New approaches to evaluating and monitoring blood pressure

The model of office-based hypertension diagnoses and management is changing with the emergence of mobile health care (mHealth) and increasing acceptance of home blood pressure monitors as a diagnostic and monitoring tool [1–3]. New bio-medical technologies can monitor heart rate, blood pressure, activity level, and various other indices of health. Mobile apps simplify the logging and trending of blood pressures, sync with electronic health records, and allow for better remote monitoring by health-care providers. Developers and early adapters are optimistic that these innovations will lead to cost savings and improved chronic disease management, while reducing the care burden of physicians. Venture funding of digital health companies reached $4.5 billion in 2015 and wearable technologies are likely to become more ubiquitous [4]. However, current clinical practice still relies heavily on traditional office-based blood pressure monitors and protocols, due in part to uncertainty regarding the reliability and safety of newer technologies.

The most recent hypertension guidelines have deemphasized office-based hypertension diagnoses and recommended home blood pressure and ambulatory blood pressure monitoring prior to starting antihypertensive treatment [5, 6]. Despite evidence-based validation protocols, hypertension guidelines have yet to address emerging wearable technologies [7, 8••]. Given the widespread enthusiasm for disease self-management, it is critical to further evaluate the efficacy, safety, and privacy concerns of new technologies in rigorous studies. We review the current literature on mHealth technologies and novel diagnostic and management protocols and make recommendations on how to incorporate these innovations into physician practice.