Review
Digital Health Approaches for the Assessment and Optimisation of Hypertension Care Provision

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Abstract

Although many aspects of our lives have been transformed by digital innovation, widespread adoption of digital health advancements within the health care sector in general, and for hypertension care specifically, has been limited. However, it is likely that, over the next decade, material increases in the uptake of digital health innovations for hypertension care delivery will be seen. In this narrative review, we summarise those innovations thought to have the greatest chance for impact in the next decade. These include provision of virtual care combined with home blood pressure (BP) telemonitoring, use of digital registries and protocolised care, leveraging continuous BP measurement to collect vast amounts of individual and population-based BP data, and adoption of digital therapeutics to provide low-cost scalable interventions for patients with or at risk for hypertension. Of these, home BP telemonitoring is likely the most ready for implementation, but it needs to be done in a way that enables efficient guideline-concordant care in a cost-effective manner. In addition, efforts must be focused on implementing digital health solutions in a manner that addresses the major challenges to digital adoption. This entails ensuring that innovations are accessible, usable, secure, validated, evidence based, cost-effective, and integrated into the electronic systems that are already used by patients or providers. Increasing the use of broader digital innovations such as artificial/augmented intelligence, data analytics, and interactive voice response is also critically important. The digital revolution holds substantial promise, but success will depend on the ability of collaborative stakeholders to adopt and implement innovative, usable solutions.

Résumé

Bien que l’innovation numérique ait déjà transformé de nombreux aspects de notre vie, force est de constater que l’adoption à grande échelle des découvertes dans le domaine de l’information numérique sur la santé n’a pas, dans le secteur des soins de santé en général et plus particulièrement de l’hypertension, demeure limitée. Cependant, il est probable qu’au cours de la prochaine décennie le déploiement du matériel pour l’adoption des innovations en information numérique sur la santé connaîtra un essor dans la prise en charge thérapeutique de l’hypertension. Dans cet article de synthèse, nous dresserons un résumé des innovations susceptibles d’avoir la plus grande incidence au cours de la prochaine décennie. Ces innovations comprennent la prestation de soins virtuels de pair avec la télésurveillance de la pression artérielle (PA) à domicile, l’utilisation de registres numériques et de protocoles thérapeutiques, le recours à la mesure continue de la PA pour la collecte de grandes quantités de données auprès des individus et des populations, et l’adoption de la thérapeutique numérique pour offrir des interventions évolutives à faible coût aux patients atteints d’hypertension ou prédisposés à celle-ci. Parmi toutes ces innovations, la télésurveillance de la PA à domicile est sans doute celle dont la mise en œuvre est la plus probable, mais cela doit se faire de manière à favoriser des soins efficaces et économiques dans le respect des lignes directrices. De plus, il faut veiller à instaurer des solutions d’information numérique sur la santé qui visent à résoudre les difficultés que pose l’adoption du numérique. Ainsi, ces innovations doivent être accessibles, utilisables, sécuritaires, validées, économiques et fondées sur des données probantes, et s’intégrer aux systèmes électroniques que les patients ou les soignants utilisent déjà. Il est également très important d’accroître l’utilisation d’innovations numériques plus vastes telles que l’intelligence artificielle ou amplifiée, l’analyse des données et la réponse vocale interactive. La révolution numérique est prometteuse, mais sa réussite dépendra de la capacité des divers intervenants à adopter et à mettre en œuvre des solutions innovantes et utilisables.

Section snippets

Definition of Digital Health and Challenges to Uptake

Digital health can be broadly defined as “the use of information technology or electronic communication tools, services, and processes to deliver health care services or to facilitate better health.”9 A major focus of digital health is to make health care more accessible and personalised. Digital health encompasses both hardware and software technologies, including telemedicine, internet, smartphones, short messaging services (texting), and mobile sensors.10 It is often subdivided into

Virtual Care

Office- or clinic-based care, the clinical practice modality that has predominated over the past half-century, requires in-person clinic attendance and, for hypertension care, uses office BP to guide clinical decision making. Unfortunately, office-based BP measurement is inherently inaccurate and often performed in unstandardised fashion, leading to results that, in up to 30%-40% of cases, are poorly reflective of an individual’s underlying BP.15 In terms of inherent inaccuracy, office BP can

Home BP Telemonitoring

To deliver guideline-concordant care during virtual hypertension visits, it is important that providers have some means of determining mean home BP, given that contemporary clinical practice guidelines recommend use of a multiday home BP series to diagnose and manage hypertension. In Canada, a home BP series consists of taking duplicate readings in the morning and evening for 1 week, discarding first-day readings, and using the mean of the remaining 6 days of measurements for clinical decision

Kaiser Permanente Northern California Hypertension Program

The seminal multifaceted Kaiser Permanente Northern California Hypertension Program was established in 2001 and included 652,763 patients in 2009. It consisted of 5 major components: creation of a health system–wide hypertension registry using existing electronic records; assessing and reporting hypertension quality performance metrics, reviewed by a central hypertension management team and disseminated back to individual clinicians and sites; development of an evidence-based protocolised

Continuous (Cuffless) BP Measurement

Cuffless BP measurement, though strictly not a digital health innovation, is relevant to the topic because its proponents promote the premise that it will provide continuous beat-to-beat BP, a development that, if realised, would undoubtedly revolutionise the diagnosis, management, and surveillance of hypertension. In particular, tied to the promise of continuous BP measurement is its potential synergy with the big data and artificial intelligence revolutions, which are critically important

Digital Therapeutics

Digital therapeutics is a relatively new field, originating in the past decade.54 The term, first used in 2015, refers to the use of personalised, evidence-based, software-based solutions for the treatment or prevention of medical conditions.55,56 Behavioural strategies are a common focus, including the use of cognitive behavioural therapy.57 Common target conditions include cardiovascular risk factors, dementia, asthma, substance abuse, and mental health disorders.54 Digital therapeutics can

Conclusion

Uptake of digital health innovations for the diagnosis and management of hypertension is in a relatively nascent stage, but is gaining traction and will undoubtedly increase markedly in coming decades. More widespread use of virtual care, increasing technologic literacy, and higher levels of penetration of technology will drive increased use. Currently, home BP telemonitoring is the innovation most likely to achieve widespread adoption. Smartphone-based registries coupled with protocolised care

Funding Sources

The authors have no funding sources to declare.

Disclosures

R.P. and P.W. are cofounders of mmHg, a University of Alberta–based digital health company. R.P. is a member of the Canadian Standards Association, American Association for the Advancement of Medical Instrumentation, and International Organisation for Standardisation sphygmomanometer committees.

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