue, Melissa and Richardson, R. Caroline and Djuric, Zora and McNaughton, Candace and Hutton, David and Robert, P. Lionel and Park, Young Sun and Levy, Phillip", title="The Effect of an mHealth Self-Monitoring Intervention (MI-BP) on Blood Pressure Among Black Individuals With Uncontrolled Hypertension: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Jun", day="28", volume="12", pages="e57863", keywords="blood pressure", keywords="hypertension", keywords="mobile health", keywords="mHealth", keywords="mobile phone", keywords="smartphone", abstract="Background: Hypertension is one of the most important cardiovascular disease risk factors and affects >100 million American adults. Hypertension-related health inequities are abundant in Black communities as Black individuals are more likely to use the emergency department (ED) for chronic disease--related ambulatory care, which is strongly linked to lower blood pressure (BP) control, diminished awareness of hypertension, and adverse cardiovascular events. To reduce hypertension-related health disparities, we developed MI-BP, a culturally tailored multibehavior mobile health intervention that targeted behaviors of BP self-monitoring, physical activity, sodium intake, and medication adherence in Black individuals with uncontrolled hypertension recruited from ED and community-based settings. Objective: We sought to determine the effect of MI-BP on BP as well as secondary outcomes of physical activity, sodium intake, medication adherence, and BP control compared to enhanced usual care control at 1-year follow-up. Methods: We conducted a 1-year, 2-group randomized controlled trial of the MI-BP intervention compared to an enhanced usual care control group where participants aged 25 to 70 years received a BP cuff and hypertension-related educational materials. Participants were recruited from EDs and other community-based settings in Detroit, Michigan, where they were screened for initial eligibility and enrolled. Baseline data collection and randomization occurred approximately 2 and 4 weeks after enrollment to ensure that participants had uncontrolled hypertension and were willing to take part. Data collection visits occurred at 13, 26, 39, and 52 weeks. Outcomes of interest included BP (primary outcome) and physical activity, sodium intake, medication adherence, and BP control (secondary outcomes). Results: We obtained consent from and enrolled 869 participants in this study yet ultimately randomized 162 (18.6\%) participants. At 1 year, compared to the baseline, both groups showed significant decreases in systolic BP (MI-BP group: 22.5 mm?Hg decrease in average systolic BP and P<.001; control group: 24.1 mm?Hg decrease and P<.001) adjusted for age and sex, with no significant differences between the groups (time-by-arm interaction: P=.99). Similar patterns where improvements were noted in both groups yet no differences were found between the groups were observed for diastolic BP, physical activity, sodium intake, medication adherence, and BP control. Large dropout rates were observed in both groups (approximately 60\%). Conclusions: Overall, participants randomized to both the enhanced usual care control and MI-BP conditions experienced significant improvements in BP and other outcomes; however, differences between groups were not detected, speaking to the general benefit of proactive outreach and engagement focused on cardiometabolic risk reduction in urban-dwelling, low-socioeconomic-status Black populations. High dropout rates were found and are likely to be expected when working with similar populations. Future work is needed to better understand engagement with mobile health interventions, particularly in this population. Trial Registration: ClinicalTrials.gov NCT02955537; https://clinicaltrials.gov/study/NCT02955537 International Registered Report Identifier (IRRID): RR2-10.2196/12601 ", doi="10.2196/57863", url="https://mhealth.jmir.org/2024/1/e57863" } @Article{info:doi/10.2196/49077, author="Terada, Marina and Okuhara, Tsuyoshi and Yokota, Rie and Kiuchi, Takahiro and Murakami, Kentaro", title="Nutrients and Foods Recommended for Blood Pressure Control on Twitter in Japan: Content Analysis", journal="J Med Internet Res", year="2024", month="Jun", day="20", volume="26", pages="e49077", keywords="Twitter", keywords="food", keywords="nutrition", keywords="misinformation", keywords="salt", keywords="content analysis", keywords="hypertension", keywords="blood pressure", keywords="sodium", keywords="salt reduction", abstract="Background: Management and prevention of hypertension are important public health issues. Healthy dietary habits are one of the modifiable factors. As Twitter (subsequently rebranded X) is a digital platform that can influence public eating behavior, there is a knowledge gap regarding the information about foods and nutrients recommended for blood pressure control and who disseminates them on Twitter. Objective: This study aimed to investigate the nature of the information people are exposed to on Twitter regarding nutrients and foods for blood pressure control. Methods: A total of 147,898 Japanese tweets were extracted from January 1, 2022, to December 31, 2022. The final sample of 2347 tweets with at least 1 retweet was manually coded into categories of food groups, nutrients, user characteristics, and themes. The number and percentage of tweets, retweets, and themes in each category were calculated. Results: Of the 2347 tweets, 80\% (n=1877) of tweets mentioned foods, which were categorized into 17 different food groups. Seasonings and spices, including salt, were most frequently mentioned (1356/1877, 72.2\%). This was followed by vegetable and fruit groups. The 15 kinds of nutrients were mentioned in 1566 tweets, with sodium being the largest proportion at 83.1\% (n=1301), followed by potassium at 8.4\% (n=132). There was misinformation regarding salt intake for hypertension, accounting for 40.8\% (n=531) of tweets referring to salt, including recommendations for salt intake to lower blood pressure. In total, 75\% (n=21) of tweets from ``doctors'' mentioned salt reduction is effective for hypertension control, while 31.1\% (n=74) of tweets from ``health, losing weight, and beauty-related users,'' 25.9\% (n=429) of tweets from ``general public,'' and 23.5\% (n=4) tweets from ``dietitian or registered dietitian'' denied salt reduction for hypertension. The antisalt reduction tweets accounted for 31.5\% (n=106) of the most disseminated tweets related to nutrients and foods for blood pressure control. Conclusions: The large number of tweets in this study indicates a high interest in nutrients and foods for blood pressure control. Misinformation asserting antisalt reduction was posted primarily by the general public and self-proclaimed health experts. The number of tweets from nutritionists, registered dietitians, and doctors who were expected to correct misinformation and promote salt reduction was relatively low, and their messages were not always positive toward salt reduction. There is a need for communication strategies to combat misinformation, promote correct information on salt reduction, and train health care professionals to effectively communicate evidence-based information on this topic. ", doi="10.2196/49077", url="https://www.jmir.org/2024/1/e49077" } @Article{info:doi/10.2196/50248, author="Arshed, Muhammad and Mahmud, Aidalina and Minhat, Sakdiah Halimatus and Lim, Ying Poh and Zakar, Rubeena", title="Effectiveness of a Multifaceted Mobile Health Intervention (Multi-Aid-Package) in Medication Adherence and Treatment Outcomes Among Patients With Hypertension in a Low- to Middle-Income Country: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Jun", day="19", volume="12", pages="e50248", keywords="mobile health", keywords="mHealth", keywords="intervention", keywords="medication adherence", keywords="hypertension", keywords="low- to middle-income country", keywords="effectiveness", keywords="randomized controlled trial", keywords="Pakistan", keywords="drug adherence", keywords="tool", keywords="mHealth module", keywords="self-efficacy", keywords="systolic blood pressure", keywords="feedback", abstract="Background: The high prevalence of uncontrolled hypertension in Pakistan is predominantly attributed to poor medication adherence. As more than 137 million people in Pakistan use cell phones, a suitable mobile health (mHealth) intervention can be an effective tool to overcome poor medication adherence. Objective: We sought to determine whether a novel mHealth intervention is useful in enhancing antihypertensive therapy adherence and treatment outcomes among patients with hypertension in a low- to middle-income country. Methods: A 6-month parallel, single-blinded, superiority randomized controlled trial recruited 439 patients with hypertension with poor adherence to antihypertensive therapy and access to smartphones. An innovative, multifaceted mHealth intervention (Multi-Aid-Package), based on the Health Belief Model and containing reminders (written, audio, visual), infographics, video clips, educational content, and 24/7 individual support, was developed for the intervention group; the control group received standard care. The primary outcome was self-reported medication adherence measured using the Self-Efficacy for Appropriate Medication Adherence Scale (SEAMS) and pill counting; the secondary outcome was systolic blood pressure (SBP) change. Both outcomes were evaluated at baseline and 6 months. Technology acceptance feedback was also assessed at the end of the study. A generalized estimating equation was used to control the covariates associated with the probability of affecting adherence to antihypertensive medication. Results: Of 439 participants, 423 (96.4\%) completed the study. At 6 months post intervention, the median SEAMS score was statistically significantly higher in the intervention group compared to the controls (median 32, IQR 11 vs median 21, IQR 6; U=10,490, P<.001). Within the intervention group, there was an increase in the median SEAMS score by 12.5 points between baseline and 6 months (median 19.5, IQR 5 vs median 32, IQR 11; P<.001). Results of the pill-counting method showed an increase in adherent patients in the intervention group compared to the controls (83/220, 37.2\% vs 2/219, 0.9\%; P<.001), as well as within the intervention group (difference of n=83, 37.2\% of patients, baseline vs 6 months; P<.001). There was a statistically significant difference in the SBP of 7 mmHg between the intervention and control groups (P<.001) at 6 months, a 4 mmHg reduction (P<.001) within the intervention group, and a 3 mmHg increase (P=.314) within the controls. Overall, the number of patients with uncontrolled hypertension decreased by 46 in the intervention group (baseline vs 6 months), but the control group remained unchanged. The variables groups (adjusted odds ratio [AOR] 1.714, 95\% CI 2.387-3.825), time (AOR 1.837, 95\% CI 1.625-2.754), and age (AOR 1.618, 95\% CI 0.225-1.699) significantly contributed (P<.001) to medication adherence. Multi-Aid-Package received a 94.8\% acceptability score. Conclusions: The novel Multi-Aid-Package is an effective mHealth intervention for enhancing medication adherence and treatment outcomes among patients with hypertension in a low- to middle-income country. Trial Registration: ClinicalTrials.gov NCT04577157; https://clinicaltrials.gov/study/NCT04577157 ", doi="10.2196/50248", url="https://mhealth.jmir.org/2024/1/e50248" } @Article{info:doi/10.2196/54946, author="Skolarus, E. Lesli and Lin, Chieh Chun and Mishra, Sonali and Meurer, William and Dinh, Mackenzie and Whitfield, Candace and Bi, Ran and Brown, Devin and Oteng, Rockefeller and Buis, R. Lorraine and Kidwell, Kelley", title="Engagement in mHealth-Prompted Self-Measured Blood Pressure Monitoring Among Participants Recruited From a Safety-Net Emergency Department: Secondary Analysis of the Reach Out Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Jun", day="12", volume="12", pages="e54946", keywords="hypertension", keywords="self-measured blood pressure", keywords="mobile health", keywords="blood pressure", keywords="emergency", keywords="blood pressure monitoring", keywords="risk factor", keywords="cardiovascular", keywords="cardiovascular disease", keywords="utilization", keywords="feedback", keywords="care", keywords="systolic blood pressure", keywords="emergency department", keywords="mHealth", keywords="health disparities", keywords="engagement", abstract="Background: Hypertension, a key modifiable risk factor for cardiovascular disease, is more prevalent among Black and low-income individuals. To address this health disparity, leveraging safety-net emergency departments for scalable mobile health (mHealth) interventions, specifically using text messaging for self-measured blood pressure (SMBP) monitoring, presents a promising strategy. This study investigates patterns of engagement, associated factors, and the impact of engagement on lowering blood pressure (BP) in an underserved population. Objective: We aimed to identify patterns of engagement with prompted SMBP monitoring with feedback, factors associated with engagement, and the association of engagement with lowered BP. Methods: This is a secondary analysis of data from Reach Out, an mHealth, factorial trial among 488 hypertensive patients recruited from a safety-net emergency department in Flint, Michigan. Reach Out participants were randomized to weekly or daily text message prompts to measure their BP and text in their responses. Engagement was defined as a BP response to the prompt. The k-means clustering algorithm and visualization were used to determine the pattern of SMBP engagement by SMBP prompt frequency---weekly or daily. BP was remotely measured at 12 months. For each prompt frequency group, logistic regression models were used to assess the univariate association of demographics, access to care, and comorbidities with high engagement. We then used linear mixed-effects models to explore the association between engagement and systolic BP at 12 months, estimated using average marginal effects. Results: For both SMBP prompt groups, the optimal number of engagement clusters was 2, which we defined as high and low engagement. Of the 241 weekly participants, 189 (78.4\%) were low (response rate: mean 20\%, SD 23.4) engagers, and 52 (21.6\%) were high (response rate: mean 86\%, SD 14.7) engagers. Of the 247 daily participants, 221 (89.5\%) were low engagers (response rate: mean 9\%, SD 12.2), and 26 (10.5\%) were high (response rate: mean 67\%, SD 8.7) engagers. Among weekly participants, those who were older (>65 years of age), attended some college (vs no college), married or lived with someone, had Medicare (vs Medicaid), were under the care of a primary care doctor, and took antihypertensive medication in the last 6 months had higher odds of high engagement. Participants who lacked transportation to appointments had lower odds of high engagement. In both prompt frequency groups, participants who were high engagers had a greater decline in BP compared to low engagers. Conclusions: Participants randomized to weekly SMBP monitoring prompts responded more frequently overall and were more likely to be classed as high engagers compared to participants who received daily prompts. High engagement was associated with a larger decrease in BP. New strategies to encourage engagement are needed for participants with lower access to care. Trial Registration: ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04340-z ", doi="10.2196/54946", url="https://mhealth.jmir.org/2024/1/e54946" } @Article{info:doi/10.2196/52182, author="Lee, Jun Jae and Lee, Hee Kyung", title="Optimal Systolic Blood Pressure for the Prevention of All-Cause and Cardiovascular Disease Mortality in Older Adults With Hypertension: Nationwide Population-Based Cohort Study", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="11", volume="10", pages="e52182", keywords="aged", keywords="blood pressure", keywords="cardiovascular diseases", keywords="hypertension", keywords="mortality", keywords="older adults", keywords="geriatric", keywords="elderly", keywords="cardiovascular", keywords="Korea", keywords="Korean", keywords="insurance", keywords="cohort study", keywords="systolic", keywords="risk", keywords="aging", keywords="health outcome", abstract="Background: Target systolic blood pressure (SBP) levels for older adults with hypertension vary across countries, leading to challenges in determining the appropriate SBP level. Objective: This study aims to identify the optimal SBP level for minimizing all-cause and cardiovascular disease (CVD) mortality in older Korean adults with hypertension. Methods: This retrospective cohort study used data from the National Health Insurance Service database. We included older adults aged 65 years or older who were newly diagnosed with hypertension and underwent a National Health Insurance Service health checkup in 2003-2004. We excluded patients who had a history of hypertension or CVD, were not prescribed medication for hypertension, had missing blood pressure or any other covariate values, and had fewer than 2 health checkups during the follow-up period until 2020. We categorized the average SBP levels into 6 categories in 10 mm Hg increments, from <120 mm Hg to ?160 mm Hg; 130-139 mm Hg was the reference range. Cox proportional hazards models were used to examine the relationship between SBP and all-cause and CVD mortalities, and subgroup analysis was conducted by age group (65-74 years and 75 years or older). Results: A total of 68,901 older adults newly diagnosed with hypertension were included in this study. During the follow-up period, 32,588 (47.3\%) participants had all-cause mortality and 4273 (6.2\%) had CVD mortality. Compared to older adults with SBP within the range of 130-139 mm Hg, individuals who fell into the other SBP categories, excluding those with SBP 120-129 mm Hg, showed significantly higher all-cause and CVD mortality. Subgroup analysis showed that older adults aged 65-74 years had higher all-cause and CVD mortality rates according to SBP categories than those aged 75 years or older. Conclusions: The SBP levels within the range of 120-139 mm Hg were associated with the lowest all-cause and CVD mortality rates among older Korean adults with hypertension. It is recommended to reduce SBP to <140 mm Hg, with 120 mm Hg as the minimum value for SBP, for older Korean adults with hypertension. Additionally, stricter SBP management is required for adults aged 65-74 years. ", doi="10.2196/52182", url="https://publichealth.jmir.org/2024/1/e52182", url="http://www.ncbi.nlm.nih.gov/pubmed/38861307" } @Article{info:doi/10.2196/48520, author="Tran, Dieu-My and Dingley, Catherine and Bonilla, Roger", title="mHealth Intervention for Elevated Blood Pressure Among College Students: Single-Arm Intervention Study", journal="JMIR Form Res", year="2024", month="Jun", day="7", volume="8", pages="e48520", keywords="blood pressure", keywords="mHealth", keywords="self-management", keywords="students", keywords="intervention", keywords="elevated blood pressure", keywords="college", keywords="hypertension", keywords="young adult", keywords="mobile app", keywords="smartphone", keywords="monitoring", keywords="text messaging", keywords="text mining", abstract="Background: Current evidence reveals a growing pattern of hypertension among young adults, significantly increasing their risk for cardiovascular disease later in life. Young adults, particularly those of college age, often develop risk factors related to lifestyle choices in diet, exercise, and alcohol consumption. Developing useful interventions that can assist with screening and possible behavioral modifications that are suitable and appealing to college-aged young adults could help with early identification and intervention for hypertension. Recent studies indicate mobile health (mHealth) apps are acceptable and effective for communication and message delivery among this population. Objective: The purpose of this study was to examine the feasibility of using a mobile smartphone delivery system that provides tailored messages based on participant self-measured blood pressure (BP) with college-aged young adults. Methods: Using a single-arm intervention, pilot study design, the mHealth to Optimize BP Improvement (MOBILE) intervention was implemented with college students aged 18 years to 39 years who had systolic BP >120 mm Hg and diastolic BP ?80 mm Hg. Participants were required to measure their BP daily for 28 days, submit the readings to the app, and receive preset educational text messages tailored to their BP value and related to encouraging healthy lifestyle modifications. Changes in a participant's BP was evaluated using a mixed regression model, and a postintervention survey evaluated their perspectives on the mHealth intervention. Results: The participants' (N=9) mean age was 22.64 (SD 4.54) years; 56\% (5/9) were overweight, and 11\% (1/9) were obese. The average daily participation rate was 86\%. Of the 9 participants, 8 completed the survey, and all indicated the intervention was easy to use, found it increased awareness of their individual BP levels, indicated the text messages were helpful, and reported making lifestyle changes based on the study intervention. They also provided suggestions for future implementation of the intervention and program. Overall, no significant changes were noted in BP over the 28 days. Conclusions: The mHealth-supported MOBILE intervention for BP monitoring and tailored text messaging was feasible to implement, as our study indicated high rates of participation and acceptability. These encouraging findings support further development and testing in a larger sample over a longer time frame and hold the potential for early identification and intervention among college-aged adults, filling a gap in current research. ", doi="10.2196/48520", url="https://formative.jmir.org/2024/1/e48520", url="http://www.ncbi.nlm.nih.gov/pubmed/38848120" } @Article{info:doi/10.2196/49617, author="Cheng, Hui and Jia, Zhihui and Li, Ting Yu and Yu, Xiao and Wang, Ji Jia and Xie, Jie Yao and Hernandez, Jose and Wang, X. Harry H.", title="Metabolic Score for Insulin Resistance and New-Onset Type 2 Diabetes in a Middle-Aged and Older Adult Population: Nationwide Prospective Cohort Study and Implications for Primary Care", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="3", volume="10", pages="e49617", keywords="metabolic score for insulin resistance", keywords="type 2 diabetes mellitus", keywords="blood pressure", keywords="longitudinal study", keywords="primary care", abstract="Background: The metabolic score for insulin resistance (METS-IR) has emerged as a noninsulin-based index for the approximation of insulin resistance (IR), yet longitudinal evidence supporting the utility of METS-IR in the primary prevention of type 2 diabetes mellitus (T2DM) remains limited. Objective: We aimed to investigate the longitudinal association between METS-IR, which combines fasting plasma glucose (FPG), lipid profiles, and anthropometrics that can be routinely obtained in resource-limited primary care settings, and the incidence of new-onset T2DM. Methods: We conducted a closed-cohort analysis of a nationwide, prospective cohort of 7583 Chinese middle-aged and older adults who were free of T2DM at baseline, sampled from 28 out of 31 provinces in China. We examined the characteristics of participants stratified by elevated blood pressure (BP) at baseline and new-onset T2DM at follow-up. We performed Cox proportional hazard regression analysis to explore associations of baseline METS-IR with incident T2DM in participants overall and in participants stratified by baseline BP. We also applied net reclassification improvement and integrated discrimination improvement to examine the incremental value of METS-IR. Results: During a mean follow-up period of 6.3 years, T2DM occurred in 527 participants, among which two-thirds (332/527, 62.9\%; 95\% CI 58.7\%-67.1\%) had baseline FPG<110 mg/dL. A SD unit increase in baseline METS-IR was associated with the first incidence of T2DM (adjusted hazard ratio [aHR] 1.33, 95\% CI 1.22-1.45; P<.001) in all participants. We obtained similar results in participants with normal baseline BP (aHR 1.41, 95\% CI 1.22-1.62; P<.001) and elevated baseline BP (aHR 1.29, 95\% CI 1.16-1.44; P<.001). The predictive capability for incident T2DM was improved by adding METS-IR to FPG. In study participants with new-onset T2DM whose baseline FPG was <126 mg/dL and <110 mg/dL, 62.9\% (332/527; 95\% CI 60\%-65.9\%) and 58.1\% (193/332; 95\% CI 54.3\%-61.9\%) of participants had baseline METS-IR above the cutoff values, respectively. Conclusions: METS-IR was significantly associated with new-onset T2DM, regardless of baseline BP level. Regular monitoring of METS-IR on top of routine blood glucose in clinical practice may add to the ability to enhance the early identification of primary care populations at risk for T2DM. ", doi="10.2196/49617", url="https://publichealth.jmir.org/2024/1/e49617", url="http://www.ncbi.nlm.nih.gov/pubmed/38569189" } @Article{info:doi/10.2196/51916, author="Leitner, Jared and Chiang, Po-Han and Agnihotri, Parag and Dey, Sujit", title="The Effect of an AI-Based, Autonomous, Digital Health Intervention Using Precise Lifestyle Guidance on Blood Pressure in Adults With Hypertension: Single-Arm Nonrandomized Trial", journal="JMIR Cardio", year="2024", month="May", day="28", volume="8", pages="e51916", keywords="blood pressure", keywords="hypertension", keywords="digital health", keywords="lifestyle change", keywords="lifestyle medicine", keywords="wearables", keywords="remote patient monitoring", keywords="artificial intelligence", keywords="AI", keywords="mobile phone", abstract="Background: Home blood pressure (BP) monitoring with lifestyle coaching is effective in managing hypertension and reducing cardiovascular risk. However, traditional manual lifestyle coaching models significantly limit availability due to high operating costs and personnel requirements. Furthermore, the lack of patient lifestyle monitoring and clinician time constraints can prevent personalized coaching on lifestyle modifications. Objective: This study assesses the effectiveness of a fully digital, autonomous, and artificial intelligence (AI)--based lifestyle coaching program on achieving BP control among adults with hypertension. Methods: Participants were enrolled in a single-arm nonrandomized trial in which they received a BP monitor and wearable activity tracker. Data were collected from these devices and a questionnaire mobile app, which were used to train personalized machine learning models that enabled precision lifestyle coaching delivered to participants via SMS text messaging and a mobile app. The primary outcomes included (1) the changes in systolic and diastolic BP from baseline to 12 and 24 weeks and (2) the percentage change of participants in the controlled, stage-1, and stage-2 hypertension categories from baseline to 12 and 24 weeks. Secondary outcomes included (1) the participant engagement rate as measured by data collection consistency and (2) the number of manual clinician outreaches. Results: In total, 141 participants were monitored over 24 weeks. At 12 weeks, systolic and diastolic BP decreased by 5.6 mm Hg (95\% CI ?7.1 to ?4.2; P<.001) and 3.8 mm Hg (95\% CI ?4.7 to ?2.8; P<.001), respectively. Particularly, for participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 9.6 mm Hg (95\% CI ?12.2 to ?6.9; P<.001) and 5.7 mm Hg (95\% CI ?7.6 to ?3.9; P<.001), respectively. At 24 weeks, systolic and diastolic BP decreased by 8.1 mm Hg (95\% CI ?10.1 to ?6.1; P<.001) and 5.1 mm Hg (95\% CI ?6.2 to ?3.9; P<.001), respectively. For participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 14.2 mm Hg (95\% CI ?17.7 to ?10.7; P<.001) and 8.1 mm Hg (95\% CI ?10.4 to ?5.7; P<.001), respectively, at 24 weeks. The percentage of participants with controlled BP increased by 17.2\% (22/128; P<.001) and 26.5\% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The percentage of participants with stage-2 hypertension decreased by 25\% (32/128; P<.001) and 26.5\% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The average weekly participant engagement rate was 92\% (SD 3.9\%), and only 5.9\% (6/102) of the participants required manual outreach over 24 weeks. Conclusions: The study demonstrates the potential of fully digital, autonomous, and AI-based lifestyle coaching to achieve meaningful BP improvements and high engagement for patients with hypertension while substantially reducing clinician workloads. Trial Registration: ClinicalTrials.gov NCT06337734; https://clinicaltrials.gov/study/NCT06337734 ", doi="10.2196/51916", url="https://cardio.jmir.org/2024/1/e51916", url="http://www.ncbi.nlm.nih.gov/pubmed/38805253" } @Article{info:doi/10.2196/54010, author="Dinh, Mackenzie and Lin, Chieh Chun and Whitfield, Candace and Farhan, Zahera and Meurer, J. William and Bailey, Sarah and Skolarus, E. Lesli", title="Exploring the Acceptability and Feasibility of Remote Blood Pressure Measurements and Cognition Assessments Among Participants Recruited From a Safety-Net Emergency Department (Reach Out Cognition): Nonrandomized Mobile Health Trial", journal="JMIR Form Res", year="2024", month="May", day="28", volume="8", pages="e54010", keywords="hypertension", keywords="cognition", keywords="mobile health", keywords="Bluetooth", keywords="remote", keywords="monitoring", keywords="monitor", keywords="low income", keywords="mHealth", keywords="hypertensive", keywords="cardiology", keywords="cardiovascular", keywords="feasibility", keywords="acceptability", keywords="satisfaction", keywords="RCT", keywords="randomized controlled trial", keywords="assessment", keywords="blood pressure", keywords="neurological", abstract="Background: Hypertension is a prevalent cardiovascular risk factor disproportionately affecting Black Americans, who also experience a higher incidence of Alzheimer disease and Alzheimer disease--related dementias. Monitoring blood pressure (BP) and cognition may be important strategies in reducing these disparities. Objective: The objective of the Reach Out Cognition study was to explore the feasibility and acceptability of remote cognitive and BP assessments in a predominantly Black, low-income population. Methods: Reach Out was a randomized, controlled, mobile health--based clinical trial to reduce BP among patients with hypertension at an emergency department in a safety-net hospital (ie, a US hospital in which 25\% of the patients are Medicaid recipients). Upon conclusion of Reach Out, participants were given the option of continuing into an extension phase, Reach Out Cognition, that included Bluetooth-enabled BP monitoring and digital cognitive assessments for 6 months. Digital cognitive assessments were text message--linked online surveys of the Self-Administered Gerocognitive Exam and Quality of Life in Neurological Disorders scale. BP assessments were measured with Bluetooth-enabled BP cuffs paired with an app and the data were manually sent to the research team. Outcomes were feasibility (ie, enrollment and 3- and 6-month completion of digital cognitive and BP assessments) and acceptability of assessments using a 4-item validated survey, ranging from 1 (not acceptable) to 5 (completely acceptable). Results: Of the 211 Reach Out participants, 107 (50.7\%) consented and 71 (33.6\%) completed enrollment in Reach Out Cognition. Participants had a mean age of 49.9 years; 70.4\% were female and 57.8\% identified as Black. Among the 71 participants, 51 (72\%) completed cognitive assessments at 3 months and 34 (48\%) completed these assessments at 6 months. BP assessments were completed by 37 (52\%) and 20 (28\%) of the 71 participants at 3 and 6 months, respectively. Participants were neutral on the acceptability of the digital cognitive assessments (mean 3.7) and Bluetooth self-measured BP (SMBP) monitoring (mean 3.9). Participants noted challenges syncing the BP cuff to the app, internet connection, and transmitting the data to the research team. Conclusions: Enrollment and assessment completion were low, while acceptability was moderate. Technological advances will eliminate some of the Bluetooth SMBP barriers and offer new strategies for cognitive assessments. Subsequent studies could benefit from offering more comprehensive support to overcome Bluetooth-related hurdles, such as personalized training materials, video conferencing, or in-person research team support. Alternatively, strategies that do not require pairing with an app and passive transmission of data could be considered. Overall, further research is warranted to optimize participant engagement and overcome technological challenges. Trial Registration: ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718 ", doi="10.2196/54010", url="https://formative.jmir.org/2024/1/e54010", url="http://www.ncbi.nlm.nih.gov/pubmed/38805251" } @Article{info:doi/10.2196/55285, author="Beverly, A. Elizabeth and Koopman-Gonzalez, Sarah and Wright, Jackson and Dungan, Kathleen and Pallerla, Harini and Gubitosi-Klug, Rose and Baughman, Kristin and Konstan, W. Michael and Bolen, D. Shari", title="Assessing Priorities in a Statewide Cardiovascular and Diabetes Health Collaborative Based on the Results of a Needs Assessment: Cross-Sectional Survey Study", journal="JMIR Form Res", year="2024", month="Apr", day="12", volume="8", pages="e55285", keywords="health collaborative", keywords="cardiovascular disease", keywords="type 2 diabetes", keywords="needs assessment", abstract="Background: The Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH) unites general and subspecialty medical staff at the 7 medical schools in Ohio with community and public health partnerships to improve cardiovascular and diabetes health outcomes and eliminate disparities in Ohio's Medicaid population. Although statewide collaboratives exist to address health improvements, few deploy needs assessments to inform their work. Objective: Cardi-OH conducts an annual needs assessment to identify high-priority clinical topics, screening practices, policy changes for home monitoring devices and referrals, and preferences for the dissemination and implementation of evidence-based best practices. The results of the statewide needs assessment could also be used by others interested in disseminating best practices to primary care teams. Methods: A cross-sectional survey was distributed electronically via REDCap (Research Electronic Data Capture; Vanderbilt University) to both Cardi-OH grant-funded and non--grant-funded members (ie, people who have engaged with Cardi-OH but are not funded by the grant). Results: In total, 88\% (103/117) of Cardi-OH grant-funded members and 8.14\% (98/1204) of non--grant-funded members completed the needs assessment survey. Of these, 51.5\% (53/103) of Cardi-OH grant-funded members and 47\% (46/98) of non--grant-funded members provided direct clinical care. The top cardiovascular medicine and diabetes clinical topics for Cardi-OH grant-funded members (clinical and nonclinical) were lifestyle prescriptions (50/103, 48.5\%), atypical diabetes (38/103, 36.9\%), COVID-19 and cardiovascular disease (CVD; 38/103, 36.9\%), and mental health and CVD (38/103, 36.9\%). For non--grant-funded members, the top topics were lifestyle prescriptions (53/98, 54\%), mental health and CVD (39/98, 40\%), alcohol and CVD (27/98, 28\%), and cardiovascular complications (27/98, 28\%). Regarding social determinants of health, Cardi-OH grant-funded members prioritized 3 topics: weight bias and stigma (44/103, 42.7\%), family-focused interventions (40/103, 38.8\%), and adverse childhood events (37/103, 35.9\%). Non--grant-funded members' choices were family-focused interventions (51/98, 52\%), implicit bias (43/98, 44\%), and adverse childhood events (39/98, 40\%). Assessment of other risk factors for CVD and diabetes across grant- and non--grant-funded members revealed screening for social determinants of health in approximately 50\% of patients in each practice, whereas some frequency of depression and substance abuse screening occurred in 80\% to 90\% of the patients. Access to best practice home monitoring devices was challenging, with 30\% (16/53) and 41\% (19/46) of clinical grant-funded and non--grant-funded members reporting challenges in obtaining home blood pressure monitoring devices and 68\% (36/53) and 43\% (20/46) reporting challenges with continuous glucose monitors. Conclusions: Cardi-OH grant- and non--grant-funded members shared the following high-priority topics: lifestyle prescriptions, CVD and mental health, family-focused interventions, alcohol and CVD, and adverse childhood experiences. Identifying high-priority educational topics and preferred delivery modalities for evidence-based materials is essential for ensuring that the dissemination of resources is practical and useful for providers. ", doi="10.2196/55285", url="https://formative.jmir.org/2024/1/e55285", url="http://www.ncbi.nlm.nih.gov/pubmed/38607661" } @Article{info:doi/10.2196/54801, author="Wang, Xuzhi and Zhang, Yuankai and Pathiravasan, H. Chathurangi and Ukonu, C. Nene and Rong, Jian and Benjamin, J. Emelia and McManus, D. David and Larson, G. Martin and Vasan, S. Ramachandran and Hamburg, M. Naomi and Murabito, M. Joanne and Liu, Chunyu and Mitchell, F. Gary", title="Association of Arterial Stiffness With Mid- to Long-Term Home Blood Pressure Variability in the Electronic Framingham Heart Study: Cohort Study", journal="JMIR Cardio", year="2024", month="Apr", day="8", volume="8", pages="e54801", keywords="arterial stiffness", keywords="mobile health", keywords="mHealth", keywords="blood pressure", keywords="blood pressure variability", keywords="risk factors", abstract="Background: Short-term blood pressure variability (BPV) is associated with arterial stiffness in patients with hypertension. Few studies have examined associations between arterial stiffness and digital home BPV over a mid- to long-term time span, irrespective of underlying hypertension. Objective: This study aims to investigate if arterial stiffness traits were associated with subsequent mid- to long-term home BPV in the electronic Framingham Heart Study (eFHS). We hypothesized that higher arterial stiffness was associated with higher home BPV over up to 1-year follow-up. Methods: At a Framingham Heart Study research examination (2016-2019), participants underwent arterial tonometry to acquire measures of arterial stiffness (carotid-femoral pulse wave velocity [CFPWV]; forward pressure wave amplitude [FWA]) and wave reflection (reflection coefficient [RC]). Participants who agreed to enroll in eFHS were provided with a digital blood pressure (BP) cuff to measure home BP weekly over up to 1-year follow-up. Participants with less than 3 weeks of BP readings were excluded. Linear regression models were used to examine associations of arterial measures with average real variability (ARV) of week-to-week home systolic (SBP) and diastolic (DBP) BP adjusting for important covariates. We obtained ARV as an average of the absolute differences of consecutive home BP measurements. ARV considers not only the dispersion of the BP readings around the mean but also the order of BP readings. In addition, ARV is more sensitive to measurement-to-measurement BPV compared with traditional BPV measures. Results: Among 857 eFHS participants (mean age 54, SD 9 years; 508/857, 59\% women; mean SBP/DBP 119/76 mm Hg; 405/857, 47\% hypertension), 1 SD increment in FWA was associated with 0.16 (95\% CI 0.09-0.23) SD increments in ARV of home SBP and 0.08 (95\% CI 0.01-0.15) SD increments in ARV of home DBP; 1 SD increment in RC was associated with 0.14 (95\% CI 0.07-0.22) SD increments in ARV of home SBP and 0.11 (95\% CI 0.04-0.19) SD increments in ARV of home DBP. After adjusting for important covariates, there was no significant association between CFPWV and ARV of home SBP, and similarly, no significant association existed between CFPWV and ARV of home DBP (P>.05). Conclusions: In eFHS, higher FWA and RC were associated with higher mid- to long-term ARV of week-to-week home SBP and DBP over 1-year follow-up in individuals across the BP spectrum. Our findings suggest that higher aortic stiffness and wave reflection are associated with higher week-to-week variation of BP in a home-based setting over a mid- to long-term time span. ", doi="10.2196/54801", url="https://cardio.jmir.org/2024/1/e54801", url="http://www.ncbi.nlm.nih.gov/pubmed/38587880" } @Article{info:doi/10.2196/53006, author="Sun, Ting and Xu, Xuejie and Ding, Zenghui and Xie, Hui and Ma, Linlin and Zhang, Jing and Xia, Yuxin and Zhang, Guoli and Ma, Zuchang", title="Development of a Health Behavioral Digital Intervention for Patients With Hypertension Based on an Intelligent Health Promotion System and WeChat: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Apr", day="5", volume="12", pages="e53006", keywords="adherence", keywords="hypertension", keywords="health behavior", keywords="mHealth", keywords="digital health", abstract="Background: The effectiveness of timely medication, physical activity (PA), a healthy diet, and blood pressure (BP) monitoring for promoting health outcomes and behavioral changes among patients with hypertension is supported by a substantial amount of literature, with ``adherence'' playing a pivotal role. Nevertheless, there is a lack of consistent evidence regarding whether digital interventions can improve adherence to healthy behaviors among individuals with hypertension. Objective: The aim was to develop a health behavioral digital intervention for hypertensive patients (HBDIHP) based on an intelligent health promotion system and WeChat following the behavior change wheel (BCW) theory and digital micro-intervention care (DMIC) model and assess its efficacy in controlling BP and improving healthy behavior adherence. Methods: A 2-arm, randomized trial design was used. We randomly assigned 68 individuals aged >60 years with hypertension in a 1:1 ratio to either the control or experimental group. The digital intervention was established through the following steps: (1) developing digital health education materials focused on adherence to exercise prescriptions, Dietary Approaches to Stop Hypertension (DASH), prescribed medication, and monitoring of BP; (2) using the BCW theory to select behavior change techniques; (3) constructing the intervention's logic following the guidelines of the DMIC model; (4) creating an intervention manual including the aforementioned elements. Prior to the experiment, participants underwent physical examinations at the community health service center's intelligent health cabin and received intelligent personalized health recommendations. The experimental group underwent a 12-week behavior intervention via WeChat, while the control group received routine health education and a self-management manual. The primary outcomes included BP and adherence indicators. Data analysis was performed using SPSS, with independent sample t tests, chi-square tests, paired t tests, and McNemar tests. A P value <.05 was considered statistically significant. Results: The final analysis included 54 participants with a mean age of 67.24 (SD 4.19) years (n=23 experimental group, n=31 control group). The experimental group had improvements in systolic BP (--7.36 mm Hg, P=.002), exercise time (856.35 metabolic equivalent [MET]-min/week, P<.001), medication adherence (0.56, P=.001), BP monitoring frequency (P=.02), and learning performance (3.23, P<.001). Both groups experienced weight reduction (experimental: 1.2 kg, P=.002; control: 1.11 kg, P=.009) after the intervention. The diet types and quantities for both groups (P<.001) as well as the subendocardial viability ratio (0.16, P=.01) showed significant improvement. However, there were no statistically significant changes in other health outcomes. Conclusions: The observations suggest our program may have enhanced specific health outcomes and adherence to health behaviors in older adults with hypertension. However, a longer-term, larger-scale trial is necessary to validate the effectiveness. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200062643; https://www.chictr.org.cn/showprojEN.html?proj=172782 International Registered Report Identifier (IRRID): RR2-10.2196/46883 ", doi="10.2196/53006", url="https://mhealth.jmir.org/2024/1/e53006", url="http://www.ncbi.nlm.nih.gov/pubmed/38578692" } @Article{info:doi/10.2196/51848, author="Yoon, Sungwon and Tan, Min Chao and Phang, Kie Jie and Liu, Xi Venice and Tan, Boon Wee and Kwan, Heng Yu and Low, Leng Lian", title="Exploring the Implementation of Shared Decision-Making Involving Health Coaches for Diabetes and Hypertension Self-Management: Qualitative Study", journal="JMIR Form Res", year="2024", month="Apr", day="4", volume="8", pages="e51848", keywords="decision-making", keywords="diabetes", keywords="health coach", keywords="health coaching", keywords="healthcare professional", keywords="hypertension", keywords="patient", keywords="patient-centered care", keywords="person-centered care", keywords="qualitative research", keywords="self-management", keywords="shared decision-making", abstract="Background: An emerging focus on person-centered care has prompted the need to understand how shared decision-making (SDM) and health coaching could support self-management of diabetes and hypertension. Objective: This study aims to explore preferences for the scope of involvement of health coaches and health care professionals (HCPs) in SDM and the factors that may influence optimal implementation of SDM from the perspectives of patients and HCPs. Methods: We conducted focus group discussions with 39 patients with diabetes and hypertension and 45 HCPs involved in their care. The main topics discussed included the roles of health coaches and HCPs in self-management, views toward health coaching and SDM, and factors that should be considered for optimal implementation of SDM that involves health coaches. All focus group discussions were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Participants agreed that the main responsibility of HCPs should be identifying the patient's stage of change and medication education, while health coaches should focus on lifestyle education, monitoring, and motivational conversation. The health coach was seen to be more effective in engaging patients in lifestyle education and designing goal management plans as health coaches have more time available to spend with patients. The importance of a health coach's personal attributes (eg, sufficient knowledge of both medical and psychosocial management of disease conditions) and credentials (eg, openness, patience, and empathy) was commonly emphasized. Participants viewed that addressing the following five elements would be necessary for the optimal implementation of SDM: (1) target population (newly diagnosed and less stable patients), (2) commitment of all stakeholders (discrepancy on targeted times and modality), (3) continuity of care (familiar faces), (4) philosophy of care (person-centered communication), and (5) faces of legitimacy (physician as the ultimate authority). Conclusions: The findings shed light on the appropriate roles of health coaches vis-{\`a}-vis HCPs in SDM as perceived by patients and HCPs. Findings from this study also contribute to the understanding of SDM on self-management strategies for patients with diabetes and hypertension and highlight potential opportunities for integrating health coaches into the routine care process. ", doi="10.2196/51848", url="https://formative.jmir.org/2024/1/e51848", url="http://www.ncbi.nlm.nih.gov/pubmed/38573763" } @Article{info:doi/10.2196/55199, author="He, Yunfan and Zhu, Wei and Wang, Tong and Chen, Han and Xin, Junyi and Liu, Yongcheng and Lei, Jianbo and Liang, Jun", title="Mining User Reviews From Hypertension Management Mobile Health Apps to Explore Factors Influencing User Satisfaction and Their Asymmetry: Comparative Study", journal="JMIR Mhealth Uhealth", year="2024", month="Mar", day="28", volume="12", pages="e55199", keywords="hypertension management", keywords="mobile health", keywords="topic modeling", keywords="satisfaction", keywords="2-factor model", keywords="comparative study", abstract="Background: Hypertension significantly impacts the well-being and health of individuals globally. Hypertension management apps (HMAs) have been shown to assist patients in controlling blood pressure (BP), with their efficacy validated in clinical trials. However, the utilization of HMAs continues to be suboptimal. Presently, there is a dearth of real-world research based on big data and exploratory mining that compares Chinese and American HMAs. Objective: This study aims to systematically gather HMAs and their user reviews from both China and the United States. Subsequently, using data mining techniques, the study aims to compare the user experience, satisfaction levels, influencing factors, and asymmetry between Chinese and American users of HMAs. In addition, the study seeks to assess the disparities in satisfaction and its determinants while delving into the asymmetry of these factors. Methods: The study sourced HMAs and user reviews from 10 prominent Chinese and American app stores globally. Using the latent Dirichlet allocation (LDA) topic model, the research identified various topics within user reviews. Subsequently, the Tobit model was used to investigate the impact and distinctions of each topic on user satisfaction. The Wald test was applied to analyze differences in effects across various factors. Results: We examined a total of 261 HMAs along with their associated user reviews, amounting to 116,686 reviews in total. In terms of quantity and overall satisfaction levels, Chinese HMAs (n=91) and corresponding reviews (n=16,561) were notably fewer compared with their American counterparts (n=220 HMAs and n=100,125 reviews). The overall satisfaction rate among HMA users was 75.22\% (87,773/116,686), with Chinese HMAs demonstrating a higher satisfaction rate (13,866/16,561, 83.73\%) compared with that for American HMAs (73,907/100,125, 73.81\%). Chinese users primarily focus on reliability (2165/16,561, 13.07\%) and measurement accuracy (2091/16,561, 12.63\%) when considering HMAs, whereas American users prioritize BP tracking (17,285/100,125, 17.26\%) and data synchronization (12,837/100,125, 12.82\%). Seven factors (easy to use: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; heart rate detection function: P=.02; blood pressure tracking function: P<.001; and interface design: P=.01) significantly influenced the positive deviation (PD) of Chinese HMA user satisfaction, while 8 factors (easy to use: P<.001; reliability: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; interface design: P<.001; real-time: P<.001; and data privacy: P=.001) affected the negative deviation (ND). Notably, BP tracking had the greatest effect on PD ($\beta$=.354, P<.001), while cost had the most significant impact on ND ($\beta$=3.703, P<.001). All 12 factors (easy to use: P<.001; blood pressure tracking function: P<.001; data synchronization: P<.001; blood pressure management effect: P<.001; heart rate detection function: P<.001; data sharing: P<.001; reliability: P<.001; compatibility: P<.001; interface design: P<.001; advertisement distribution: P<.001; measurement accuracy: P<.001; and cost: P<.001) significantly influenced the PD and ND of American HMA user satisfaction. Notably, BP tracking had the greatest effect on PD ($\beta$=0.312, P<.001), while data synchronization had the most significant impact on ND ($\beta$=2.662, P<.001). In addition, the influencing factors of PD and ND in user satisfaction of HMA in China and the United States are different. Conclusions: User satisfaction factors varied significantly between different countries, showing considerable asymmetry. For Chinese HMA users, ease of use and interface design emerged as motivational factors, while factors such as cost, measurement accuracy, and compatibility primarily contributed to user dissatisfaction. For American HMA users, motivational factors were ease of use, BP tracking, BP management effect, interface design, measurement accuracy, and cost. Moreover, users expect features such as data sharing, synchronization, software reliability, compatibility, heart rate detection, and nonintrusive advertisement distribution. Tailored experience plans should be devised for different user groups in various countries to address these diverse preferences and requirements. ", doi="10.2196/55199", url="https://mhealth.jmir.org/2024/1/e55199", url="http://www.ncbi.nlm.nih.gov/pubmed/38547475" } @Article{info:doi/10.2196/53722, author="Ibrahim, Yakubu and Basri, Iftida Nurul and Nordin, Norshariza and Mohd Jamil, Afzan Amilia", title="Vitamin D Deficiency and Its Association With Vitamin D Receptor Gene Variants Among Malaysian Women With Hypertensive Disorders in Pregnancy: Protocol for a Nutrigenomics Study", journal="JMIR Res Protoc", year="2024", month="Mar", day="26", volume="13", pages="e53722", keywords="gestational hypertension", keywords="preeclampsia", keywords="hypertensive disorder", keywords="vitamin D deficiency", keywords="vitamin D receptor gene polymorphism", keywords="vitamin D sequence", abstract="Background: Vitamin D deficiency has been associated with hypertensive disorders in pregnancy (HDP). The risk of developing HDP was reported to be further augmented among individuals with a vitamin D receptor (VDR) genetic variant. However, the reported roles of VDR variants in hypertensive disorders are inconsistent among different populations. Given the relatively higher incidence of vitamin D deficiency among Malaysian pregnant women and the high incidence of HDP in this population, we hypothesize that there may be associations between the risk of vitamin D deficiency and HDP with VDR genetic variants. Objective: This paper outlines the protocol for a study to determine the association of vitamin D status and VDR sequence variants among Malaysian pregnant women with HDP. Methods: This prospective study consists of two phases. The first phase is a cross-sectional study that will entail gathering medical records, a questionnaire survey, and laboratory testing for vitamin D status, with a planned recruitment of 414 pregnant women. The questionnaire will be utilized to assess the risk factors for vitamin D deficiency. The vitamin D status will be obtained from measurement of the vitamin D (25-hydroxyvitamin D3) level in the blood. The second phase is a case-control study involving a Malay ethnic cohort with vitamin D deficiency. Participants will be divided into two groups with and without HDP (n=150 per group). Genomic DNA will be extracted from the peripheral blood monocytes of participants using the Qiagen DNA blood kit, and VDR sequence variants will be determined using polymerase chain reaction--high-resolution melting (PCR-HRM) analysis. Sanger sequencing will then be used to sequence randomly selected samples corresponding to each identified variant to validate our PCR-HRM results. The VDR genotype and mutation frequencies of BsmI, ApaI, TaqI, and FokI will be statistically analyzed to evaluate their relationships with developing HDP. Results: As of December 2023, 340 subjects have been recruited for the phase 1 study, 63\% of whom were determined to have vitamin D deficiency. In the phase 2 study, 50 and 22 subjects have been recruited from the control and case groups, respectively. Recruitment is expected to be completed by March 2024 and all analyses should be completed by August 2024. Conclusions: The outcome of the study will identify the nonmodifiable genetic components contributing to developing vitamin D deficiency leading to HDP. This will in turn enable gaining a better understanding of the contribution of genetic variability to the development of HDP, thus providing more evidence for a need of customized vitamin D supplementation during pregnancy according to the individual variability in the response to vitamin D intake. Trial Registration: ClinicalTrials.gov NCT05659173; https://clinicaltrials.gov/study/NCT05659173 International Registered Report Identifier (IRRID): DERR1-10.2196/53722 ", doi="10.2196/53722", url="https://www.researchprotocols.org/2024/1/e53722", url="http://www.ncbi.nlm.nih.gov/pubmed/38530345" } @Article{info:doi/10.2196/55615, author="Kargarandehkordi, Ali and Slade, Christopher and Washington, Peter", title="Personalized AI-Driven Real-Time Models to Predict Stress-Induced Blood Pressure Spikes Using Wearable Devices: Proposal for a Prospective Cohort Study", journal="JMIR Res Protoc", year="2024", month="Mar", day="25", volume="13", pages="e55615", keywords="stress", keywords="hypertension", keywords="precision health", keywords="personalized artificial intelligence", keywords="wearables", keywords="ecological momentary assessments", keywords="passive sensing", keywords="mobile phone", abstract="Background: Referred to as the ``silent killer,'' elevated blood pressure (BP) often goes unnoticed due to the absence of apparent symptoms, resulting in cumulative harm over time. Chronic stress has been consistently linked to increased BP. Prior studies have found that elevated BP often arises due to a stressful lifestyle, although the effect of exact stressors varies drastically between individuals. The heterogeneous nature of both the stress and BP response to a multitude of lifestyle decisions can make it difficult if not impossible to pinpoint the most deleterious behaviors using the traditional mechanism of clinical interviews. Objective: The aim of this study is to leverage machine learning (ML) algorithms for real-time predictions of stress-induced BP spikes using consumer wearable devices such as Fitbit, providing actionable insights to both patients and clinicians to improve diagnostics and enable proactive health monitoring. This study also seeks to address the significant challenges in identifying specific deleterious behaviors associated with stress-induced hypertension through the development of personalized artificial intelligence models for individual patients, departing from the conventional approach of using generalized models. Methods: The study proposes the development of ML algorithms to analyze biosignals obtained from these wearable devices, aiming to make real-time predictions about BP spikes. Given the longitudinal nature of the data set comprising time-series data from wearables (eg, Fitbit) and corresponding time-stamped labels representing stress levels from Ecological Momentary Assessment reports, the adoption of self-supervised learning for pretraining the network and using transformer models for fine-tuning the model on a personalized prediction task is proposed. Transformer models, with their self-attention mechanisms, dynamically weigh the importance of different time steps, enabling the model to focus on relevant temporal features and dependencies, facilitating accurate prediction. Results: Supported as a pilot project from the Robert C Perry Fund of the Hawaii Community Foundation, the study team has developed the core study app, CardioMate. CardioMate not only reminds participants to initiate BP readings using an Omron HeartGuide wearable monitor but also prompts them multiple times a day to report stress levels. Additionally, it collects other useful information including medications, environmental conditions, and daily interactions. Through the app's messaging system, efficient contact and interaction between users and study admins ensure smooth progress. Conclusions: Personalized ML when applied to biosignals offers the potential for real-time digital health interventions for chronic stress and its symptoms. The project's clinical use for Hawaiians with stress-induced high BP combined with its methodological innovation of personalized artificial intelligence models highlights its significance in advancing health care interventions. Through iterative refinement and optimization, the aim is to develop a personalized deep-learning framework capable of accurately predicting stress-induced BP spikes, thereby promoting individual well-being and health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/55615 ", doi="10.2196/55615", url="https://www.researchprotocols.org/2024/1/e55615", url="http://www.ncbi.nlm.nih.gov/pubmed/38526539" } @Article{info:doi/10.2196/48300, author="Allen, S. Katie and Valvi, Nimish and Gibson, Joseph P. and McFarlane, Timothy and Dixon, E. Brian", title="Electronic Health Records for Population Health Management: Comparison of Electronic Health Record--Derived Hypertension Prevalence Measures Against Established Survey Data", journal="Online J Public Health Inform", year="2024", month="Mar", day="13", volume="16", pages="e48300", keywords="public health informatics", keywords="surveillance", keywords="chronic conditions", keywords="electronic health record", keywords="health management", keywords="hypertension", keywords="public health", keywords="prevalence", keywords="population-based survey", abstract="Background: Hypertension is the most prevalent risk factor for mortality globally. Uncontrolled hypertension is associated with excess morbidity and mortality, and nearly one-half of individuals with hypertension do not have the condition under control. Data from electronic health record (EHR) systems may be useful for community hypertension surveillance, filling a gap in local public health departments' community health assessments and supporting the public health data modernization initiatives currently underway. To identify patients with hypertension, computable phenotypes are required. These phenotypes leverage available data elements---such as vitals measurements and medications---to identify patients diagnosed with hypertension. However, there are multiple methodologies for creating a phenotype, and the identification of which method most accurately reflects real-world prevalence rates is needed to support data modernization initiatives. Objective: This study sought to assess the comparability of 6 different EHR-based hypertension prevalence estimates with estimates from a national survey. Each of the prevalence estimates was created using a different computable phenotype. The overarching goal is to identify which phenotypes most closely align with nationally accepted estimations. Methods: Using the 6 different EHR-based computable phenotypes, we calculated hypertension prevalence estimates for Marion County, Indiana, for the period from 2014 to 2015. We extracted hypertension rates from the Behavioral Risk Factor Surveillance System (BRFSS) for the same period. We used the two 1-sided t test (TOST) to test equivalence between BRFSS- and EHR-based prevalence estimates. The TOST was performed at the overall level as well as stratified by age, gender, and race. Results: Using both 80\% and 90\% CIs, the TOST analysis resulted in 2 computable phenotypes demonstrating rough equivalence to BRFSS estimates. Variation in performance was noted across phenotypes as well as demographics. TOST with 80\% CIs demonstrated that the phenotypes had less variance compared to BRFSS estimates within subpopulations, particularly those related to racial categories. Overall, less variance occurred on phenotypes that included vitals measurements. Conclusions: This study demonstrates that certain EHR-derived prevalence estimates may serve as rough substitutes for population-based survey estimates. These outcomes demonstrate the importance of critically assessing which data elements to include in EHR-based computer phenotypes. Using comprehensive data sources, containing complete clinical data as well as data representative of the population, are crucial to producing robust estimates of chronic disease. As public health departments look toward data modernization activities, the EHR may serve to assist in more timely, locally representative estimates for chronic disease prevalence. ", doi="10.2196/48300", url="https://ojphi.jmir.org/2024/1/e48300", url="http://www.ncbi.nlm.nih.gov/pubmed/38478904" } @Article{info:doi/10.2196/53835, author="Hofner, Michael and Hurnaus, Patrick and DiStefano, Dan and Philip, Shaji and Kim, Sarah and Shaw, Julie and Waring, Chander Avantika", title="Outcomes of an Asynchronous Care Model for Chronic Conditions in a Diverse Population: 12-Month Retrospective Chart Review Study", journal="JMIR Diabetes", year="2024", month="Mar", day="13", volume="9", pages="e53835", keywords="asynchronous", keywords="blood pressure", keywords="cardiology", keywords="chronic disease", keywords="cohort", keywords="diabetes mellitus therapy", keywords="diabetes", keywords="diabetics", keywords="eHealth", keywords="e-health", keywords="HbA1c", keywords="health disparities", keywords="heart", keywords="hemoglobin A1c", keywords="hypertension therapy", keywords="hypertension", keywords="hypertensive", keywords="remote care", keywords="retrospective", keywords="telehealth", keywords="telemedicine", keywords="virtual care", abstract="Background: Diabetes and hypertension are some of the most prevalent and costly chronic conditions in the United States. However, outcomes continue to lag behind targets, creating further risk of long-term complications, morbidity, and mortality for people living with these conditions. Furthermore, racial and ethnic disparities in glycemic and hypertension control persist. Flexible telehealth programs leveraging asynchronous care allow for increased provider access and more convenient follow-up, ultimately improving critical health outcomes across demographic groups. Objective: We aim to evaluate the 12-month clinical outcomes of participants in the 9amHealth web-based clinic for diabetes and hypertension. We hypothesized that participation in the 9amHealth program would be associated with significant improvements in glycemic and blood pressure (BP) control across a diverse group of individuals. Methods: We enrolled 95 patients in a completely web-based care clinic for diabetes and hypertension who received nutrition counseling, health coaching, and asynchronous physician consultations for medication prescribing. Patients received standard or cellular-connected glucose meters and BP cuffs in order to share data. Laboratory tests were completed either with at-home phlebotomy draws or a self-administered test kit. Patients' first and last hemoglobin A1c (HbA1c) and BP results over the 12-month period were compared, and analyses were repeated across race and ethnicity groups. Results: Among all 95 patients, the average HbA1c decreased by --1.0 (from 8.2\% to 7.2\%; P<.001) over 12 months of program participation. In those with a baseline HbA1c >8\%, the average HbA1c decreased by --2.1 (from 10.2\% to 8.1\%; P<.001), and in those with a baseline HbA1c >9\%, the average HbA1c decreased by --2.8 (from 11\% to 8.2\%; P<.001). Among participants who identified as a race or ethnicity other than White, the HbA1c decreased by --1.2 (from 8.6\% to 7.4\%, P=.001). Further examination of subgroups confirmed HbA1c lowering within each race or ethnicity group. In the overall population, the average systolic BP decreased by 17.7 mm Hg (P=.006) and the average diastolic BP decreased by 14.3 mm Hg (P=.002). Among participants self-identifying as a race or ethnicity other than White, the results similarly showed a decrease in BP (average reduction in systolic BP of 10 mm Hg and in diastolic BP of 9 mm Hg). Conclusions: A fully web-based model leveraging all-asynchronous physician review and prescribing, combined with synchronous and asynchronous coaching and nutrition support, was associated with clinically meaningful improvement in HbA1c and BP control over a 12-month period among a diverse group of individuals. Further studies should prospectively evaluate the effectiveness of such models among larger populations, assess the longer-term sustainability of these outcomes, and explore financial models to make these types of programs broadly accessible. ", doi="10.2196/53835", url="https://diabetes.jmir.org/2024/1/e53835", url="http://www.ncbi.nlm.nih.gov/pubmed/38363585" } @Article{info:doi/10.2196/51802, author="Wang, Jie and Tan, Fangqin and Wang, Zhenzhong and Yu, Yiwen and Yang, Jingsong and Wang, Yueqing and Shao, Ruitai and Yin, Xuejun", title="Understanding Gaps in the Hypertension and Diabetes Care Cascade: Systematic Scoping Review", journal="JMIR Public Health Surveill", year="2024", month="Feb", day="16", volume="10", pages="e51802", keywords="care cascade", keywords="hypertension", keywords="diabetes", keywords="scoping review", keywords="hypertension and diabetes care", keywords="review", abstract="Background: Hypertension and diabetes are global health challenges requiring effective management to mitigate their considerable burden. The successful management of hypertension and diabetes requires the completion of a sequence of stages, which are collectively termed the care cascade. Objective: This scoping review aimed to describe the characteristics of studies on the hypertension and diabetes care cascade and identify potential interventions as well as factors that impact each stage of the care cascade. Methods: The method of this scoping review has been guided by the framework by Arksey and O'Malley. We systematically searched MEDLINE, Embase, and Web of Science using terms pertinent to hypertension, diabetes, and specific stages of the care cascade. Articles published after 2011 were considered, and we included all studies that described the completion of at least one stage of the care cascade of hypertension and diabetes. Study selection was independently performed by 2 paired authors. Descriptive statistics were used to elucidate key patterns and trends. Inductive content analysis was performed to generate themes regarding the barriers and facilitators for improving the care cascade in hypertension and diabetes management. Results: A total of 128 studies were included, with 42.2\% (54/128) conducted in high-income countries. Of them, 47 (36.7\%) focused on hypertension care, 63 (49.2\%) focused on diabetes care, and only 18 (14.1\%) reported on the care of both diseases. The majority (96/128, 75.0\%) were observational in design. Cascade stages documented in the literature were awareness, screening, diagnosis, linkage to care, treatment, adherence to medication, and control. Most studies focused on the stages of treatment and control, while a relative paucity of studies examined the stages before treatment initiation (76/128, 59.4\% vs 52/128, 40.6\%). There was a wide spectrum of interventions aimed at enhancing the hypertension and diabetes care cascade. The analysis unveiled a multitude of individual-level and system-level factors influencing the successful completion of cascade sequences in both high-income and low- and middle-income settings. Conclusions: This review offers a comprehensive understanding of hypertension and diabetes management, emphasizing the pivotal factors that impact each stage of care. Future research should focus on upstream cascade stages and context-specific interventions to optimize patient retention and care outcomes. ", doi="10.2196/51802", url="https://publichealth.jmir.org/2024/1/e51802", url="http://www.ncbi.nlm.nih.gov/pubmed/38149840" } @Article{info:doi/10.2196/54530, author="Kormanis, Aryn and Quinones, Selina and Obermiller, Corey and Denizard-Thompson, Nancy and Palakshappa, Deepak", title="Feasibility of Using Text Messaging to Identify and Assist Patients With Hypertension With Health-Related Social Needs: Cross-Sectional Study", journal="JMIR Cardio", year="2024", month="Feb", day="13", volume="8", pages="e54530", keywords="social determinants of health", keywords="health-related social needs", keywords="mobile health", keywords="health information technology", keywords="feasibility", keywords="mobile phone", keywords="SMS text messaging", keywords="message", keywords="pilot study", keywords="patients", keywords="patient", keywords="hypertension", keywords="screening", abstract="Background: Health-related social needs are associated with poor health outcomes, increased acute health care use, and impaired chronic disease management. Given these negative outcomes, an increasing number of national health care organizations have recommended that the health system screen and address unmet health-related social needs as a routine part of clinical care, but there are limited data on how to implement social needs screening in clinical settings to improve the management of chronic diseases such as hypertension. SMS text messaging could be an effective and efficient approach to screen patients; however, there are limited data on the feasibility of using it. Objective: We conducted a cross-sectional study of patients with hypertension to determine the feasibility of using SMS text messaging to screen patients for unmet health-related social needs. Methods: We randomly selected 200 patients (?18 years) from 1 academic health system. Patients were included if they were seen at one of 17 primary care clinics that were part of the academic health system and located in Forsyth County, North Carolina. We limited the sample to patients seen in one of these clinics to provide tailored information about local community-based resources. To ensure that the participants were still patients within the clinic, we only included those who had a visit in the previous 3 months. The SMS text message included a link to 6 questions regarding food, housing, and transportation. Patients who screened positive and were interested received a subsequent message with information about local resources. We assessed the proportion of patients who completed the questions. We also evaluated for the differences in the demographics between patients who completed the questions and those who did not using bivariate analyses. Results: Of the 200 patients, the majority were female (n=109, 54.5\%), non-Hispanic White (n=114, 57.0\%), and received commercial insurance (n=105, 52.5\%). There were no significant differences in demographics between the 4446 patients who were eligible and the 200 randomly selected patients. Of the 200 patients included, the SMS text message was unable to be delivered to 9 (4.5\%) patients and 17 (8.5\%) completed the social needs questionnaire. We did not observe a significant difference in the demographic characteristics of patients who did versus did not complete the questionnaire. Of the 17, a total of 5 (29.4\%) reported at least 1 unmet need, but only 2 chose to receive resource information. Conclusions: We found that only 8.5\% (n=17) of patients completed a SMS text message--based health-related social needs questionnaire. SMS text messaging may not be feasible as a single modality to screen patients in this population. Future research should evaluate if SMS text message--based social needs screening is feasible in other populations or effective when paired with other screening modalities. ", doi="10.2196/54530", url="https://cardio.jmir.org/2024/1/e54530", url="http://www.ncbi.nlm.nih.gov/pubmed/38349714" } @Article{info:doi/10.2196/49592, author="Tran, C. Karen and Mak, Meagan and Kuyper, M. Laura and Bittman, Jesse and Mangat, Birinder and Lindsay, Heather and Kim Sing, Chad and Xu, Liang and Wong, Hubert and Dawes, Martin and Khan, Nadia and Ho, Kendall", title="Home Blood Pressure Telemonitoring Technology for Patients With Asymptomatic Elevated Blood Pressure Discharged From the Emergency Department: Pilot Study", journal="JMIR Form Res", year="2024", month="Jan", day="30", volume="8", pages="e49592", keywords="hypertension", keywords="remote-home monitoring", keywords="feasibility study", keywords="health monitor", keywords="telehealth", keywords="pilot study", keywords="mobile phone", keywords="monitoring", keywords="telemonitoring", keywords="blood pressure", keywords="emergency department", keywords="morbidity", keywords="mortality", keywords="primary care", keywords="physician care", keywords="management", keywords="hypertension medication", abstract="Background: Hypertension affects 1 in 5 Canadians and is the leading cause of morbidity and mortality globally. Hypertension control is declining due to multiple factors including lack of access to primary care. Consequently, patients with hypertension frequently visit the emergency department (ED) due to high blood pressure (BP). Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring Blood Pressure is a pilot project that implements and evaluates a comprehensive home blood pressure telemonitoring (HBPT) and physician case management protocol designed as a postdischarge management strategy to support patients with asymptomatic elevated BP as they transition from the ED to home. Objective: Our objective was to conduct a feasibility study of an HBPT program for patients with asymptomatic elevated BP discharged from the ED. Methods: Patients discharged from an urban, tertiary care hospital ED with asymptomatic elevated BP were recruited in Vancouver, British Columbia, Canada, and provided with HBPT technology for 3 months of monitoring post discharge and referred to specialist hypertension clinics. Participants monitored their BP twice in the morning and evenings and tele-transmitted readings via Bluetooth Sensor each day using an app. A monitoring clinician received these data and monitored the patient's condition daily and adjusted antihypertensive medications. Feasibility outcomes included eligibility, recruitment, adherence to monitoring, and retention rates. Secondary outcomes included proportion of those who were defined as having hypertension post-ED visits, changes in mean BP, overall BP control, medication adherence, changes to antihypertensive medications, quality of life, and end user experience at 3 months. Results: A total of 46 multiethnic patients (mean age 63, SD 17 years, 69\%, n=32 women) found to have severe hypertension (mean 191, SD 23/mean 100, SD 14 mm Hg) in the ED were recruited, initiated on HBPT with hypertension specialist physician referral and followed up for 3 months. Eligibility and recruitment rates were 40\% (56/139) and 88\% (49/56), respectively. The proportion of participants that completed ?80\% of home BP measurements at 1 and 3 months were 67\% (31/46) and 41\% (19/46), respectively. The proportion of individuals who achieved home systolic BP and diastolic BP control at 3 months was 71.4\% (30/42) and 85.7\% (36/42) respectively. Mean home systolic and diastolic BP improved by --13/--5 mm Hg after initiation of HBPT to the end of the study. Patients were prescribed 1 additional antihypertensive medication. No differences in medication adherence from enrollment to 3 months were noted. Most patients (76\%, 25/33) were highly satisfied with the HBPT program and 76\% (25/33) found digital health tools easy to use. Conclusions: HBPT intervention is a feasible postdischarge management strategy and can be beneficial in supporting patients with asymptomatic elevated BP from the ED. A randomized trial is underway to evaluate the efficacy of this intervention on BP control. ", doi="10.2196/49592", url="https://formative.jmir.org/2024/1/e49592", url="http://www.ncbi.nlm.nih.gov/pubmed/38111177" } @Article{info:doi/10.2196/43809, author="Liu, Fang and Song, Ting and Yu, Ping and Deng, Ning and Guan, Yingping and Yang, Yang and Ma, Yuanji", title="Efficacy of an mHealth App to Support Patients' Self-Management of Hypertension: Randomized Controlled Trial", journal="J Med Internet Res", year="2023", month="Dec", day="19", volume="25", pages="e43809", keywords="mobile app", keywords="mHealth", keywords="mobile health", keywords="smartphone", keywords="high blood pressure", keywords="medication adherence", keywords="reminder", keywords="health education", keywords="motivation", keywords="hypertension control", keywords="hypertension", keywords="blood pressure", keywords="self-management", abstract="Background: Hypertension is a significant global disease burden. Mobile health (mHealth) offers a promising means to provide patients with hypertension with easy access to health care services. Yet, its efficacy needs to be validated, especially in lower-income areas with a high-salt diet. Objective: This study aims to assess the efficacy of an mHealth app--based intervention in supporting patients' self-management of hypertension. Methods: A 2-arm randomized controlled trial was conducted among 297 patients with hypertension at the General Hospital of Ningxia Medical University, Ningxia Hui Autonomous Region, China. Participants selected via convenience sampling were randomly allocated into intervention and control groups. Intervention group participants were trained and asked to use an mHealth app named Blood Pressure Assistant for 6 months. They could use the app to record and upload vital signs, access educational materials, and receive self-management reminders and feedback from health care providers based on the analysis of the uploaded data. Control group participants received usual care. Blood pressure (BP) and 2 questionnaire surveys about hypertension knowledge and lifestyle behavior were used to assess all participants at baseline and 6 months. Data analysis was performed with SPSS software using 2-tailed t tests and a chi-square test. Results: There were no significant differences in baseline characteristics and medication use between the 2 groups (all P>.05). After 6 months, although both groups show a significant pre-post improvement (P<.001 each), the BP control rate (ie, the proportion of patients with a systolic BP of <140 mm Hg and diastolic BP of <90 mm Hg) in the intervention group was better than that in the control group (100/111, 90.1\% vs 75/115, 65.2\%; P<.001). The mean systolic and diastolic BP were significantly reduced by 25.83 (SD 8.99) and 14.28 (SD 3.74) mm Hg in the intervention group (P<.001) and by 21.83 (SD 6.86) and 8.87 (SD 4.22) mm Hg in the control group (P<.001), respectively. The differences in systolic and diastolic BP between the 2 groups were significant (P<.001 and P=.01, respectively). Hypertension knowledge significantly improved only in the intervention group in both pre-post and intergroup comparisons (both P<.001). However, only intragroup improvement was observed for lifestyle behaviors in the intervention group (P<.001), including medication adherence (P<.001), healthy diet (P=.02), low salt intake (P<.001), and physical exercises (P=.02), and no significant difference was observed in the control group or on intergroup comparisons. Conclusions: This research shows that the mHealth app--based intervention has the potential to improve patient health knowledge and support self-management among them toward a healthier lifestyle, including medication adherence, low-salt diets, and physical exercises, thereby achieving optimal BP control. Further research is still needed to verify the specific effects of these interventions. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900026437; https://www.chictr.org.cn/showproj.html?proj=38801 ", doi="10.2196/43809", url="https://www.jmir.org/2023/1/e43809", url="http://www.ncbi.nlm.nih.gov/pubmed/38113071" } @Article{info:doi/10.2196/52464, author="Wang, Yijun and Guo, Fuding and Wang, Jun and Li, Zeyan and Tan, Wuping and Xie, Mengjie and Yang, Xiaomeng and Duan, Shoupeng and Song, Lingpeng and Cheng, Siyi and Liu, Zhihao and Liu, Hengyang and Qiao, Jiaming and Wang, Yueyi and Zhou, Liping and Zhou, Xiaoya and Jiang, Hong and Yu, Lilei", title="Efficacy of a WeChat-Based Multimodal Digital Transformation Management Model in New-Onset Mild to Moderate Hypertension: Randomized Clinical Trial", journal="J Med Internet Res", year="2023", month="Dec", day="4", volume="25", pages="e52464", keywords="digital health care", keywords="mHealth", keywords="mobile health", keywords="apps", keywords="applications", keywords="controlled trials", keywords="digital transformation", keywords="precision", keywords="multimodal", keywords="precision medicine", keywords="hypertension", keywords="blood pressure", keywords="WeChat", keywords="social media", keywords="self-management", keywords="mobile phone", abstract="Background: The advantages of multimodal digitally transformed mobile health management for patients diagnosed with mild to moderate hypertension are not yet established. Objective: We aim to evaluate the therapeutic benefits of a novel WeChat-based multimodal digital transforming management model in mobile health blood pressure (BP) management. Methods: This randomized controlled clinical trial included 175 individuals with new-onset mild to moderate hypertension who were admitted to our center between September and October 2022. The patients were randomly assigned to either the multimodal intervention group (n=88) or the usual care group (n=87). The primary composite outcome was home and office BP differences after 6 months. The major secondary outcomes were 6-month quality-of-life scores, including the self-rating anxiety scale, self-rating depression scale, and Pittsburgh Sleep Quality Index. Results: The mean home BP decreased from 151.74 (SD 8.02)/94.22 (SD 9.32) to 126.19 (SD 8.45)/82.28 (SD 9.26) mm Hg in the multimodal intervention group and from 150.78 (SD 7.87)/91.53 (SD 9.78) to 133.48 (SD 10.86)/84.45 (SD 9.19) mm Hg in the usual care group, with a mean difference in systolic blood pressure and diastolic blood pressure of --8.25 mm Hg (95\% CI --11.71 to --4.78 mm Hg; P<.001) and --4.85 mm Hg (95\% CI --8.41 to --1.30 mm Hg; P=.008), respectively. The mean office BP decreased from 153.64 (SD 8.39)/93.56 (SD 8.45) to 127.81 (SD 8.04)/ 82.16 (SD 8.06) mm Hg in the multimodal intervention group and from 151.48 (SD 7.14)/(91.31 (SD 9.61) to 134.92 (SD 10.11)/85.09 (SD 8.26) mm Hg in the usual care group, with a mean difference in systolic blood pressure and diastolic blood pressure of --9.27 mm Hg (95\% CI --12.62 to --5.91 mm Hg; P<.001) and --5.18 mm Hg (95\% CI --8.47 to --1.89 mm Hg; P=.002), respectively. From baseline to 6 months, home BP control <140/90 mm Hg was achieved in 64 (72.7\%) patients in the multimodal intervention group and 46 (52.9\%) patients in the usual care group (P=.007). Meanwhile, home BP control <130/80 mm Hg was achieved in 32 (36.4\%) patients in the multimodal intervention group and 16 (18.4\%) patients in the usual care group (P=.008). After 6 months, there were significant differences in the quality-of-life total and graded scores, including self-rating anxiety scale scores (P=.04), self-rating depression scale scores (P=.03), and Pittsburgh Sleep Quality Index scores (P<.001), in the multimodal intervention group compared with the usual care group. Conclusions: The WeChat-based multimodal intervention model improved the BP control rates and lowered the BP levels more than the usual care approach. The multimodal digital transforming management model for hypertension represents an emerging medical practice that utilizes the individual's various risk factor profiles for primary care and personalized therapy decision-making in patients with hypertension. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200063550; https://www.chictr.org.cn/showproj.html?proj=175816 ", doi="10.2196/52464", url="https://www.jmir.org/2023/1/e52464", url="http://www.ncbi.nlm.nih.gov/pubmed/38048156" } @Article{info:doi/10.2196/51316, author="Einhorn, Julian and Murphy, R. Andrew and Rogal, S. Shari and Suffoletto, Brian and Irizarry, Taya and Rollman, L. Bruce and Forman, E. Daniel and Muldoon, F. Matthew", title="Automated Messaging Program to Facilitate Systematic Home Blood Pressure Monitoring: Qualitative Analysis of Provider Interviews", journal="JMIR Cardio", year="2023", month="Dec", day="4", volume="7", pages="e51316", keywords="mHealth", keywords="digital intervention", keywords="qualitative research", keywords="provider stakeholders", keywords="hypertension", keywords="home blood pressure monitoring", keywords="implementation research", keywords="short-messaging system", keywords="remote monitoring", keywords="qualitative analysis", keywords="messaging program", keywords="blood pressure", keywords="monitoring", keywords="cardiovascular", keywords="disease", keywords="text messaging", keywords="text mining", keywords="self-management", keywords="mobile phone", abstract="Background: Hypertension is a leading cause of cardiovascular and kidney disease in the United States, yet blood pressure (BP) control at a population level is poor and worsening. Systematic home BP monitoring (HBPM) programs can lower BP, but programs supporting HBPM are not routinely used. The MyBP program deploys automated bidirectional text messaging for HBPM and disease self-management support. Objective: We aim to produce a qualitative analysis of input from providers and staff regarding implementation of an innovative HBPM program in primary care practices. Methods: Semistructured interviews (average length 31 minutes) were conducted with physicians (n=11), nurses, and medical assistants (n=6) from primary care settings. The interview assessed multiple constructs in the Consolidated Framework for Implementation Research domains of intervention characteristics, outer setting, inner setting, and characteristics of individuals. Interviews were transcribed verbatim and analyzed using inductive coding to organize meaningful excerpts and identify salient themes, followed by mapping to the updated Consolidated Framework for Implementation Research constructs. Results: Health care providers reported that MyBP has good ease of use and was likely to engage patients in managing their high BP. They also felt that it would directly support systematic BP monitoring and habit formation in the convenience of the patient's home. This could increase health literacy and generate concrete feedback to raise the day-to-day salience of BP control. Providers expressed concern that the cost of BP devices remains an encumbrance. Some patients were felt to have overriding social or emotional barriers, or lack the needed technical skills to interact with the program, use good measurement technique, and input readings accurately. With respect to effects on their medical practice, providers felt MyBP would improve the accuracy and frequency of HBPM data, and thereby improve diagnosis and treatment management. The program may positively affect the patient-provider relationship by increasing rapport and bidirectional accountability. Providers appreciated receiving aggregated HBPM data to increase their own efficiency but also expressed concern about timely routing of incoming HBPM reports, lack of true integration with the electronic health record, and the need for a dedicated and trained staff member. Conclusions: In this qualitative analysis, health care providers perceived strong relative advantages of using MyBP to support patients. The identified barriers suggest the need for corrective implementation strategies to support providers in adopting the program into routine primary care practice, such as integration into the workflow and provider education. Trial Registration: ClinicalTrials.gov NCT03650166; https://tinyurl.com/bduwn6r4 ", doi="10.2196/51316", url="https://cardio.jmir.org/2023/1/e51316", url="http://www.ncbi.nlm.nih.gov/pubmed/38048147" } @Article{info:doi/10.2196/46614, author="Schwab, Josephine and Wachinger, Jonas and Munana, Richard and Nabiryo, Maxencia and Sekitoleko, Isaac and Cazier, Juliette and Ingenhoff, Rebecca and Favaretti, Caterina and Subramonia Pillai, Vasanthi and Weswa, Ivan and Wafula, John and Emmrich, Valentin Julius and B{\"a}rnighausen, Till and Knauf, Felix and Knauss, Samuel and Nalwadda, K. Christine and Sudharsanan, Nikkil and Kalyesubula, Robert and McMahon, A. Shannon", title="Design Research to Embed mHealth into a Community-Led Blood Pressure Management System in Uganda: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2023", month="Nov", day="30", volume="12", pages="e46614", keywords="Uganda", keywords="hypertension", keywords="mobile health", keywords="mHealth", keywords="mobile money", keywords="pooled financing", keywords="medication availability", keywords="human-centered design", keywords="mixed methods", keywords="mobile phone", abstract="Background: Uncontrolled hypertension is a leading risk factor for cardiovascular diseases. In Uganda, such diseases account for approximately 10\% of all deaths, with 1 in 5 adults having hypertension (>90\% of the hypertensive cases are uncontrolled). Although basic health care in the country is available free of cost at government facilities, regularly accessing medication to control hypertension is difficult because supply chain challenges impede availability. Clients therefore frequently suspend treatment or buy medication individually at private facilities or pharmacies (incurring significant costs). In recent years, mobile health (mHealth) interventions have shown increasing potential in addressing health system challenges in sub-Saharan Africa, but the acceptability, feasibility, and uptake conditions of mobile money approaches to chronic disease management remain understudied. Objective: This study aims to design and pilot-test a mobile money--based intervention to increase the availability of antihypertensive medication and lower clients' out-of-pocket payments. We will build on existing local approaches and assess the acceptability, feasibility, and uptake of the designed intervention. Furthermore, rather than entering the study setting with a ready-made intervention, this research will place emphasis on gathering applied ethnographic insights early, which can then inform the parameters of the intervention prototype and concurrent trial. Methods: We will conduct a mixed methods study following a human-centered design approach. We will begin by conducting extensive qualitative research with a range of stakeholders (clients; health care providers; religious, cultural, and community leaders; academics; and policy makers at district and national levels) on their perceptions of hypertension management, money-saving systems, and mobile money in the context of health care. Our results will inform the design, iterative adaptation, and implementation of an mHealth-facilitated pooled financing intervention prototype. At study conclusion, the finalized prototype will be evaluated quantitatively via a randomized controlled trial. Results: As of August 2023, qualitative data collection, which started in November 2022, is ongoing, with data analysis of the first qualitative interviews underway to inform platform and implementation design. Recruitment for the quantitative part of this study began in August 2023. Conclusions: Our results aim to inform the ongoing discourse on novel and sustainable pathways to facilitate access to medication for the management of hypertension in resource-constrained settings. Trial Registration: German registry of clinical trials DRKS00030922; https://drks.de/search/en/trial/DRKS00030922 International Registered Report Identifier (IRRID): DERR1-10.2196/46614 ", doi="10.2196/46614", url="https://www.researchprotocols.org/2023/1/e46614", url="http://www.ncbi.nlm.nih.gov/pubmed/38032702" } @Article{info:doi/10.2196/45915, author="Lee, R. David and Chenoweth, Matthew and Chuong, H. Linh and Villaflores, W. Chad and Cuevas, Miguel and Vangala, Sitaram and Borenstein, Jeff and Kwak, Hannah and Chima-Melton, Chidinma and Han, Maria and Skootsky, A. Samuel and Chan Tack, Therese and Branagan, Linda and Martin, Heather and Gupta, Reshma and Phan, Linda and Sanchez, A. Michael and Malaak, M. Mina and Dermenchyan, Anna and Pearson, N. Kandyce and Altunyan, Marine and Barakat, F. Peter and Pablo, Ray and Sarkisian, Catherine", title="A Multisite Electronic Health Record Integrated Remote Monitoring Intervention for Hypertension Improvement: Protocol for a Randomized Pragmatic Comparative Effectiveness Trial", journal="JMIR Res Protoc", year="2023", month="Oct", day="30", volume="12", pages="e45915", keywords="blood pressure", keywords="EHR", keywords="electronic health record", keywords="hypertension", keywords="hypertensive", keywords="improvement science", keywords="monitor", keywords="monitoring", keywords="randomized controlled trial", keywords="RCT", keywords="remote blood pressure monitoring", abstract="Background: Hypertension is a major contributor to various adverse health outcomes. Although previous studies have shown the benefits of home blood pressure (BP) monitoring over office-based measurements, there is limited evidence comparing the effectiveness of whether a BP monitor integrated into the electronic health record is superior to a nonintegrated BP monitor. Objective: In this paper, we describe the protocol for a pragmatic multisite implementation of a quality improvement initiative directly comparing integrated to nonintegrated BP monitors for hypertension improvement. Methods: We will conduct a randomized, comparative effectiveness trial at 3 large academic health centers across California. The 3 sites will enroll a total of 660 participants (approximately n=220 per site), with 330 in the integrated BP monitor arm and 330 in the nonintegrated BP control arm. The primary outcome of this study will be the absolute difference in systolic BP in mm Hg from enrollment to 6 months. Secondary outcome measures include binary measures of hypertension (controlled vs uncontrolled), hypertension-related health complications, hospitalizations, and death. The list of possible participants will be generated from a central data warehouse. Randomization will occur after enrollment in the study. Participants will use their assigned BP monitor and join site-specific hypertension interventions. Cross-site learning will occur at regular all-site meetings facilitated by the University of California, Los Angeles Value-Based Care Research Consortium. A pre- and poststudy questionnaire will be conducted to further evaluate participants' perspectives regarding their BP monitor. Linear mixed effects models will be used to compare the primary outcome measure between study arms. Mixed effects logistic regression models will be used to compare secondary outcome measures between study arms. Results: The study will start enrolling participants in the second quarter of 2023 and will be completed by the first half of 2024. Results will be published by the end of 2024. Conclusions: This pragmatic trial will contribute to the growing field of chronic care management using remote monitoring by answering whether a hypertension intervention coupled with an electronic health record integrated home BP monitor improves patients' hypertension better than a hypertension intervention with a nonintegrated BP monitor. The outcomes of this study may help health system decision makers determine whether to invest in integrated BP monitors for vulnerable patient populations. Trial Registration: ClinicalTrials.gov NCT05390502; clinicaltrials.gov/study/NCT05390502 International Registered Report Identifier (IRRID): PRR1-10.2196/45915 ", doi="10.2196/45915", url="https://www.researchprotocols.org/2023/1/e45915", url="http://www.ncbi.nlm.nih.gov/pubmed/37902819" } @Article{info:doi/10.2196/48454, author="Nakrys, Marius and Valinskas, Sarunas and Aleknavicius, Kasparas and Jonusas, Justinas", title="Pilot Investigation of Blood Pressure Control Using a Mobile App (Cardi.Health): Retrospective Chart Review Study", journal="JMIR Cardio", year="2023", month="Oct", day="17", volume="7", pages="e48454", keywords="mobile app", keywords="Cardi.Health", keywords="blood pressure", keywords="engagement", keywords="app", keywords="pilot study", keywords="hypertension", keywords="effective", keywords="blood pressure control", keywords="self-monitoring", keywords="medication", keywords="management", keywords="users", keywords="use", abstract="Background: The high prevalence of hypertension necessitates effective, scalable interventions for blood pressure (BP) control. Self-monitoring has shown improved adherence to medication and better BP management. Mobile apps offer a promising approach with their increasing popularity and potential for large-scale implementation. Studies have demonstrated associations between mobile app interventions and lowered BP, yet real-world data on app effectiveness and engagement remain limited. Objective: In this study, we analyzed real-world user data from the Cardi.Health mobile app, which is aimed at helping its users monitor and control their BP. Our goal was to find out whether there is an association between the use of the mobile app and a decrease in BP. Additionally, the study explored how engagement with the app may influence this outcome. Methods: This was a retrospective chart review study. The initial study population comprised 4407 Cardi.Health users who began using the app between January 2022 and April 2022. After applying inclusion criteria, the final study cohort comprised 339 users with elevated BP at the baseline. The sample consisted of 108 (31.9\%) men and 231 (68.1\%) women (P=.04). This retrospective chart review study obtained permission from the Biomedical Research Alliance of New York Institutional Review Board (June 2022, registration ID 22-08-503-939). Results: The study's main findings were that there is a possible relationship between use of the Cardi.Health mobile app and a decrease in systolic BP. Additionally, there was a significant association between active use of the app and systolic BP decrease ($\chi$21=5.311; P=.02). Finally, active users had an almost 2 times greater chance of reducing systolic BP by 5 mm Hg or more over 4 weeks (odds ratio 1.932, 95\% CI 1.074-3.528; P=.03). Conclusions: This study shows a possible relationship between Cardi.Health mobile app use and decreased BP. Additionally, engagement with the app may be related to better results---active use was associated with an almost 2-fold increase in the odds of reducing BP by 5 or more mm Hg. ", doi="10.2196/48454", url="https://cardio.jmir.org/2023/1/e48454", url="http://www.ncbi.nlm.nih.gov/pubmed/37847544" } @Article{info:doi/10.2196/46883, author="Sun, Ting and Zhao, Huanhuan and Ding, Zenghui and Xie, Hui and Ma, Linlin and Zhang, Yu and Wang, Yingying and Yang, Yinju and Xu, Chunyi and Sun, Yining and Xu, Xuejie and Ma, Zuchang", title="Evaluating a WeChat-Based Health Behavioral Digital Intervention for Patients With Hypertension: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Sep", day="12", volume="12", pages="e46883", keywords="adherence", keywords="community health", keywords="hypertension", keywords="health behavior", keywords="mobile phone", abstract="Background: Hypertension is the most prevalent chronic condition and a significant risk factor for cardiovascular and kidney diseases. The efficacy of health behavioral interventions in blood pressure (BP) control has been demonstrated by a large and expanding body of literature, with ``adherence'' playing a crucial role. WeChat is the most common social communication mobile app in China, and it has been shown to be an acceptable delivery platform for delivering health interventions. The WeChat-based health behavioral digital intervention program (WHBDIP) showed high feasibility and efficacy. However, the results regarding BP improvement between the WHBDIP and control groups were inconsistent. Objective: The objective of this study is to develop a WHBDIP and assess its efficacy in controlling BP and improving adherence among patients with hypertension. Methods: A 2-arm, parallel-group, and randomized trial design was used. Patients older than 60 years and with hypertension were randomly assigned to either the control group or the experimental group, which received a 12-week intervention. The program, primarily developed based on the Behavior Change Wheel (BCW) theory, offers health education on exercise, diet, BP monitoring, and medicine adherence (MA). It also includes other behavior interventions guided by an intervention manual, incorporating behavior change techniques (BCTs). The primary outcomes encompass BP and adherence indicators, while the secondary outcomes encompass cardiovascular function indicators, body composition indicators, learning performance, satisfaction, and acceptability. The exercise and blood pressure monitoring adherence (BPMA) indicators for the WHBDIP group were assessed weekly via WeChat during the initial 3 months, while other outcome data for both groups will be collected at the baseline assessment phase, 3 months after the intervention, and 1 year after the program. Results: The trial will assess the efficacy of WHBDIP for patients with hypertension (N=68). The WHBDIP seeks to enhance participants' knowledge of healthy behaviors and assist patients in developing positive health behaviors to improve their health outcomes. Patient recruitment for individuals with hypertension commenced on September 5, 2022, and concluded on September 19, 2022. The 3-month intervention and phased data collection were finalized in January 2023. Data analysis will commence in August 2023, and the final 1-year health outcome results will be collected in September 2023. Conclusions: A successful WHBDIP will establish the management mode as a feasible approach for hypertension management in the community. Additionally, it will pave the way for the development of related mobile health programs. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200062643; https://tinyurl.com/mwyv67wk International Registered Report Identifier (IRRID): PRR1-10.2196/46883 ", doi="10.2196/46883", url="https://www.researchprotocols.org/2023/1/e46883", url="http://www.ncbi.nlm.nih.gov/pubmed/37698909" } @Article{info:doi/10.2196/44772, author="Jones, M. Lenette and Piscotty Jr, J. Ronald and Sullivan, Stephen and Manzor Mitrzyk, Beatriz and Ploutz-Snyder, J. Robert and Ghosh, Bidisha and Veinot, Tiffany", title="Psychometric Evaluation of the Modes of Health Information Acquisition, Sharing, and Use Questionnaire: Prospective Cross-Sectional Observational Study", journal="J Med Internet Res", year="2023", month="Sep", day="11", volume="25", pages="e44772", keywords="psychometric evaluation", keywords="health information behavior", keywords="construct validity", keywords="reliability", keywords="chronic illness", keywords="MHIASU", keywords="hypertension", abstract="Background: Health information is a critical resource for individuals with health concerns and conditions, such as hypertension. Enhancing health information behaviors may help individuals to better manage chronic illness. The Modes of Health Information Acquisition, Sharing, and Use (MHIASU) is a 23-item questionnaire that measures how individuals with health risks or chronic illness acquire, share, and use health information. Yet this measure has not been psychometrically evaluated in a large national sample. Objective: The objective of this study was to evaluate the psychometric properties of the self-administered MHIASU in a large, diverse cohort of individuals living with a chronic illness. Methods: Sharing Information, a prospective, observational study, was launched in August 2018 and used social media campaigns to advertise to Black women. Individuals who were interested in participating clicked on the advertisements and were redirected to a Qualtrics eligibility screener. To meet eligibility criteria individuals had to self-identify as a Black woman, be diagnosed with hypertension by a health care provider, and live in the United States. A total of 320 Black women with hypertension successfully completed the eligibility screener and then completed a web-based version of the MHIASU questionnaire. We conducted a psychometric evaluation of the MHIASU using exploratory factor analysis. The evaluation included item review, construct validity, and reliability. Results: Construct validity was established using exploratory factor analysis with principal axis factoring. The analysis was constricted to the expected domains. Interitem correlations were examined for possible item extraction. There were no improvements in factor structure with the removal of items with high interitem correlation (n=3), so all items of the MHIASU were retained. As anticipated, the instrument was found to have 3 subscales: acquisition, sharing, and use. Reliability was high for all 3 subscales, as evidenced by Cronbach $\alpha$ scores of .81 (acquisition), .81 (sharing), and .93 (use). Factor 3 (use of health information) explained the maximum variance (74\%). Conclusions: Construct validity and reliability of the web-based, self-administered MHIASU was demonstrated in a large national cohort of Black women with hypertension. Although this sample was highly educated and may have had higher digital literacy compared to other samples not recruited via social media, the population captured (Black women living with hypertension) are often underrepresented in research and are particularly vulnerable to this chronic condition. Future studies can use the MHIASU to examine health information behavior in other diverse populations managing health concerns and conditions. ", doi="10.2196/44772", url="https://www.jmir.org/2023/1/e44772", url="http://www.ncbi.nlm.nih.gov/pubmed/37695669" } @Article{info:doi/10.2196/43199, author="Ganie, Ashraf Mohd and Chowdhury, Subhankar and Suri, Vanita and Joshi, Beena and Bhattacharya, Kumar Prasanta and Agrawal, Sarita and Malhotra, Neena and Sahay, Rakesh and Jabbar, Khadar Puthiyaveettil and Rozati, Roya and Wani, Ahmad Imtiyaz and Shukla, Amlin and Arora, Taruna and Rashid, Haroon", title="Prevalence, Regional Variations, and Predictors of Overweight, Obesity, and Hypertension Among Healthy Reproductive-Age Indian Women: Nationwide Cross-Sectional Polycystic Ovary Syndrome Task Force Study", journal="JMIR Public Health Surveill", year="2023", month="Sep", day="6", volume="9", pages="e43199", keywords="Indian Council of Medical Research--polycystic ovary syndrome study", keywords="ICMR-PCOS study", keywords="noncommunicable diseases", keywords="disease surveillance", keywords="obesity", keywords="hypertension", keywords="anthropometry", keywords="healthy reproductive-age women", keywords="socioeconomic status", abstract="Background: A clear understanding of the anthropometric and sociodemographic risk factors related to BMI and hypertension categories is essential for more effective disease prevention, particularly in India. There is a paucity of nationally representative data on the dynamics of these risk factors, which have not been assessed among healthy reproductive-age Indian women. Objective: This cross-sectional polycystic ovary syndrome (PCOS) task force study aimed to assess the anthropometric and sociodemographic characteristics of healthy reproductive-age Indian women and explore the association of these characteristics with various noncommunicable diseases. Methods: We conducted a nationwide cross-sectional survey from 2018 to 2022 as part of the Indian Council of Medical Research--PCOS National Task Force study, with the primary aim of estimating the national prevalence of PCOS and regional phenotypic variations among women with PCOS. A multistage random sampling technique was adopted, and 7107 healthy women (aged 18-40 years) from 6 representative geographical zones of India were included in the study. The anthropometric indices and sociodemographic characteristics of these women were analyzed. Statistical analysis was performed to assess the association between exposure and outcome variables. Results: Of the 7107 study participants, 3585 (50.44\%) were from rural areas and 3522 (49.56\%) were from urban areas. The prevalence of obesity increased from 8.1\% using World Health Organization criteria to 40\% using the revised consensus guidelines for Asian Indian populations. Women from urban areas showed higher proportions of overweight (524/1908, 27.46\%), obesity (775/1908, 40.62\%), and prehypertension (1008/1908, 52.83\%) categories. A rising trend of obesity was observed with an increase in age. Women aged 18 to 23 years were healthy (314/724, 43.4\%) and overweight (140/724, 19.3\%) compared with women aged 36 to 40 years with obesity (448/911, 49.2\%) and overweight (216/911, 23.7\%). The proportion of obesity was high among South Indian women, with 49.53\% (531/1072) and 66.14\% (709/1072), using both World Health Organization criteria and the revised Indian guidelines for BMI, respectively. BMI with waist circumference and waist-to-height ratio had a statistically significant linear relationship (r=0.417; P<.001 and r=0.422; P<.001, respectively). However, the magnitude, or strength, of the association was relatively weak (0.3<|r|<0.5). Statistical analysis showed that the strongest predictors of being overweight or obese were older age, level of education, wealth quintile, and area of residence. Conclusions: Anthropometric and sociodemographic characteristics are useful predictors of overweight- and obesity-related syndromes, including prehypertension, among healthy Indian women. Increased attention to the health of Indian women from public health experts and policy makers is warranted. The findings of this study can be leveraged to offer valuable insights, informing health decision-making and targeted interventions that mitigate risk factors of overweight, obesity, and hypertension. International Registered Report Identifier (IRRID): RR2-10.2196/23437 ", doi="10.2196/43199", url="https://publichealth.jmir.org/2023/1/e43199", url="http://www.ncbi.nlm.nih.gov/pubmed/37672315" } @Article{info:doi/10.2196/43489, author="Wu, Justin and Napoleone, Jenna and Linke, Sarah and Noble, Madison and Turken, Michael and Rakotz, Michael and Kirley, Kate and Folk Akers, Jennie and Juusola, Jessie and Jasik, Bradner Carolyn", title="Long-Term Results of a Digital Hypertension Self-Management Program: Retrospective Cohort Study", journal="JMIR Cardio", year="2023", month="Aug", day="24", volume="7", pages="e43489", keywords="hypertension", keywords="digital health program", keywords="home measurement", keywords="self-management", keywords="behavior change", abstract="Background: Digital health programs that incorporate frequent blood pressure (BP) self-monitoring and support for behavior change offer a scalable solution for hypertension management. Objective: We examined the impact of a digital hypertension self-management and lifestyle change support program on BP over 12 months. Methods: Data were analyzed from a retrospective observational cohort of commercially insured members (n=1117) that started the Omada for Hypertension program between January 1, 2019, and September 30, 2021. Paired t tests and linear regression were used to measure the changes in systolic blood pressure (SBP) over 12 months overall and by SBP control status at baseline (?130 mm Hg vs <130 mm Hg). Results: Members were on average 50.9 years old, 50.8\% (n=567) of them were female, 60.5\% (n=675) of them were White, and 70.5\% (n=788) of them had uncontrolled SBP at baseline (?130 mm Hg). At 12 months, all members (including members with controlled and uncontrolled BP at baseline) and those with uncontrolled SBP at baseline experienced significant mean reductions in SBP (mean --4.8 mm Hg, 95\% CI --5.6 to --4.0; --8.1 mm Hg, 95\% CI --9.0 to --7.1, respectively; both P<.001). Members with uncontrolled SBP at baseline also had significant reductions in diastolic blood pressure (--4.7 mm Hg; 95\% CI --5.3 to --4.1), weight (--6.5 lbs, 95\% CI --7.7 to --5.3; 2.7\% weight loss), and BMI (--1.1 kg/m2; 95\% CI --1.3 to --0.9; all P<.001). Those with controlled SBP at baseline maintained within BP goal range. Additionally, 48\% (418/860) of members with uncontrolled BP at baseline experienced enough change in BP to improve their BP category. Conclusions: This study provides real-world evidence that a comprehensive digital health program involving hypertension education, at-home BP monitoring, and behavior change coaching support was effective for self-managing hypertension over 12 months. ", doi="10.2196/43489", url="https://cardio.jmir.org/2023/1/e43489", url="http://www.ncbi.nlm.nih.gov/pubmed/37463311" } @Article{info:doi/10.2196/48332, author="Park, Sangil and Woo, Geol Ho and Kim, Soeun and Kim, Sunyoung and Lim, Hyunjung and Yon, Keon Dong and Rhee, Youl Sang", title="Real-World Evidence of a Hospital-Linked Digital Health App for the Control of Hypertension and Diabetes Mellitus in South Korea: Nationwide Multicenter Study", journal="JMIR Form Res", year="2023", month="Aug", day="21", volume="7", pages="e48332", keywords="hypertension", keywords="blood pressure", keywords="diabetes", keywords="glucose", keywords="digital health technology", keywords="effectiveness", keywords="application", keywords="blood glucose", keywords="systolic", keywords="diastolic", keywords="management", keywords="consumer", keywords="cost", keywords="monitoring", abstract="Background: Digital health care apps have been widely used for managing chronic conditions such as diabetes mellitus and hypertension, providing promising prospects for enhanced health care delivery, increased patient engagement, and improved self-management. However, the impact of integrating these apps within hospital systems for managing such conditions still lacks conclusive evidence. Objective: We aimed to investigate the real-world effectiveness of using hospital-linked digital health care apps in lowering blood pressure (BP) and blood glucose levels in patients with hypertension and diabetes mellitus. Methods: Nationwide multicenter data on demographic characteristics and the use of a digital health care app from 233 hospitals were collected for participants aged 20 to 80 years in South Korea between August 2021 and June 2022. We divided the participants into 2 groups: 1 group consisted of individuals who exclusively used the digital health app (control) and the other group used the hospital-linked digital health app. All the patients participated in a 12-week digital health care intervention. We conducted a comparative analysis to assess the real-world effectiveness of the hospital-linked digital health app. The primary outcome was the differences in the systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG) level, and postprandial glucose (PPG) level between baseline and 12 weeks. Results: A total of 1029 participants were analyzed for the FBG level, 527 participants were analyzed for the PPG level, and 2029 participants for the SBP and DBP were enrolled. After 12 weeks, a hospital-linked digital health app was found to reduce SBP (?5.4 mm Hg, 95\% CI ?7.0 to ?3.9) and DBP (?2.4 mm Hg, 95\% CI ?3.4 to ?1.4) in participants without hypertension and FBG level in all participants (those without diabetes, ?4.4 mg/dL, 95\% CI ?7.9 to ?1.0 and those with diabetes, ?3.2 mg/dL, 95\% CI ?5.4 to ?1.0); however, there was no statistically significant difference compared to the control group (using only digital health app). Specifically, participants with diabetes using a hospital-linked digital health app demonstrated a significant decrease in PPG after 12 weeks (?10.9 mg/dL, 95\% CI ?31.1 to ?5.3) compared to those using only a digital health app (P=.006). Conclusions: Hospital-linked digital interventions have greatly improved glucose control for diabetes compared with using digital health technology only. These hospital-linked digital health apps have the potential to offer consumers and health care professionals cost-effective support in decreasing glucose levels when used in conjunction with self-monitoring. ", doi="10.2196/48332", url="https://formative.jmir.org/2023/1/e48332", url="http://www.ncbi.nlm.nih.gov/pubmed/37603401" } @Article{info:doi/10.2196/45769, author="Li, Wen-Wen and Toh, Prisca", title="WeChat-Based Intervention for Chinese Immigrants With Hypertension: Development and Evaluation Study", journal="Asian Pac Isl Nurs J", year="2023", month="Jul", day="27", volume="7", pages="e45769", keywords="social media", keywords="hypertension", keywords="medication adherence", keywords="Chinese immigrants", keywords="WeChat", keywords="blood pressure", keywords="BP", abstract="Background: Despite Chinese immigrants having a higher or comparable proportion of hypertension (HTN) compared to non-Hispanic White and Hispanic individuals, there are no effective technology-based intervention studies that target HTN management in Chinese immigrants in the United States. Objective: The aim of this study was to develop and pilot-test the efficacy of a culturally and linguistically sensitive social media--based intervention (WeChat) for Chinese immigrants to improve blood pressure (BP) control, antihypertensive medication adherence, and self-efficacy. Methods: The study was conducted in 2020 with a pre- and posttest design (N=20). A WeChat-based intervention was implemented using one 20-minute video presentation plus one 20-minute nurse counseling session via WeChat at the baseline, followed by 4 biweekly 20-minute nurse counseling sessions via WeChat calls. The primary outcome (BP control) and secondary outcomes, including medication adherence and self-efficacy in HTN management, were measured at baseline and at 6 months. Results: The participants' mean age was 68.9 (SD 10.2; range: 51-86) years. The majority of the participants were female (n=13, 65\%), had a high school degree or less (n=15, 75\%), were married (n=16, 80\%), not religious (n=13, 65\%), and not employed (n=12, 60\%). The results showed that the mean baseline systolic BP was 131.43 (SD 9.61) mmHg, and the mean diastolic BP was 79.79 (SD 9.62) mmHg. The 6-month outcome showed a reduction of systolic BP (--0.74, SD 9.18 mmHg; P=.05) and diastolic BP (--0.96, SD 6.92 mmHg; P=.001). The mean score for medication adherence at baseline was 4.50 (SD 1.70), and it significantly improved to 3.65 (SD 1.18) at 6 months (reversely scored; possible range was 1-5, with 1 being the best score; P=.001). Self-efficacy in HTN management had a trend in reduction from a baseline score of 8.28 (SD 1.25) decreasing to 7.93 (SD 1.48) at 6 months, with a mean difference of 0.34 (SD 2.02), with a score of 0 indicating the lowest self-efficacy and a score of 10 indicating the highest self-efficacy. Conclusions: Our WeChat-based HTN management program showed a significant improvement in diastolic BP and medication adherence as well as a trend of reduction for systolic BP and self-efficacy in managing HTN in Chinese immigrants. Compared to the traditional health care system, the proposed WeChat-based HTN management program has a low cost and is easy to implement. Thus, further investigation is recommended to generate further results. This intervention should be tested across different regions and clinical settings to verify the findings. The long-term goal is to implement the intervention in clinical settings to help Chinese immigrants at large achieve better HTN management. ", doi="10.2196/45769", url="https://apinj.jmir.org/2023/1/e45769", url="http://www.ncbi.nlm.nih.gov/pubmed/37498663" } @Article{info:doi/10.2196/46313, author="Poblete, Yareli Jacqueline and Vawter, Lauren Natalie and Lewis, Virginia Sydney and Felisme, Marc Earl and Mohn, Adriana Paloma and Shea, Jennifer and Northrup, William Adam and Liu, Jie and Al-Rousan, Tala and Godino, Gideon Job", title="Digitally Based Blood Pressure Self-Monitoring Program That Promotes Hypertension Self-Management and Health Education Among Patients With Low-Income: Usability Study", journal="JMIR Hum Factors", year="2023", month="Jul", day="24", volume="10", pages="e46313", keywords="hypertension", keywords="blood pressure", keywords="digital health", keywords="health education", keywords="self-measured blood pressure monitoring", keywords="remote patient monitoring", abstract="Background: According to evidence-based clinical guidelines, adults with hypertension are advised to self-monitor their blood pressure (BP) twice daily. Self-measured BP monitoring is a recommended strategy for improving hypertension management. Objective: We aimed to determine the feasibility and acceptability of a digitally based BP self-monitoring program that promotes hypertension self-management and health education among low-income patients. We hypothesized that the program would be highly feasible and acceptable and that at least 50\% of the patients would use the monitor at the rate required for the reimbursement of the device's cost (16 days of measurements in any 30-day period). Methods: Withings BPM Connect was deployed to patients at Family Health Centers of San Diego. Program elements included training, SMS text message reminders, and physician communication. Compliance, use, mean BP, and BP control status were calculated. A Kaplan-Meier time-to-event analysis was conducted to compare time to compliance between a strict definition (?16 days in any rolling 30-day window) and a lenient definition (?1 day per week for 4 consecutive weeks). A log-rank test was performed to determine whether the difference in time to compliance between the definitions was statistically significant. Mean systolic BP (SBP) and diastolic BP (DBP) before the intervention and after the intervention and mean change in SBP and DBP across patients were calculated. Paired sample t tests (2-tailed) were performed to assess the changes in SBP and DBP from before to after the intervention. Results: A total of 179 patients received the monitors. The mean changes in SBP and DBP from before to after the intervention were +2.62 (SE 1.26) mm?Hg and +3.31 (SE 0.71) mm?Hg, respectively. There was a statistically significant increase in both SBP and DBP after the intervention compared with before the intervention (P=.04 and P<.001). At the first and last measurements, 37.5\% (63/168) and 48.8\% (82/168) of the patients had controlled BP, respectively. During the observation period, 83.3\% (140/168) of the patients had at least 1 controlled BP measurement. Use decreased over time, with 53.6\% (90/168) of the patients using their monitor at week 2 and only 25\% (42/168) at week 11. Although only 25.6\% (43/168) achieved the strict definition of compliance, 42.3\% (71/168) achieved the lenient definition of compliance. The median time to compliance was 130 days for the strict definition and 95 days for the lenient definition. The log-rank test showed a statistically significant difference in time to compliance between the compliance definitions (P<.001). Only 26.8\% (45/168) complied with the measurement rate that would result in device cost reimbursement. Conclusions: Few patients used the monitors at a rate that would result in reimbursement, raising financial feasibility concerns. Plans for sustaining costs among low-income patients need to be further evaluated. ", doi="10.2196/46313", url="https://humanfactors.jmir.org/2023/1/e46313", url="http://www.ncbi.nlm.nih.gov/pubmed/37486745" } @Article{info:doi/10.2196/45324, author="Wu, Zhiyuan and Zhang, Haiping and Wang, Yutao and Li, Zhiwei and Li, Xia and Tao, Lixin and Guo, Xiuhua", title="Temporal and Bidirectional Association Between Blood Pressure Variability and Arterial Stiffness: Cross-Lagged Cohort Study", journal="JMIR Public Health Surveill", year="2023", month="Jul", day="4", volume="9", pages="e45324", keywords="blood pressure variability", keywords="brachial-ankle pulse wave velocity", keywords="arterial stiffness", keywords="cross-lagged panel analysis", abstract="Background: The causal relationship between blood pressure variability (BPV) and arterial stiffness remains debated. Objective: This study aimed to explore the temporal and bidirectional associations between long-term BPV and arterial stiffness using a cohort design with multiple surveys. Methods: Participants from the Beijing Health Management Cohort who underwent health examinations from visit 1 (2010-2011) to visit 5 (2018-2019) were enrolled in this study. Long-term BPV was defined as intraindividual variation using the coefficient of variation (CV) and SD. Arterial stiffness was measured by brachial-ankle pulse wave velocity (baPWV). The bidirectional relationship between BPV and arterial stiffness was explored using cross-lagged analysis and linear regression models, with records before and after visit 3 categorized as phase 1 and phase 2, respectively. Results: Of the 1506 participants, who were a mean of 56.11 (SD 8.57) years old, 1148 (76.2\%) were male. The cross-lagged analysis indicated that the standardized coefficients of BPV at phase 1 directing to the baPWV level at phase 2 were statistically significant but not vice-versa. The adjusted regression coefficients of the CV were 4.708 (95\% CI 0.946-8.470) for systolic blood pressure, 3.119 (95\% 0.166-6.073) for diastolic pressure, and 2.205 (95\% CI 0.300-4.110) for pulse pressure. The coefficients of the SD were 4.208 (95\% CI 0.177-8.239) for diastolic pressure and 4.247 (95\% CI 0.448-8.046) for pulse pressure. The associations were predominant in the subgroup with hypertension, but we did not observe any significant association of baPWV level with subsequent BPV indices. Conclusions: The findings supported a temporal relationship between long-term BPV and arterial stiffness level, especially among people with hypertension. ", doi="10.2196/45324", url="https://publichealth.jmir.org/2023/1/e45324", url="http://www.ncbi.nlm.nih.gov/pubmed/37402142" } @Article{info:doi/10.2196/45230, author="Nishizaki, Yuji and Kuroki, Haruo and Ishii, So and Ohtsu, Shigeyuki and Watanabe, Chizuru and Nishizawa, Hiroto and Nagao, Masashi and Nojima, Masanori and Watanabe, Ryo and Sato, Daisuke and Sato, Kensuke and Kawata, Yumi and Wada, Hiroo and Toyoda, Goichiro and Ohbayashi, Katsumi", title="Determining Optimal Intervals for In-Person Visits During Video-Based Telemedicine Among Patients With Hypertension: Cluster Randomized Controlled Trial", journal="JMIR Cardio", year="2023", month="Jun", day="8", volume="7", pages="e45230", keywords="hypertension", keywords="Japan", keywords="lost productivity time", keywords="patient satisfaction", keywords="telemedicine", abstract="Background: Introducing telemedicine in outpatient treatment may improve patient satisfaction and convenience. However, the optimal in-person visit interval for video-based telemedicine among patients with hypertension remains unreported in Japan. Objective: We determined the optimal in-person visit interval for video-based telemedicine among patients with hypertension. Methods: This was a cluster randomized controlled noninferiority trial. The target sites were 8 clinics in Japan that had a telemedicine system, and the target patients were individuals with essential hypertension. Among patients receiving video-based telemedicine, those who underwent in-person visits at 6-month intervals were included in the intervention group, and those who underwent in-person visits at 3-month intervals were included in the control group. The follow-up period of the participants was 6 months. The primary end point of the study was the change in systolic blood pressure, and the secondary end points were the rate of treatment continuation after 6 months, patient satisfaction, health economic evaluation, and safety evaluation. Results: Overall, 64 patients were enrolled. Their mean age was 54.5 (SD 10.3) years, and 60.9\% (39/64) of patients were male. For the primary end point, the odds ratio for the estimated difference in the change in systolic blood pressure between the 2 groups was 1.18 (90\% CI --3.68 to 6.04). Notably, the criteria for noninferiority were met. Patient satisfaction was higher in the intervention group than in the control group. Furthermore, the indirect costs indicated that lost productivity was significantly lesser in the intervention group than in the control group. Moreover, the treatment continuation rate did not differ between the intervention and control groups, and there were no adverse events in either group. Conclusions: Blood pressure control status and safety did not differ between the intervention and control groups. In-person visits at 6-month intervals may cause a societal cost reduction and improve patient satisfaction during video-based telemedicine. Trial Registration: UMIN Clinical Trials Registry (UMIN-CTR) UMIN000040953; https://tinyurl.com/2p8devm9 ", doi="10.2196/45230", url="https://cardio.jmir.org/2023/1/e45230", url="http://www.ncbi.nlm.nih.gov/pubmed/37161483" } @Article{info:doi/10.2196/43678, author="Wong, Ching Arkers Kwan and Bayuo, Jonathan and Wong, Yuet Frances Kam and Chow, Sum Karen Kit and Wong, Man Siu and Lau, Ki Avis Cheuk", title="The Synergistic Effect of Nurse Proactive Phone Calls With an mHealth App Program on Sustaining App Usage: 3-Arm Randomized Controlled Trial", journal="J Med Internet Res", year="2023", month="May", day="1", volume="25", pages="e43678", keywords="adults", keywords="application", keywords="apps", keywords="behavior", keywords="community", keywords="depression", keywords="diabetes", keywords="disease", keywords="hypertension", keywords="intervention", keywords="mHealth", keywords="older adults", keywords="proactive", keywords="program", keywords="self-efficacy", keywords="self-management", keywords="technology", keywords="usage", abstract="Background: Although mobile health application (mHealth app) programs have effectively promoted disease self-management behaviors in the last decade, usage rates have tended to fall over time. Objective: We used a case management approach led by a nurse and supported by a health-social partnership team with the aim of sustaining app usage among community-dwelling older adults and evaluated the outcome differences (i.e, self-efficacy, levels of depression, and total health service usages) between those who continued to use the app. Methods: This was a 3-arm randomized controlled trial. A total of 221 older adults with hypertension, diabetes, or chronic pain were randomized into 3 groups: mHealth (n=71), mHealth with interactivity (mHealth+I; n=74), and the control (n=76). The mHealth application was given to the mHealth and mHealth+I groups. The mHealth+I group also received 8 proactive calls in 3 months from a nurse to encourage use of the app. The control group received no interventions. Data were collected at preintervention (T1), postintervention (T2), and at 3 months' postintervention (T3) to ascertain the sustained effect. Results: A total of 37.8\% of mHealth+I and 18.3\% of mHealth group participants continued using the mHealth app at least twice per week until the end of the sixth month. The difference in app usage across the 2 groups between T2 and T3 was significant ($\chi$21=6.81, P=.009). Improvements in self-efficacy ($\beta$=4.30, 95\% CI 0.25-8.35, P=.04) and depression levels ($\beta$=--1.98, 95\% CI --3.78 to --0.19, P=.03) from T1 to T3 were observed in the mHealth group participants who continued using the app. Although self-efficacy and depression scores improved from T1 to T2 in the mHealth+I group, the mean values decreased at T3. Health service usage decreased for all groups from T1 to T2 ($\beta$=--1.38, 95\% CI --1.98 to --0.78, P<.001), with a marginal increase at T3. Conclusions: The relatively low rates of mHealth app usage at follow-up are comparable to those reported in the literature. More work is needed to merge the technology-driven and in-person aspects of mHealth. Trial Registration: ClinicalTrials.gov NCT03878212; https://clinicaltrials.gov/ct2/show/NCT03878212 International Registered Report Identifier (IRRID): RR2-10.1159/000509129 ", doi="10.2196/43678", url="https://www.jmir.org/2023/1/e43678", url="http://www.ncbi.nlm.nih.gov/pubmed/37126378" } @Article{info:doi/10.2196/43849, author="Jones, M. Lenette and de Marco, Kayla and Keener, Katharine and Monroe, E. Korrey", title="Blood Pressure and Self-management in Black Women With Hypertension: Protocol Revisions to the Brain Relationships Among Information, Neuroprocessing, and Self-Management Study Due to the COVID-19 Pandemic", journal="JMIR Res Protoc", year="2023", month="Apr", day="27", volume="12", pages="e43849", keywords="Black", keywords="BRAINS", keywords="COVID-19 pandemic", keywords="eHealth", keywords="Facebook", keywords="hypertension", keywords="protocol", keywords="videoconferencing", keywords="web-based", keywords="women", abstract="Background: The COVID-19 pandemic and the halt to in-person research activities beginning in March 2020 brought new challenges to protocol development and implementation. Due to the pandemic, we had to revise our protocol for the Brain Relationships Among Information, Neuroprocessing, and Self-Management (BRAINS) study, which was designed to examine health information behavior, brain activity, diabetes status, and self-management behavior among Black women with hypertension. Objective: This report outlines 7 steps describing how our research team (1) revised the BRAINS study protocol, (2) implemented a remote method of data collection, and (3) mitigated the challenges we faced. Methods: Prior to March 2020, Black women with hypertension were invited to participate in the BRAINS study to undergo a functional magnetic resonance imaging scan, complete surveys, have their blood pressure measured, and have their blood drawn. After these measures were collected, participants would receive phone calls from a dietician to complete two 24-hour dietary recalls using the Nutrition Data System for Research. Our revised protocol relied on a web-based, interactive approach. Participants received a study kit that included an Omron automatic home blood pressure monitor and a hemoglobin A1c kit from the DTIL laboratory. In a Zoom meeting with each participant, our team played an introductory video, administered surveys (via Qualtrics), and guided participants through measuring their blood pressure and performing a finger stick to collect a blood sample for hemoglobin A1c testing. We examined cognitive function using the TestMyBrain Digital Neuropsychology Toolkit, as we were unable to access the functional magnetic resonance imaging laboratory to assess brain activity. The 7 steps in revising our protocol were as follows: conceptualizing the move from in-person to remote study activities (step 1); contacting the funders (step 2); submitting changes for Institutional Review Board approval (step 3); preparing to implement the revised protocol (step 4); implementing the study changes (step 5); mitigating challenges (step 6); and evaluating protocol implementation (step 7). Results: Approximately 1700 individuals responded to web-based advertisements about the BRAINS study. A total of 131 individuals completed our eligibility screener. We conducted our first Zoom appointment in July 2020 and our last Zoom appointment in September 2020. Using our revised strategies, a total of 99 participants completed all study measures within a 3-month period. Conclusions: In this report, we discuss successes and challenges in revising our protocol and reaching our population of interest remotely, safely, and effectively. The information we have outlined can help researchers create similar protocols to reach and conduct research remotely with diverse populations, such as individuals who are unable to participate in studies in person. International Registered Report Identifier (IRRID): DERR1-10.2196/43849 ", doi="10.2196/43849", url="https://www.researchprotocols.org/2023/1/e43849", url="http://www.ncbi.nlm.nih.gov/pubmed/37104029" } @Article{info:doi/10.2196/41146, author="Susanto, Tantut and Rasny, Hanny and Kurdi, Fahruddin and Yunanto, Adi Rismawan and Rahmawati, Ira", title="Management of Hypertension Using a Plant-Based Diet Among Farmers: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2023", month="Apr", day="3", volume="12", pages="e41146", keywords="hypertension", keywords="farming", keywords="plant-based diet", keywords="nursing", abstract="Background: Farmers in Indonesia have a high risk for hypertension owing to their lifestyle and working environment. Diet management is a solution to reduce hypertension, and Indonesia has natural resources in the agricultural sector that could help manage hypertension. Optimizing vegetable and fruit intake in a plant-based diet (PBD) could help maintain blood pressure among farmers in Indonesia. Objective: This study aims to explore the health problem of hypertension and the characteristics of local food sources to formulate a PBD menu for treating hypertension, as well as assess the prevalence of hypertension, level of acceptability of a PBD, and associated sociodemographic factors. Further, we want to examine the effectiveness of a community-based nursing program for managing hypertension using a PBD. Methods: We will use the exploratory sequential mixed methods approach. There will be a qualitative study (phase I) in 2022 and a quantitative study (phase II) in 2023. We will analyze data using a thematic framework in phase I. In phase II, the study will involve (1) questionnaire development and validation; (2) examination of the prevalence of hypertension, the level of acceptability of a PBD, and the associated factors; and (3) a randomized controlled trial. We will recruit farmers with hypertension who meet the study criteria. Moreover, in phase II, we will invite expert nurses and nutritionists to assess the face and content validity of the questionnaire. We will use multiple logistic regression models to estimate the associated sociodemographic factors and the level of acceptability of a PBD. Furthermore, a linear generalized estimating equation will be used to estimate the parameters of a generalized linear model with a possible unmeasured correlation between observations from different time points for systolic and diastolic blood pressure. Results: A model PBD for hypertension management is expected to be developed. In 2022, we will collect information on hypertension and the characteristics of local food sources for managing hypertension, and will formulate a PBD menu to treat hypertension among farmers. In 2023, we will develop a questionnaire to assess the acceptability of a PBD to manage hypertension among farmers, the prevalence of hypertension, and the sociodemographic factors associated with hypertension among farmers. We will implement a community-based nursing program for managing hypertension using a PBD among farmers. Conclusions: The PBD model will not be readily available for other agricultural areas since validation of local food variation is required to design the menu. We expect contributions from the local government to implement the intervention as one of the policies in the management of hypertension for farmers in the agricultural plantation areas of Jember. This program may also be implemented in other agricultural countries with similar problems, so that hypertension can be optimally treated among farmers. International Registered Report Identifier (IRRID): PRR1-10.2196/41146 ", doi="10.2196/41146", url="https://www.researchprotocols.org/2023/1/e41146", url="http://www.ncbi.nlm.nih.gov/pubmed/37010908" } @Article{info:doi/10.2196/42896, author="Chen, Botian and Dou, Yuqi and Yu, Xue and Ma, Defu", title="Influence of Internet-Based Health Management on Control of Clinical Parameters in Patients With Hypertension: Four-Year Longitudinal Study", journal="J Med Internet Res", year="2023", month="Mar", day="20", volume="25", pages="e42896", keywords="hypertension", keywords="internet-based health management", keywords="blood pressure control", keywords="longitudinal study", keywords="health management", keywords="primary care", keywords="online based", keywords="eHealth", keywords="telehealth", keywords="telemedicine", abstract="Background: In recent years, more and more studies have shown that internet-based health management can help patients with hypertension control their blood pressure. However, there is a lack of similar research in China. Objective: We designed this study to clarify the impact of long-term internet-based health management on the control of clinical parameters in patients with hypertension. These results are also expected to identify the relevant factors affecting the control of clinical parameters in hypertension more accurately toward developing more targeted health management strategies. Methods: This was a longitudinal study of internet-based health management in the five provinces of northwest China. The inclusion criteria were aged ?18 years and no serious cognitive disease or mental disorder. After collecting the physical examination data of 8567 people in the five northwest provinces in 2013, we conducted online health management (including diet, exercise, and behavior) and follow-up. In the physical examination in 2013, 1008 new patients with hypertension were identified, who were divided into a good blood pressure control group and poor blood pressure control group. Physical examination and a questionnaire survey were conducted every 2 years to understand the changes of health management on the subjects' health-related behaviors. We then analyzed the changes of clinical indicators related to hypertension and the influencing factors related to blood pressure control in patients with hypertension. All statistical analyses were performed using R software (version 4.1.2) and a P value <.05 was considered statistically significant. Results: A total of 8567 people met the inclusion criteria and underwent health management. Self-comparison showed that after 4 years of health management, the smoking cessation rate and amount of exercise significantly increased (both P<.001). The low-density lipoprotein-cholesterol levels also increased (P=.005), whereas the high-density lipoprotein-cholesterol levels decreased (P=.007). The newly discovered patients with hypertension in 2013 were further screened. After 4 years of health management, their smoking cessation rate increased significantly (P=.03) and the amount of exercise increased but not significantly (P=.08). In terms of clinical indicators, the diastolic blood pressure considerably decreased (P<.001) and the systolic blood pressure slightly decreased (P=.13). The correlation analysis of blood pressure control in patients with new-onset hypertension showed that gender (female) and changing relevant factors according to health management behaviors (BMI; cereals and potatoes intake; fish, livestock meat, and eggs intake; fruit intake; and physical activity) were the protective factors of blood pressure control. Conclusions: Internet-based health management has a significant and long-term effect on blood pressure control in patients with hypertension. ", doi="10.2196/42896", url="https://www.jmir.org/2023/1/e42896", url="http://www.ncbi.nlm.nih.gov/pubmed/36939826" } @Article{info:doi/10.2196/42134, author="Khalid, Ayisha and Dong, Quanfang and Chuluunbaatar, Enkhzaya and Haldane, Victoria and Durrani, Hammad and Wei, Xiaolin", title="Implementation Science Perspectives on Implementing Telemedicine Interventions for Hypertension or Diabetes Management: Scoping Review", journal="J Med Internet Res", year="2023", month="Mar", day="14", volume="25", pages="e42134", keywords="telemedicine", keywords="hypertension", keywords="diabetes", keywords="implementation science", keywords="mobile phone", abstract="Background: Hypertension and diabetes are becoming increasingly prevalent worldwide. Telemedicine is an accessible and cost-effective means of supporting hypertension and diabetes management, especially as the COVID-19 pandemic has accelerated the adoption of technological solutions for care. However, to date, no review has examined the contextual factors that influence the implementation of telemedicine interventions for hypertension or diabetes worldwide. Objective: We adopted a comprehensive implementation research perspective to synthesize the barriers to and facilitators of implementing telemedicine interventions for the management of hypertension, diabetes, or both. Methods: We performed a scoping review involving searches in Ovid MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, and Google Scholar to identify studies published in English from 2017 to 2022 describing barriers and facilitators related to the implementation of telemedicine interventions for hypertension and diabetes management. The coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research. Results: Of the 17,687 records identified, 35 (0.2\%) studies were included in our scoping review. We found that facilitators of and barriers to implementation were dispersed across the constructs of the Consolidated Framework for Implementation Research. Barriers related to cost, patient needs and resources (eg, lack of consideration of language needs, culture, and rural residency), and personal attributes of patients (eg, demographics and priorities) were the most common. Facilitators related to the design and packaging of the intervention (eg, user-friendliness), patient needs and resources (eg, personalized information that leveraged existing strengths), implementation climate (eg, intervention embedded into existing infrastructure), knowledge of and beliefs about the intervention (eg, convenience of telemedicine), and other personal attributes (eg, technical literacy) were the most common. Conclusions: Our findings suggest that the successful implementation of telemedicine interventions for hypertension and diabetes requires comprehensive efforts at the planning, execution, engagement, and reflection and evaluation stages of intervention implementation to address challenges at the individual, interpersonal, organizational, and environmental levels. ", doi="10.2196/42134", url="https://www.jmir.org/2023/1/e42134", url="http://www.ncbi.nlm.nih.gov/pubmed/36917174" } @Article{info:doi/10.2196/43675, author="Eyles, Helen and Grey, Jacqueline and Jiang, Yannan and Umali, Elaine and McLean, Rachael and Te Morenga, Lisa and Neal, Bruce and Rodgers, Anthony and Doughty, N. Robert and Ni Mhurchu, Cliona", title="Effectiveness of a Sodium-Reduction Smartphone App and Reduced-Sodium Salt to Lower Sodium Intake in Adults With Hypertension: Findings From the Salt Alternatives Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2023", month="Mar", day="9", volume="11", pages="e43675", keywords="mobile health", keywords="mHealth", keywords="smartphone", keywords="smartphone app", keywords="cardiovascular disease", keywords="sodium", keywords="salt", keywords="blood pressure", keywords="technology", keywords="reduced-sodium salt", keywords="mobile phone", abstract="Background: Even modest reductions in blood pressure (BP) can have an important impact on population-level morbidity and mortality from cardiovascular disease. There are 2 promising approaches: the SaltSwitch smartphone app, which enables users to scan the bar code of a packaged food using their smartphone camera and receive an immediate, interpretive traffic light nutrition label on-screen alongside a list of healthier, lower-salt options in the same food category; and reduced-sodium salts (RSSs), which are an alternative to regular table salt that are lower in sodium and higher in potassium but have a similar mouthfeel, taste, and flavor. Objective: Our aim was to determine whether a 12-week intervention with a sodium-reduction package comprising the SaltSwitch smartphone app and an RSS could reduce urinary sodium excretion in adults with high BP. Methods: A 2-arm parallel randomized controlled trial was conducted in New Zealand (target n=326). Following a 2-week baseline period, adults who owned a smartphone and had high BP (?140/85 mm Hg) were randomized in a 1:1 ratio to the intervention (SaltSwitch smartphone app + RSS) or control (generic heart-healthy eating information from The Heart Foundation of New Zealand). The primary outcome was 24-hour urinary sodium excretion at 12 weeks estimated via spot urine. Secondary outcomes were urinary potassium excretion, BP, sodium content of food purchases, and intervention use and acceptability. Intervention effects were assessed blinded using intention-to-treat analyses with generalized linear regression adjusting for baseline outcome measures, age, and ethnicity. Results: A total of 168 adults were randomized (n=84, 50\% per group) between June 2019 and February 2020. Challenges associated with the COVID-19 pandemic and smartphone technology detrimentally affected recruitment. The adjusted mean difference between groups was 547 (95\% CI ?331 to 1424) mg for estimated 24-hour urinary sodium excretion, 132 (95\% CI ?1083 to 1347) mg for urinary potassium excretion, ?0.66 (95\% CI ?3.48 to 2.16) mm Hg for systolic BP, and 73 (95\% CI ?21 to 168) mg per 100 g for the sodium content of food purchases. Most intervention participants reported using the SaltSwitch app (48/64, 75\%) and RSS (60/64, 94\%). SaltSwitch was used on 6 shopping occasions, and approximately 1/2 tsp per week of RSS was consumed per household during the intervention. Conclusions: In this randomized controlled trial of a salt-reduction package, we found no evidence that dietary sodium intake was reduced in adults with high BP. These negative findings may be owing to lower-than-anticipated engagement with the trial intervention package. However, implementation and COVID-19--related challenges meant that the trial was underpowered, and it is possible that a real effect may have been missed. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000352101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377044 and Universal Trial U1111-1225-4471 ", doi="10.2196/43675", url="https://mhealth.jmir.org/2023/1/e43675", url="http://www.ncbi.nlm.nih.gov/pubmed/36892914" } @Article{info:doi/10.2196/39058, author="Ko, Jisook and Wang, Jing and Chung, L. Misook and Sharma, Kumar", title="Examining the Individual Response to a Low-Sodium Diet in Patients with Hypertension: Protocol for a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Feb", day="13", volume="12", pages="e39058", keywords="adherence to low-sodium diet intervention", keywords="adherence", keywords="metabolite profile", keywords="salt sensitivity", keywords="digital self-monitoring", keywords="hypertension", keywords="salt", keywords="blood pressure", keywords="sodium", keywords="diet", keywords="metabolite", keywords="nutrition", keywords="metabolomics", keywords="precision medicine", keywords="personalized", keywords="personalization", keywords="RCT", keywords="randomized controlled trial", keywords="genetics", keywords="genomics", keywords="chronic disease", keywords="chronic condition", keywords="urinary", keywords="dietary", keywords="dietary sodium", keywords="hypertensive patient", keywords="cardiovascular disease", abstract="Background: Excessive dietary sodium intake is an independent risk factor for hypertension and cardiovascular disease (CVD). Despite the large body of evidence concerning the effects of dietary interventions on blood pressure (BP) and CVD outcomes, trials have often reported low adherence to decreased sodium intake, likely due in part to heterogeneous BP responses. To address the challenges, recent clinical findings suggested a precise and personalized dietary approach that seeks to deliver more preventive and practical dietary advice than the ``one-size-fits-all'' guidelines and weighs the personal risk of developing specific diseases. Objective: The purpose of this pilot randomized controlled trial was to test the feasibility and preliminary efficacy of integrating the use of mobile technology and metabolomics with a low-sodium diet intervention in patients with hypertension to develop personalized low-sodium diet programs. Additionally, the study will examine the associations of urine metabolites with urinary sodium levels and BP control based on the hypothesis that targeted urine metabolites. In this report, we describe the design and protocol of the pilot trial. Methods: A total of 40 patients with hypertension will be randomly assigned to either a 8-week low-sodium diet group (n=20) or a standard care group (n=20). Each week, intervention participants went through individual sessions with an interventionist via videoconferencing to discuss low-sodium diet regimens, patients' food choices, and BP tracks on mobile apps. The control group followed their usual care for hypertension management. All participants in both groups monitored diet and BP using mobile apps for 8 weeks. A 24-hour urinary sodium excretion for the estimation of dietary sodium intake, systolic, and diastolic BPs were measured at the baseline and at 8 weeks. The primary outcomes of this study include the feasibility of conducting a randomized controlled trial (RCT) by reporting recruitment, retention, and completion statistics. The preliminary effects of intervention will be tested by a generalized estimating equation model. Results: This pilot RCT study was approved by the institutional review board at the University of Texas Health San Antonio in January 2021. The first participant was enrolled in April 2021, and currently, 26 participants were enrolled. All data collection is expected to conclude by March 2023, with data analysis and study results ready for reporting by December 2023. Findings from this pilot RCT will further guide the team in planning a future large-scale study. Conclusions: The findings of this proposed study will establish a comprehensive knowledge base for future research and development of personalized dietary interventions to promote adherence to dietary strategies and self-management of chronic disease using the Precision Health approach for millions of Americans who are struggling with uncontrolled hypertension. Trial Registration: ClinicalTrials.gov NCT04764253; https://clinicaltrials.gov/ct2/show/NCT04764253 International Registered Report Identifier (IRRID): DERR1-10.2196/39058 ", doi="10.2196/39058", url="https://www.researchprotocols.org/2023/1/e39058", url="http://www.ncbi.nlm.nih.gov/pubmed/36780210" } @Article{info:doi/10.2196/42190, author="Oh, Sung-Hee and Kim, Dohyang and Hwang, Jinseub and Kang, Jae-Heon and Kwon, Yeongkeun and Kwon, Jin-Won", title="Association of Uncontrolled Hypertension or Diabetes Mellitus With Major Adverse Cardiovascular Events and Mortality in South Korea: Population-Based Cohort Study", journal="JMIR Public Health Surveill", year="2023", month="Feb", day="3", volume="9", pages="e42190", keywords="prevention and control", keywords="cardiovascular diseases", keywords="diabetes mellitus", keywords="hypertension", keywords="extended Cox regression", keywords="cohort study", abstract="Background: Managing hypertension (HT) and diabetes mellitus (DM) is crucial to preventing cardiovascular diseases. Few studies have investigated the incidence and risk of cardiovascular diseases or mortality in uncontrolled HT or DM in the Asian population. Epidemiological studies of cardiovascular disease should be conducted with continuous consideration of the changing disease risk profiles, lifestyles, and socioeconomic status over time. Objective: We aimed to examine the association of uncontrolled HT or DM with the incidence of cardiovascular events or deaths from any cause. Methods: This population-based retrospective study was conducted using data from the Korean National Health Insurance Service--National Health Screening Cohort, including patients aged 40-79 years who participated in national screening from 2002 to 2003 and were followed up until 2015. The health screening period from 2002 to 2013 was stratified into 6 index periods in 2-year cycles, and the follow-up period from 2004 to 2015 was stratified accordingly into 6 subsequent 2-year periods. The incidence rates and hazard ratio (HR) for major adverse cardiovascular events (MACE) and death from any cause were estimated according to HT or DM control status. Extended Cox models with time-dependent variables updated every 2 years, including sociodemographic characteristics, blood pressure (BP), fasting blood glucose (FBG), medication prescription, and adherence, were used. Results: Among the total cohort of 440,249 patients, 155,765 (35.38\%) were in the uncontrolled HT or DM group. More than 60\% of the patients with HT or DM who were prescribed medications did not achieve the target BP or FBG. The incidence of MACE was 10.8-15.5 and 9.6-13.3 per 1000 person-years in the uncontrolled DM and uncontrolled HT groups, respectively, and increased with age. In the uncontrolled HT and DM group, the incidence of MACE was high (15.2-17.5 per 1000 person-years) at a relatively young age and showed no age-related trend. Adjusted HR for MACE were 1.28 (95\% CI 1.23-1.32) for the uncontrolled DM group, 1.32 (95\% CI 1.29-1.35) for the uncontrolled HT group, and 1.54 (95\% CI 1.47-1.60) for the uncontrolled HT and DM group. Adjusted HR for death from any cause were 1.05 (95\% CI 1.01-1.10) for the uncontrolled DM group, 1.13 (95\% CI 1.10-1.16) for the uncontrolled HT group, and 1.17 (95\% CI 1.12-1.23) for the uncontrolled HT and DM group. Conclusions: This up-to-date evidence of cardiovascular epidemiology in South Korea serves as the basis for planning public health policies to prevent cardiovascular diseases. The high uncontrolled rates of HT or DM, regardless of medication prescription, have led us to suggest the need for a novel system for effective BP or glycemic control, such as a community-wide management program using mobile health technology. ", doi="10.2196/42190", url="https://publichealth.jmir.org/2023/1/e42190", url="http://www.ncbi.nlm.nih.gov/pubmed/36735297" } @Article{info:doi/10.2196/41442, author="Yuan, Zhichao and Wang, Hai-Jun and Li, Qin and Su, Tao and Yang, Jie and Chen, Junjun and Peng, Yuanzhou and Zhou, Shuang and Bao, Heling and Luo, Shusheng and Wang, Hui and Liu, Jue and Han, Na and Guo, Yuming and Ji, Yuelong", title="Risk of De Novo Hypertensive Disorders of Pregnancy After Exposure to PM1 and PM2.5 During the Period From Preconception to Delivery: Birth Cohort Study", journal="JMIR Public Health Surveill", year="2023", month="Jan", day="23", volume="9", pages="e41442", keywords="air pollution", keywords="PM2.5", keywords="PM1", keywords="hypertensive disorders of pregnancy", keywords="preconceptional period", keywords="lag effect", keywords="pregnancy", keywords="hypertension", keywords="hypertensive disorders", keywords="risk", keywords="pollutants", keywords="exposure", keywords="maternal health", keywords="perinatal health", keywords="pollution", abstract="Background: Particulate matter (PM) is detrimental to the respiratory and circulatory systems. However, no study has evaluated the lag effects of weekly exposure to fine PM during the period from preconception to delivery on the risk of hypertensive disorders of pregnancy (HDPs). Objective: We set out to investigate the lag effect windows of PM on the risk of HDPs on a weekly scale. Methods: Data from women with de novo HDPs and normotensive pregnant women who were part of the Peking University Retrospective Birth Cohort, based on the hospital information system of Tongzhou district, were obtained for this study. Meteorological data and data on exposure to fine PM were predicted by satellite remote sensing data based on maternal residential address. The de novo HDP group consisted of pregnant women who were diagnosed with gestational hypertension or preeclampsia. Fine PM was defined as PM2.5 and PM1. The gestational stage of participants was from preconception (starting 12 weeks before gestation) to delivery (before the 42nd gestational week). A distributed-lag nonlinear model (DLNM) was nested in a Cox regression model to evaluate the lag effects of weekly PM exposure on de novo HDP hazard by controlling the nonlinear relationship of exposure--reaction. Stratified analyses by employment status (employed or unemployed), education level (higher or lower), and parity (primiparity or multiparity) were performed. Results: A total of 22,570 pregnant women (mean age 29.1 years) for whom data were available between 2013 and 2017 were included in this study. The prevalence of de novo HDPs was 6.7\% (1520/22,570). Our findings showed that PM1 and PM2.5 were significantly associated with an elevated hazard of HDPs. Exposure to PM1 during the 5th week before gestation to the 6th gestational week increased the hazard of HDPs. A significant lag effect of PM2.5 was observed from the 1st week before gestation to the 6th gestational week. The strongest lag effects of PM1 and PM2.5 on de novo HDPs were observed at week 2 and week 6 (hazard ratio [HR] 1.024, 95\% CI 1.007-1.042; HR 1.007, 95\% CI 1.000-1.015, respectively, per 10 $\mu$g/m3 increase). The stratified analyses indicated that pregnant women who were employed, had low education, and were primiparous were more vulnerable to PM exposure for de novo HDPs. Conclusions: Exposure to PM1 and PM2.5 was associated with the risk of de novo HDPs. There were significant lag windows between the preconception period and the first trimester. Women who were employed, had low education, and were primiparous were more vulnerable to the effects of PM exposure; more attention should be paid to these groups for early prevention of de novo HDPs. ", doi="10.2196/41442", url="https://publichealth.jmir.org/2023/1/e41442", url="http://www.ncbi.nlm.nih.gov/pubmed/36689262" } @Article{info:doi/10.2196/39490, author="Dorr, David and D'Autremont, Chris and Richardson, E. Joshua and Bobo, Michelle and Terndrup, Christopher and Dunne, J. M. and Cheng, Anthony and Rope, Robert", title="Patient-Facing Clinical Decision Support for High Blood Pressure Control: Patient Survey", journal="JMIR Cardio", year="2023", month="Jan", day="23", volume="7", pages="e39490", keywords="high blood pressure", keywords="hypertension", keywords="clinical decision support", keywords="shared decision-making", keywords="blood pressure control", keywords="decision-making support", keywords="patient engagement", keywords="patient support tool", abstract="Background: High blood pressure (HBP) affects nearly half of adults in the United States and is a major factor in heart attacks, strokes, kidney disease, and other morbidities. To reduce risk, guidelines for HBP contain more than 70 recommendations, including many related to patient behaviors, such as home monitoring and lifestyle changes. Thus, the patient's role in controlling HBP is crucial. Patient-facing clinical decision support (CDS) tools may help patients adhere to evidence-based care, but customization is required. Objective: Our objective was to understand how to adapt CDS to best engage patients in controlling HBP. Methods: We conducted a mixed methods study with two phases: (1) survey-guided interviews with a limited cohort and (2) a nationwide web-based survey. Participation in each phase was limited to adults aged between 18 and 85 years who had been diagnosed with hypertension. The survey included general questions that assessed goal setting, treatment priorities, medication load, comorbid conditions, satisfaction with blood pressure (BP) management, and attitudes toward CDS, and also a series of questions regarding A/B preferences using paired information displays to assess perceived trustworthiness of potential CDS user interface options. Results: We conducted 17 survey-guided interviews to gather patient needs from CDS, then analyzed results and created a second survey of 519 adults with clinically diagnosed HBP. A large majority of participants reported that BP control was a high priority (83\%), had monitored BP at home (82\%), and felt comfortable using technology (88\%). Survey respondents found displays with more detailed recommendations more trustworthy (56\%-77\% of them preferred simpler displays), especially when incorporating social trust and priorities from providers and patients like them, but had no differences in action taken. Conclusions: Respondents to the survey felt that CDS capabilities could help them with HBP control. The more detailed design options for BP display and recommendations messaging were considered the most trustworthy yet did not differentiate perceived actions. ", doi="10.2196/39490", url="https://cardio.jmir.org/2023/1/e39490", url="http://www.ncbi.nlm.nih.gov/pubmed/36689260" } @Article{info:doi/10.2196/36072, author="Chew, Evelyn and Teo, Huang Sok and Tang, Ee Wern and Ng, Liang David Wei and Koh, Huat Gerald Choon and Teo, Ying Valerie Hui", title="Trust and Uncertainty in the Implementation of a Pilot Remote Blood Pressure Monitoring Program in Primary Care: Qualitative Study of Patient and Health Care Professional Views", journal="JMIR Hum Factors", year="2023", month="Jan", day="5", volume="10", pages="e36072", keywords="telemedicine", keywords="hypertension", keywords="remote blood pressure monitoring", keywords="health IT", keywords="primary health care", keywords="trust", keywords="health care provider relationship", keywords="blood pressure", keywords="primary care", keywords="qualitative study", keywords="health care workers", keywords="patients", abstract="Background: Trust is of fundamental importance to the adoption of technologies in health care. The increasing use of telemedicine worldwide makes it important to consider user views and experiences. In particular, we ask how the mediation of a technological platform alters the trust relationship between patient and health care provider. Objective: To date, few qualitative studies have focused on trust in the use of remote health care technologies. This study examined the perspectives of patients and clinical staff who participated in a remote blood pressure monitoring program, focusing on their experiences of trust and uncertainty in the use of technology and how this telehealth intervention may have affected the patient-provider relationship. Methods: A secondary qualitative analysis using inductive thematic analysis was conducted on interview data from 13 patients and 8 staff members who participated in a remote blood pressure monitoring program to elicit themes related to trust. Results: In total, 4 themes were elicited that showed increased trust (patients felt reassured, patients trusted the telehealth program, staff felt that the data were trustworthy, and a better patient-provider partnership based on the mutually trusted data), and 4 themes were elicited that reflected decreased trust (patients' distrust of technology, clinicians' concerns about the limitations of technologically mediated interactions, experiences of uncertainty, and institutional risk). Conclusions: Managing trust relationships plays an important role in the successful implementation of telemedicine. Ensuring that trust building is incorporated in the design of telehealth interventions can contribute to improved effectiveness and quality of care. ", doi="10.2196/36072", url="https://humanfactors.jmir.org/2023/1/e36072", url="http://www.ncbi.nlm.nih.gov/pubmed/36602847" } @Article{info:doi/10.2196/38782, author="Tang, Dongfeng and Zhou, Yiheng and Long, Chengxu and Tang, Shangfeng", title="The Association of Midday Napping With Hypertension Among Chinese Adults Older Than 45 Years: Cross-sectional Study", journal="JMIR Public Health Surveill", year="2022", month="Nov", day="22", volume="8", number="11", pages="e38782", keywords="hypertension", keywords="risk factor", keywords="midday napping", keywords="BMI", keywords="mediation effect", abstract="Background: Hypertension is one of the main public health issues around worldwide, and midday napping is a popular habit. The association between the two remains to be explored. Objective: The goal of the research was to explore the association of midday napping with hypertension. Methods: This study separately selected 11,439, 12,689, and 9464 Chinese respondents aged over 45 years from the China Health and Retirement Longitudinal Study 2011, 2015, and 2018 data sets. Binary logistic regression was used to explore the association of midday napping with hypertension, and the 3-step method was used to test the mediation effect of BMI. Results: Among all respondents, the prevalence rates of hypertension were 24.6\% (2818/11439) in 2011, 21.1\% (2683/12689) in 2015, and 22.1\% (2092/9464) in 2018. Midday napping was positively correlated with hypertension. In 2011 and 2015, napping 60 to 90 minutes had the greatest odds ratios [OR] (OR2011 1.705, OR2015 1.494). In 2018, the biggest OR came from the group napping 30 to 60 minutes (OR 1.223), and ORs of different napping durations decreased from 2011 to 2018. In addition, BMI had a partial mediation effect in 2015 and 2018. Conclusions: Midday napping is a potential risk factor for hypertension with BMI acting as a mediator. To prevent hypertension, avoiding prolonged duration of midday napping and taking action to maintain a normal BMI level are recommended. ", doi="10.2196/38782", url="https://publichealth.jmir.org/2022/11/e38782", url="http://www.ncbi.nlm.nih.gov/pubmed/36279195" } @Article{info:doi/10.2196/35876, author="Alnooh, Ghadah and Alessa, Tourkiah and Hawley, Mark and de Witte, Luc", title="The Use of Dietary Approaches to Stop Hypertension (DASH) Mobile Apps for Supporting a Healthy Diet and Controlling Hypertension in Adults: Systematic Review", journal="JMIR Cardio", year="2022", month="Nov", day="2", volume="6", number="2", pages="e35876", keywords="DASH diet", keywords="Dietary Approaches to Stop Hypertension", keywords="smartphone app", keywords="mobile app", keywords="blood pressure", abstract="Background: Uncontrolled hypertension is a public health issue, with increasing prevalence worldwide. The Dietary Approaches to Stop Hypertension (DASH) diet is one of the most effective dietary approaches for lowering blood pressure (BP). Dietary mobile apps have gained popularity and are being used to support DASH diet self-management, aiming to improve DASH diet adherence and thus lower BP. Objective: This systematic review aimed to assess the effectiveness of smartphone apps that support self-management to improve DASH diet adherence and consequently reduce BP. A secondary aim was to assess engagement, satisfaction, acceptance, and usability related to DASH mobile app use. Methods: The Embase (OVID), Cochrane Library, CINAHL, Web of Science, Scopus, and Google Scholar electronic databases were used to conduct systematic searches for studies conducted between 2008 and 2021 that used DASH smartphone apps to support self-management. The reference lists of the included articles were also checked. Studies were eligible if they (1) were randomized controlled trials (RCTs) or pre-post studies of app-based interventions for adults (aged 18 years or above) with prehypertension or hypertension, without consideration of gender or sociodemographic characteristics; (2) used mobile phone apps alone or combined with another component, such as communication with others; (3) used or did not use any comparator; and (4) had the primary outcome measures of BP level and adherence to the DASH diet. For eligible studies, data were extracted and outcomes were organized into logical categories, including clinical outcomes (eg, systolic BP, diastolic BP, and weight loss), DASH diet adherence, app usability and acceptability, and user engagement and satisfaction. The quality of the studies was evaluated using the Cochrane Collaboration's Risk of Bias tool for RCTs, and nonrandomized quantitative studies were evaluated using a tool provided by the US National Institutes of Health. Results: A total of 5 studies (3 RCTs and 2 pre-post studies) including 334 participants examined DASH mobile apps. All studies found a positive trend related to the use of DASH smartphone apps, but the 3 RCTs had a high risk of bias. One pre-post study had a high risk of bias, while the other had a low risk. As a consequence, no firm conclusions could be drawn regarding the effectiveness of DASH smartphone apps for increasing DASH diet adherence and lowering BP. All the apps appeared to be acceptable and easy to use. Conclusions: There is weak emerging evidence of a positive effect of using DASH smartphone apps for supporting self-management to improve DASH diet adherence and consequently lower BP. Further research is needed to provide high-quality evidence that can determine the effectiveness of DASH smartphone apps. ", doi="10.2196/35876", url="https://cardio.jmir.org/2022/2/e35876", url="http://www.ncbi.nlm.nih.gov/pubmed/36322108" } @Article{info:doi/10.2196/38215, author="Branch, H. OraLee and Rikhy, Mohit and Auster-Gussman, A. Lisa and Lockwood, G. Kimberly and Graham, A. Sarah", title="Relationships Between Blood Pressure Reduction, Weight Loss, and Engagement in a Digital App--Based Hypertension Care Program: Observational Study", journal="JMIR Form Res", year="2022", month="Oct", day="27", volume="6", number="10", pages="e38215", keywords="high blood pressure", keywords="obesity", keywords="weight loss", keywords="conversational artificial intelligence", keywords="lifestyle coaching", abstract="Background: Home blood pressure (BP) monitoring is recommended for people with hypertension; however, meta-analyses have demonstrated that BP improvements are related to additional coaching support in combination with self-monitoring, with little or no effect of self-monitoring alone. High-contact coaching requires substantial resources and may be difficult to deliver via human coaching models. Objective: This observational study assessed changes in BP and body weight following participation in a fully digital program called Lark Hypertension Care with coaching powered by artificial intelligence (AI). Methods: Participants (N=864) had a baseline systolic BP (SBP) ?120 mm Hg, provided their baseline body weight, and had reached at least their third month in the program. The primary outcome was the change in SBP at 3 and 6 months, with secondary outcomes of change in body weight and associations of changes in SBP and body weight with participant demographics, characteristics, and program engagement. Results: By month 3, there was a significant drop of --5.4 mm Hg (95\% CI --6.5 to --4.3; P<.001) in mean SBP from baseline. BP did not change significantly (ie, the SBP drop maintained) from 3 to 6 months for participants who provided readings at both time points (P=.49). Half of the participants achieved a clinically meaningful drop of ?5 mm Hg by month 3 (178/349, 51.0\%) and month 6 (98/199, 49.2\%). The magnitude of the drop depended on starting SBP. Participants classified as hypertension stage 2 had the largest mean drop in SBP of --12.4 mm Hg (SE 1.2 mm Hg) by month 3 and --13.0 mm Hg (SE 1.6 mm Hg) by month 6; participants classified as hypertension stage 1 lowered by --5.2 mm Hg (SE 0.8) mm Hg by month 3 and --7.3 mm Hg (SE 1.3 mm Hg) by month 6; participants classified as elevated lowered by --1.1 mm Hg (SE 0.7 mm Hg) by month 3 but did not drop by month 6. Starting SBP ($\beta$=.11; P<.001), percent weight change ($\beta$=--.36; P=.02), and initial BMI ($\beta$=--.56; P<.001) were significantly associated with the likelihood of lowering SBP ?5 mm Hg by month 3. Percent weight change acted as a mediator of the relationship between program engagement and drop in SBP. The bootstrapped unstandardized indirect effect was --0.0024 (95\% CI --0.0052 to 0; P=.002). Conclusions: A hypertension care program with coaching powered by AI was associated with a clinically meaningful reduction in SBP following 3 and 6 months of program participation. Percent weight change was significantly associated with the likelihood of achieving a ?5 mm Hg drop in SBP. An AI-powered solution may offer a scalable approach to helping individuals with hypertension achieve clinically meaningful reductions in their BP and associated risk of cardiovascular disease and other serious adverse outcomes via healthy lifestyle changes such as weight loss. ", doi="10.2196/38215", url="https://formative.jmir.org/2022/10/e38215", url="http://www.ncbi.nlm.nih.gov/pubmed/36301618" } @Article{info:doi/10.2196/38567, author="Yang, Yuting and Hou, Mengchi and Gong, Xue and Guo, Rui and Feng, Lin Xing and Tian, Rui", title="Quality Assessment of Hypertension Treatment--Related Information on WeChat: Cross-sectional Study", journal="J Med Internet Res", year="2022", month="Oct", day="26", volume="24", number="10", pages="e38567", keywords="quality assessment", keywords="hypertension", keywords="WeChat", keywords="DISCERN instrument", abstract="Background: The WeChat platform has become a primary source for medical information in China. However, no study has been conducted to explore the quality of information on WeChat for the treatment of hypertension, the leading chronic condition. Objective: This study aimed to explore the quality of information in articles on WeChat that are related to hypertension treatment from the aspects of credibility, concreteness, accuracy, and completeness. Methods: We searched for all information related to hypertension treatment on WeChat based on several inclusion and exclusion criteria. We used 2 tools to evaluate information quality, and 2 independent reviewers performed the assessment with the 2 tools separately. First, we adopted the DISCERN instrument to assess the credibility and concreteness of the treatment information, with the outcomes classified into five grades: excellent, good, fair, poor, and very poor. Second, we applied the Chinese Guidelines for Prevention and Treatment of Hypertension (2018 edition) to evaluate the accuracy and completeness of the article information with regard to specific medical content. Third, we combined the results from the 2 assessments to arrive at the overall quality of the articles and explored the differences between, and associations of, the 2 independent assessments. Results: Of the 223 articles that were retrieved, 130 (58.3\%) full texts were included. Of these 130 articles, 81 (62.3\%) described therapeutic measures for hypertension. The assessment based on the DISCERN instrument reported a mean score of 31.22 (SD 8.46). There were no articles rated excellent (mean score >63); most (111/130, 85.4\%) of the articles did not refer to the consequences---in particular, quality of life---of no treatment. For specific medical content, adherence to the Chinese Guidelines for Prevention and Treatment of Hypertension was generally low in terms of accuracy and completeness, and there was much erroneous information. The overall mean quality score was 10.18 (SD 2.22) for the 130 articles, and the scores differed significantly across the 3 types (P=.03) and 5 sources (P=.02). Articles with references achieved higher scores for quality than those reporting none (P<.001). The results from the DISCERN assessment and the medical content scores were highly correlated ($\rho$=0.58; P<.001). Conclusions: The quality of hypertension treatment--related information on the WeChat platform is low. Future work is warranted to regulate information sources and strengthen references. For the treatment of hypertension, crucial information on the consequences of no treatment is urgently needed. ", doi="10.2196/38567", url="https://www.jmir.org/2022/10/e38567", url="http://www.ncbi.nlm.nih.gov/pubmed/36287598" } @Article{info:doi/10.2196/37648, author="Xue, Qun and Zhang, Xuewu and Liu, Rong and Guan, Xiaoqin and Li, Guocheng and Zhao, Linhai and Wang, Qian and Wang, Debin and Shen, Xingrong", title="Differentiated Effects and Determinants of Home Blood Pressure Telemonitoring: Three-Year Cohort Study in Jieshou, Anhui, China", journal="J Med Internet Res", year="2022", month="Oct", day="11", volume="24", number="10", pages="e37648", keywords="blood pressure", keywords="home telemonitoring", keywords="effect", keywords="influence factors", keywords="China", abstract="Background: Home blood pressure telemonitoring (HBPT) is witnessing rapid diffusion worldwide. Contemporary studies documented mainly short-term (6-12 months) effects of HBPT, and there are limited data about its uptake. Objective: The aim of this study was to explore the 3-year use and determinants of HBPT, and the interactions with systolic and diastolic blood pressure (SBP/DBP) and overall blood pressure (BP) control rate. Methods: HBPT records were obtained from a 3-year cohort of 5658 patients with hypertension in Jieshou, Anhui, China, and data from a structured household survey of a random sample (n=3005) of the cohort. The data analysis comprised (1) timeline trajectories of the rates of monthly active HBPT and mean SBP/DBP for overall and subgroups of patients with varied start-month SBP/DBP; and (2) multivariable linear, logistic, and percentile regression analyses using SBP/DBP, BP control rate, and yearly times of HBPT as the dependent variable, respectively. Results: HBPT was followed by mixed changes in mean monthly SBP/DBP for varied patient groups. The magnitude of changes ranged from --43 to +39 mmHg for SBP and from --27 to +15 mmHg for DBP. The monthly rates of active HBPT all exhibited a rapid and then gradually slower decline. When controlled for commonly reported confounders, times of HBPT in the last year were found to have decreasing correlation coefficients for SBP/DBP (from 0.16 to --0.35 and from 0.11 to --0.35, respectively) and for BP control rate (from 0.53 to --0.62). Conclusions: HBPT had major and ``target-converging'' effects on SBP/DBP. The magnitude of changes was much greater than commonly reported. BP, variation in BP, and time were the most important determinants of HBPT uptake. Age, education, duration of hypertension, family history, and diagnosis of hypertension complications were also linked to the uptake but at weaker strength. There is a clear need for differentiated thinking over the application and assessment of HBPT, and for identifying and correcting/leveraging potential outdated/new opportunities or beliefs. ", doi="10.2196/37648", url="https://www.jmir.org/2022/10/e37648", url="http://www.ncbi.nlm.nih.gov/pubmed/36114000" } @Article{info:doi/10.2196/21878, author="Abid, Leila and Hammami, Rania and Abdesselem, Salem and Boudiche, Selim and H{\'e}di, Slima Ben and Sayahi, Khaled and Bahloul, Amine and Chamtouri, Ikram and Charfeddine, Salma and Rais, Lamia and Drissa, Meriem and Ben Kaab, Badreddine and Ibn hadj amor, Hassen and Ben Fatma, Lilia and Garbaa, Riadh and Boukhris, Sabrine and Emna, Allouche and Ben Halima, Manel and Amdouni, Nesrine and Ghorbel, Shayma and Soudani, Sabrine and Khaled, Imen and Triki, Syrine and Bouazizi, Feten and Jemai, Imen and Abdeljalil, Ouday and Ammar, Yemna and Farah, Amani and Neji, Adnen and Oumaya, Zeineb and Seghaier, Sana and Mokrani, Samir and Thawaba, Hamza and Sarray, Hela and Ouaghlani, Khalil and Thabet, Houssem and Mnif, Zeineb and Fatma, Masmoudi Boujelben and Sghaier, Mohamed and Khalifa, Roueida and Fourati, Sami and Kammoun, Yassmine and Abid, Syrine and Hamza, Chiheb and Ben Jeddou, Syrine and Sabbah, Lassaad and Lakhdhar, Rim and Dammak, Najla and Sellami, Tarak and Herbegue, Basma and Koubaa, Alia and Triki, Faten and Ellouze, Tarek and Hmoudi, Aicha and Ben Ameur, Ikhlas and Boukhchina, Mongi Mohamed and Abid, Neila and Ouechtati, Wejdene and Nasrallah, Nizar and Houidi, Yousra and Mghaieth Zghal, Fathia and Elhem, Ghodhbane and Chayeb, Mounira and Sarra, Chenik and Kaabachi, Samira and Saadaoui, Nizar and Ben Ameur, Ines and Affes, Moufida and Ouali, Sana and Chaker, Mouna and Naana, Hela and Meriem, Dghim and Jarrar, Mourad and Mnif, Jihen and Turki, Ahmed and Zairi, Ihsen and Langar, Jamel and Dardouri, Safa and Hachaichi, Imen and Chettaoui, Rafik and Smat, Wajih and Chakroun, Amel and Mzoughi, Khadija and Mechmeche, Rachid and Ben Halima, Afef and Ben Kahla Koubaa, Sahar and Chtourou, Slim and Mohamed abdelkader, Maalej and Ayari, Mohsen and Hadrich, Moufid and Rami, Tlili and Azaiez, Fares and Bouhlel, Imen and Sahnoun, Samir and Jerbi, Habib and Imtinene, Mrad Ben and Riahi, Leila and Sahnoun, Mohamed and Ben Jemaa, Abdelhamid and Ben Salem, Amal and Rekik, Bassem and Ben Doudou, Maroua and Boujnah, Rachid Mohamed and Joulak, Anissa and Omar, Abid and Razgallah, Rabie and Sami, Milouchi and Neffati, Elyes and Gamra, Habib and Ben Youssef, Soraya and Sdiri, Wissem and Ben Halima, Nejeh and Ben Ameur, Youssef and Kachboura, Salem and Kraiem, Sondes and Fehri, Wafa and Zakhama, Lilia and Bezdah, leila and Mohamed Sami, Mourali and Drissa, Habiba and Maatouk, Faouzi Mohamed and Kammoun, Samir and Addad, Faouzi", title="Design and Rationale of the National Observational Multicentric Tunisian Registry of Hypertension: Protocol for Evaluating Hypertensive Patient Care in Clinical Practice", journal="JMIR Res Protoc", year="2022", month="Sep", day="2", volume="11", number="9", pages="e21878", keywords="National Tunisian Registry", keywords="hypertension", abstract="Background: This study was designed to evaluate the care of hypertensive patients in daily clinical practice in public and private centers in all Tunisian regions. Objective: This study will provide us an overview of hypertension (HTN) management in Tunisia and the degree of adherence of practitioners to international recommendations. Methods: This is a national observational cross-sectional multicenter study that will include patients older than 18 years with HTN for a duration of 4 weeks, managed in the public sector from primary and secondary care centers as well as patients managed in the private sector. Every participating patient signed a consent form. The study will exclude patients undergoing dialysis. The parameters that will be evaluated are demographic and anthropometric data, lifestyle habits, blood pressure levels, lipid profiles, treatment, and adherence to treatment. The data are collected via the web interface in the Dacima Clinical Suite. Results: The study began on April 15, 2019 and ended on May 15, 2019. During this period, we included 25,890 patients with HTN. Data collection involved 321 investigators from 24 Tunisian districts. The investigators were doctors working in the private and public sectors. Conclusions: Observational studies are extremely useful in improving the management of HTN in developing countries. Trial Registration: ClinicalTrials.gov NCT04013503; https://clinicaltrials.gov/ct2/show/NCT04013503 International Registered Report Identifier (IRRID): DERR1-10.2196/21878 ", doi="10.2196/21878", url="https://www.researchprotocols.org/2022/9/e21878", url="http://www.ncbi.nlm.nih.gov/pubmed/36053572" } @Article{info:doi/10.2196/36747, author="Te, Vannarath and Wouters, Edwin and Buffel, Veerle and Van Damme, Wim and van Olmen, Josefien and Ir, Por", title="Generation of Cascades of Care for Diabetes and Hypertension Care Continuum in Cambodia: Protocol for a Population-Based Survey Protocol", journal="JMIR Res Protoc", year="2022", month="Sep", day="2", volume="11", number="9", pages="e36747", keywords="diabetes", keywords="hypertension", keywords="cascade of care", keywords="implementation research", keywords="care models", keywords="population-based survey", keywords="continuum of care", abstract="Background: Cardiovascular diseases (CVDs) were accountable for 24\% of the total deaths in Cambodia, one of the low- and middle-income countries, where primary health care (PHC) settings generally do not perform well in the early detection, diagnosis, and monitoring of leading risk factors for CVDs, that is, type 2 diabetes (T2D) and hypertension (HT). Integrated care for T2D and HT in the Cambodian PHC system remains limited, with more than two-thirds of the population never having had their blood glucose measured and more than half of the population with T2D having not received treatment, with only few of them achieving recommended treatment targets. With regard to care for T2D and HT in the public health care system, 3 care models are being scaled up, including (1) a hospital-based model, (2) a health center--based model, and (3) a community-based model. These 3 care models are implemented in isolation with relatively little interaction between each other. The question arises as to what extent the 3 care models have performed in providing care to patients with T2D or HT or both in Cambodia. Objective: This protocol aims to show how to use primary data from a population-based survey to generate data for the cascades of care to assess the continuum of care for T2D and HT across different care models. Methods: We adapt the HIV test-treat-retain cascade of care to assess the continuum of care for patients living with T2D and HT. The cascade-of-care approach outlines the sequential steps in long-term care: testing, diagnosis, linkage with care, retention in care, adherence to treatment, and reaching treatment targets. Five operational districts (ODs) in different provinces will be purposefully selected out of 103 ODs across the country. The population-based survey will follow a multistage stratified random cluster sampling, with expected recruitment of 5280 eligible individuals aged 40 and over as the total sample size. Data collection process will follow the STEPS (STEPwise approach to NCD risk factor surveillance) survey approach, with modification of the sequence of the steps to adapt the data collection to the study context. Data collection involves 3 main steps: (1) structured interviews with questionnaires, (2) anthropometric measurements, and (3) biochemical measurements. Results: As of December 2021, the recruitment process was completed, with 5072 eligible individuals participating in the data collection; however, data analysis is pending. Results are expected to be fully available in mid-2022. Conclusions: The cascade of care will allow us to identify leakages in the system as well as the unmet need for care. Identifying gaps in the health system is vital to improve efficiency and effectiveness of its performance. This study protocol and its expected results will help implementers and policy makers to assess scale-up and adapt strategies for T2D and HT care in Cambodia. Trial Registration: International Standard Randomised Controlled Trials Number (ISRCTN) registry ISRCTN41932064; https://www.isrctn.com/ISRCTN41932064 International Registered Report Identifier (IRRID): DERR1-10.2196/36747 ", doi="10.2196/36747", url="https://www.researchprotocols.org/2022/9/e36747", url="http://www.ncbi.nlm.nih.gov/pubmed/36053576" } @Article{info:doi/10.2196/34767, author="Kassavou, Aikaterini and Wang, Michael and Mirzaei, Venus and Shpendi, Sonia and Hasan, Rana", title="The Association Between Smartphone App--Based Self-monitoring of Hypertension-Related Behaviors and Reductions in High Blood Pressure: Systematic Review and Meta-analysis", journal="JMIR Mhealth Uhealth", year="2022", month="Jul", day="12", volume="10", number="7", pages="e34767", keywords="self-monitoring", keywords="smartphone apps", keywords="behavior change", keywords="hypertension", keywords="blood pressure", keywords="mobile health", keywords="mHealth", keywords="mobile app", keywords="self-management", keywords="lifestyle", abstract="Background: Self-monitoring of behavior can support lifestyle modifications; however, we do not know whether such interventions are effective in supporting positive changes in hypertension-related health behaviors and thus in reducing blood pressure in patients treated for hypertension. Objective: This systematic literature review evaluates the extent to which smartphone app--based self-monitoring of health behavior supports reductions in blood pressure and changes in hypertension-related behaviors. It also explores the behavioral components that might explain intervention effectiveness. Methods: A systematic search of 7 databases was conducted in August 2021. Article screening, study and intervention coding, and data extraction were completed independently by reviewers. The search strategy was developed using keywords from previous reviews and relevant literature. Trials involving adults, published after the year 2000, and in the English language were considered for inclusion. The random-effects meta-analysis method was used to account for the distribution of the effect across the studies. Results: We identified 4638 articles, of which 227 were included for full-text screening. A total of 15 randomized controlled trials were included in the review. In total, 7415 patients with hypertension were included in the meta-analysis. The results indicate that app-based behavioral self-monitoring interventions had a small but significant effect in reducing systolic blood pressure (SBP), on average, by 1.64 mmHg (95\% CI 2.73-0.55, n=7301; odds ratio [OR] 1.60, 95\% CI 0.74-3.42, n=114) and in improving changes in medication adherence behavior (standardized mean difference [SMD] 0.78, 95\% CI 0.22-1.34) compared to usual care or minimal intervention. The review found the intervention had a small effect on supporting improvements in healthy diet by changing habits related to high sodium food (SMD --0.44, 95\% CI --0.79 to --0.08) and a trend, although insignificant, toward supporting smoking cessation, low alcohol consumption, and better physical activity behaviors. A subgroup analysis found that behavioral self-monitoring interventions combined with tailored advice resulted in higher and significant changes in both SBP and diastolic blood pressure (DBP) in comparison to those not providing tailored advice (SBP: --2.92 mmHg, 95\% CI --3.94 to --1.90, n=3102 vs --0.72 mmHg, 95\% CI --1.67 to 0.23, n=4199, $\chi$2=9.65, P=.002; DBP: --2.05 mmHg, 95\% CI --3.10 to --1.01, n=968 vs 1.54 mmHg, 95\% CI --0.53 to 3.61, n=400, $\chi$2=9.19, P=.002). Conclusions: Self-monitoring of hypertension-related behaviors via smartphone apps combined with tailored advice has a modest but potentially clinically significant effect on blood pressure reduction. Future studies could use rigorous methods to explore its effects on supporting changes in both blood pressure and hypertension-related health behaviors to inform recommendations for policy making and service provision. Trial Registration: PROSPERO CRD42019136158; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=136158 ", doi="10.2196/34767", url="https://mhealth.jmir.org/2022/7/e34767", url="http://www.ncbi.nlm.nih.gov/pubmed/35819830" } @Article{info:doi/10.2196/32874, author="Baratta, Juliana and Brown-Johnson, Cati and Safaeinili, Nadia and Goldman Rosas, Lisa and Palaniappan, Latha and Winget, Marcy and Mahoney, Megan", title="Patient and Health Professional Perceptions of Telemonitoring for Hypertension Management: Qualitative Study", journal="JMIR Form Res", year="2022", month="Jun", day="10", volume="6", number="6", pages="e32874", keywords="hypertension", keywords="remote blood pressure monitoring", keywords="precision health", keywords="mobile phone", abstract="Background: Hypertension is the most prevalent and important risk factor for cardiovascular disease, affecting nearly 50\% of the US adult population; however, only 30\% of these patients achieve controlled blood pressure (BP). Incorporating strategies into primary care that take into consideration individual patient needs, such as remote BP monitoring, may improve hypertension management. Objective: From March 2018 to December 2018, Stanford implemented a precision health pilot called Humanwide, which aimed to leverage high-technology and high-touch medicine to tailor individualized care for conditions such as hypertension. We examined multi-stakeholder perceptions of hypertension management in Humanwide to evaluate the program's acceptability, appropriateness, feasibility, and sustainability. Methods: We conducted semistructured interviews with 16 patients and 15 health professionals to assess their experiences with hypertension management in Humanwide. We transcribed and analyzed the interviews using a hybrid approach of inductive and deductive analysis to identify common themes around hypertension management and consensus methods to ensure reliability and validity. Results: A total of 63\% (10/16) of the patients and 40\% (6/15) of the health professionals mentioned hypertension in the context of Humanwide. These participants reported that remote BP monitoring improved motivation, BP control, and overall clinic efficiency. The health professionals discussed feasibility challenges, including the time needed to analyze BP data and provide individualized feedback, integration of BP data, technological difficulties with the BP cuff, and decreased patient use of remote BP monitoring over time. Conclusions: Remote BP monitoring for hypertension management in Humanwide was acceptable to patients and health professionals and appropriate for care. Important challenges need to be addressed to improve the feasibility and sustainability of this approach by leveraging team-based care, engaging patients to sustain remote BP monitoring, standardizing electronic medical record integration of BP measurements, and finding more user-friendly BP cuffs. ", doi="10.2196/32874", url="https://formative.jmir.org/2022/6/e32874", url="http://www.ncbi.nlm.nih.gov/pubmed/35687380" } @Article{info:doi/10.2196/31292, author="Abba, Mustapha and Nduka, Chidozie and Anjorin, Seun and Mohamed, Shukri and Agogo, Emmanuel and Uthman, Olalekan", title="One Hundred Years of Hypertension Research: Topic Modeling Study", journal="JMIR Form Res", year="2022", month="May", day="18", volume="6", number="5", pages="e31292", keywords="hypertension", keywords="high blood pressure", keywords="machine learning", keywords="topic modeling", keywords="latent Dirichlet allocation", keywords="LDA", keywords="cardiovascular", keywords="research trends", abstract="Background: Due to scientific and technical advancements in the field, published hypertension research has developed substantially during the last decade. Given the amount of scientific material published in this field, identifying the relevant information is difficult. We used topic modeling, which is a strong approach for extracting useful information from enormous amounts of unstructured text. Objective: This study aims to use a machine learning algorithm to uncover hidden topics and subtopics from 100 years of peer-reviewed hypertension publications and identify temporal trends. Methods: The titles and abstracts of hypertension papers indexed in PubMed were examined. We used the latent Dirichlet allocation model to select 20 primary subjects and then ran a trend analysis to see how popular they were over time. Results: We gathered 581,750 hypertension-related research articles from 1900 to 2018 and divided them into 20 topics. These topics were broadly categorized as preclinical, epidemiology, complications, and therapy studies. Topic 2 (evidence review) and topic 19 (major cardiovascular events) are the key (hot topics). Most of the cardiopulmonary disease subtopics show little variation over time, and only make a small contribution in terms of proportions. The majority of the articles (414,206/581,750; 71.2\%) had a negative valency, followed by positive (119, 841/581,750; 20.6\%) and neutral valency (47,704/581,750; 8.2\%). Between 1980 and 2000, negative sentiment articles fell somewhat, while positive and neutral sentiment articles climbed substantially. Conclusions: The number of publications has been increasing exponentially over the period. Most of the uncovered topics can be grouped into four categories (ie, preclinical, epidemiology, complications, and treatment-related studies). ", doi="10.2196/31292", url="https://formative.jmir.org/2022/5/e31292", url="http://www.ncbi.nlm.nih.gov/pubmed/35583933" } @Article{info:doi/10.2196/29227, author="Gardiner, Paula and McGonigal, Lisa and Villa, Ariel and Kovell, C. Lara and Rohela, Pallavi and Cauley, Andrew and Rinker, Diana and Olendzki, Barbara", title="Our Whole Lives for Hypertension and Cardiac Risk Factors---Combining a Teaching Kitchen Group Visit With a Web-Based Platform: Feasibility Trial", journal="JMIR Form Res", year="2022", month="May", day="16", volume="6", number="5", pages="e29227", keywords="hypertension", keywords="health disparities", keywords="teaching kitchen", keywords="technology", keywords="mindfulness", keywords="low income", keywords="medical group visits", keywords="mobile phone", abstract="Background: Hypertension (HTN) affects millions of Americans. Our Whole Lives: an eHealth toolkit for Hypertension and Cardiac Risk Factors (OWL-H) is an eHealth platform that teaches evidence-based lifestyle strategies, such mindfulness and cooking skills, to improve self-management of HTN. Objective: The primary goal of this pilot study was to evaluate the feasibility of OWL-H combined with teaching kitchen medical group visits (TKMGVs) in a low-income population of participants with HTN. Methods: We conducted a pre-post 8-week study to assess the feasibility of a hybrid program (a web-based 9-module self-management program, which includes mindfulness and Mediterranean and Dietary Approaches to Stop Hypertension diet) accompanied by 3 in-person TKMGVs among patients with HTN. Data including demographics, platform use, and satisfaction after using OWL-H were examined. Outcome data collected at baseline and 8 weeks included the Mediterranean Diet Questionnaire, Hypertension Self-Care Profile Self-Efficacy Instrument, Blood Pressure Knowledge Questionnaire, and the number of self-reported blood pressure readings. For the statistical analysis, we used descriptive statistics, paired sample t tests (1-tailed), and qualitative methods. Results: Of the 25 enrolled participants, 22 (88\%) participants completed the study. Participants' average age was 57 (SD 12.1) years, and 46\% (11/24) of them reported a household income