Lorraine Ross has been afflicted with high blood pressure since she was 25. Over the years, doctors told her to avoid salty foods, get regular exercise and not to smoke – or else, they warned, her condition would deteriorate.
But Ross, now 64, didn't appreciate the value of maintaining a healthy lifestyle until she recently participated in a medical study for a smartphone application.
As part of the study, she measured her blood pressure two days a week using a commercially available home device that was modified to transmit readings to her BlackBerry, which relayed the data to the research team.
The BlackBerry also provided instant feedback. A text message would note if her blood pressure was in the normal range and offer tips for keeping it on an even keel. If Ross forgot to take a reading, she would get an automated phone call with a reminder that her results were due.
Once she got into the routine of taking the measurements, she noticed that her blood pressure was closely linked to what she did. If she smoked or had a particularly salty meal, her blood pressure would go up.
"It was life-changing for me because it made me understand my blood pressure," she said. "I realized my whole lifestyle had to change." In fact, the experience prompted her to quit smoking, a habit she had had since the age of 12.
The study illustrates the ability of smartphone apps to help people live healthier lives. There are scores of medical-related apps ready to be downloaded or under development. Some help diabetics keep track of their blood-sugar levels. Others direct addicts to rehab services. They all empower patients by giving them direct access to personal health information in a comprehensive way.
The blood-pressure app was developed as a collaborative effort between Dr. Alexander Logan, a staff nephrologist at Mount Sinai Hospital-University Health Network (UHN) in Toronto, and Joseph Cafazzo, a biomedical engineer who is in charge of the UHN's Centre for Global eHealth Innovation.
"What we were trying to devise is a system whereby patients could take more control of their own care," Logan explained. He noted many people with chronic medical conditions usually see a doctor only a few times a year. In between appointments, they may lose the motivation to adhere to a healthy lifestyle or may stop taking their medication.
In the case of hypertension, the medical term for high blood pressure, there are no obvious physical symptoms. So the patient won't necessarily sense that prolonged hypertension is slowing damaging their blood vessels and internal organs, setting the stage for cardiovascular disease and other health problems.
"Our research shows that if a medical app is well designed, it can make a big difference," Cafazzo said, noting that many patients had a significant drop in their blood pressure during the course of the study.
In addition to Ross, the study included more than 100 volunteers who were randomly divided into two groups. One group was told to take measurements two days a week using a conventional home device. The other group was given the equipment linked to the BlackBerry so that they were in regular contact with the research team and received regular text feedback.
After one year, the patients using the smartphone app showed a substantial improvement in their blood pressure, while the others had no change, according to the findings published in the journal Hypertension. On average, the app group had a 9.1-millimetre mercury drop in systolic blood pressure (or the force of blood in the arteries when the heart beats) and a 3.4-mm Hg decrease in the diastolic blood pressure (or the force of blood in the arteries when the heart is at rest). "In real terms, that means their risk of cardiovascular mortality dropped by 20 per cent," Cafazzo said.
"We suspect that regularly taking their blood pressure measurements and being given feedback made the patients far more self-aware – and this self-awareness probably led them to take their medication and caused them to be more cognizant of their lifestyle."
He also thinks that many patients in the control group stopped taking measurements partway through the study and the equipment "likely end up in a drawer somewhere."
Logan agreed. "I think, without feedback messaging, without reminders to take their blood-pressure readings, it is going to fall by the wayside."
Cafazzo and Logan said their app has the potential to improved patient care without adding to the workload of physicians or other health-care providers.
The analysis of the patient blood-pressure readings, and the routine text feedback, is automated "because we did not want to burden the physicians with all this data," Cafazzo said. Doctors would be alerted only when a patient's blood pressure is clearly heading in a worrisome direction.
The Toronto researchers hope to soon make their app widely available to patients. The product first needs to be modified so it works on other devices – not just the BlackBerry.
"Smartphones are now ubiquitous. And we view them as a perfect conduit to get self-management tools into the hands of patients," Cafazzo said.
But the researchers acknowledge that their app is not for everyone. During the study, one patient became anxious every time she measured her blood pressure and was overly concerned about even small fluctuations in the readings.
On the other hand, patients like Lorraine Ross embraced the experience. She ended up taking her blood pressure daily rather than just a few times a week, as required for the study. "It was the best thing I have ever done in my life," she said.