PHTI review of digital hypertension tools gives mixed results
An evaluation of digital health technologies for hypertension by the Peterson Health Technology Institute (PHTI) finds some provide a clinical benefit, while others are lacking.
On the plus side, the health technology assessment (HTA) body has concluded that tools to help people manage their antihypertensive drug treatment can deliver benefits in reduced blood pressure.
However, its review found that two other categories of digital tech – for transmitting home monitoring data to providers and trying to change patient behaviour – do not provide clinically meaningful improvements.
It is the latest in a series of reviews by PHTI focusing on specific disease categories, coming after earlier assessments of DTx for musculoskeletal conditions and diabetes, with another on depression and anxiety therapeutics due to be published later in the year.
The body – affiliated with the Institute for Clinical and Economic Review (ICER) that conducts cost-effectiveness assessments on prescription medicines sold in the US market – was set up to test the claim that 80% of digital health products lack clinical evidence.
Drilling down into the details, the latest report came out in favour of apps from Cadence, Ochsner Digital Medicine, and Story Health that combine connected blood pressure cuffs with virtual care teams that help manage prescribing and dosing. It noted, however, that Story Health does not have independent evidence about its blood pressure improvements.
These long-term clinical benefits have the potential, over a decade, to offset upfront spending on the DTx, according to PHTI, and should be integrated into standard care for patients.
In the blood pressure monitoring category – digital health tools that support patients' home monitoring and delivering data back to the healthcare provider – the review focused on apps from AMC Health, HRS, and VitalSight.
It found that the clinical benefits with these are modest and do not outweigh the increase in costs unless healthcare providers are particularly rigorous in reviewing and acting on the monitoring data.
The behaviour change apps – Dario, Hello Heart, Lark, Omada, and Teladoc's Livongo – deliver educational content, reminders, and virtual interactions with coaches to improve patients' self-management of their blood pressure. These showed limited effects on blood pressure that are a poor return on the added cost to patient care, according to the report.
"Too many people are living with uncontrolled hypertension, but there are effective digital solutions to help patients improve their cardiovascular health, save lives, and lower spending over the long run," said Caroline Pearson, executive director of PHTI.
"Digital medication management solutions support healthcare providers with virtual teams to monitor blood pressure and adjust medications to help bring patients into control within months, rather than years," she added.
Looking ahead, PHTI recommends that the combination of blood pressure monitoring, medication management, and behaviour change apps be studied to see if they work better in tandem, pointing out that approach could "close access and equity gaps for underserved patient populations."
