Smartphone Application-Assisted Home Blood Pressure Monitoring Compared With Office and Ambulatory Blood Pressure Monitoring in Patients With Hypertension: the AMUSE-BP Study

Author:

Groenland Eline H.1ORCID,Vendeville Jean-Paul A.C.1,Bemelmans Remy H.H.2,Monajemi Houshang3ORCID,Bots Michiel L.4ORCID,Visseren Frank L.J.1ORCID,Spiering Wilko1ORCID

Affiliation:

1. Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (E.H.G., J.-P.A.C.V., F.L.J.V., W.S.).

2. Department of Internal Medicine, Ziekenhuis Gelderse Vallei, Ede, the Netherlands (R.H.H.B.).

3. Department of Internal Medicine, Rijnstate, Arnhem, the Netherlands (H.M.).

4. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (M.L.B.).

Abstract

Background: The development of automated, smartphone application (app)-assisted home blood pressure monitoring (HBPM) allows for standardized measurement of blood pressure (BP) at home. The aim of this study was to evaluate the (diagnostic) agreement between app-assisted HBPM, automated office BP (OBP), and the reference standard 24-hour ambulatory BP monitoring (ABPM). Methods: In this open randomized 5-way cross-over study, patients diagnosed with hypertension were randomized to one of 10 clusters, each containing 5 BP measurement methods (ABPM, HBPM, attended OBP, unattended OBP, and unattended 30-minute BP) in different order. Results: In total, 113 patients were included. The average 24-hour ABPM was 126±11/73±8 mm Hg compared with 141±14/82±10 mm Hg with app-assisted HBPM, 134±13/80±9 mm Hg with unattended 30-minute BP, 137±16/81±11 mm Hg with attended OBP, and 135±15/81±10 mm Hg with unattended OBP monitoring. Diagnostic agreement between app-assisted HBPM and 24-hour ABPM for diagnosing sustained (OBP >140/90 mm Hg and ABPM ≥130/80 mm Hg or HBPM ≥135/85 mm Hg), white-coat (OBP ≥140/90 mm Hg and ABPM <130/80 mm Hg or HBPM <135/85 mm Hg), and masked hypertension (OBP <140/90 mm Hg and ABPM ≥130/80 mm Hg or HBPM ≥135/85 mm Hg) was fair-to-moderate (κ statistics ranging from 0.34 to 0.40). App-assisted HBPM had high sensitivities (78%–91%) and negative predictive values (90%–97%) for diagnosing sustained and masked hypertension. Conclusions: This study showed a considerable (diagnostic) disagreement between app-assisted HBPM and ABPM. App-assisted HBPM had high sensitivity in the diagnosis of sustained and masked hypertension and may therefore be used as complementary to, but not a replacement of, ABPM.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Internal Medicine

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