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This book edition has all the information of volume one, "Blood Pressure Monitoring Journal: A Hypertension Diary and Log, including the monitoring logs.
Table of contents

In , approximately , new health-related apps were published, resulting in a total of , health apps currently available in the major app stores [ 17 ]. The health app download rates were estimated to reach 3. The main target areas of app developers are chronic diseases such as hypertension and diabetes [ 17 ]. Furthermore, patients and physicians agree about the potential benefits of health apps and wearables [ 18 ]. Using a mobile app for self-management purposes could make it easier for patients with hypertension to have insight into and control their blood pressure.

These apps may have several useful features: logbook or diary features facilitate logging of blood pressure measurements in an organized way, while reminder functions could facilitate monitoring and medication adherence. In addition, health apps may provide valuable background information for patients about the disease, its treatment, how to measure blood pressure adequately, and lifestyle management.

Analysis tools eg, graphs and trend analysis may provide an overview of the course of blood pressure over time. Furthermore, some apps can export blood pressure readings and other user data to be sent by email. This enables patients to share their measurements with their health care providers and relatives.

Although mobile apps have the potential to be beneficial for patients with hypertension, little is known about the availability, quality, and features of mobile apps targeting blood pressure. Therefore, the aim of this study was to perform a systematic review of apps to determine the availability, functionality, and quality of mobile apps that could be used to collect readings of blood pressure for monitoring purposes. We performed a systematic app search based on the standards for systematic reviews.

Although we followed the standards for systematic reviews of scientific literature, these guidelines are not completely applicable to app reviews. All apps available in the Google Play store for Android and iOS App Store targeting blood pressure monitoring in which blood pressure measurements could be entered manually were potentially eligible for inclusion.

On March 1, , the Dutch app stores were searched using the following search terms: blood pressure, diastolic, health, heart rate, hypertension, hypotension, pressure, systolic, and their Dutch equivalents bloeddruk, diastole, gezondheid, hartslag, hypertensie, hypotensie, and systole. Apps in languages other than English or Dutch and duplicates and irrelevant apps, such as games, were excluded. Some apps had a free version and a pro version.

In cases where there was no difference in the functionality and relevant features between the two versions, only the free version was included in this app review. Two independent assessors HJ and FRdG selected the eligible apps based on app titles, description of the app in the app store, and screenshots provided.

Discrepancies were discussed until a final decision was reached. The selected apps were downloaded on either a Samsung Galaxy S6 Android version 6. Two independent assessors HJ and LCHL tested each app on each platform in duplicate for a minimum of 10 minutes before performing the final assessment. Using a standardized form, the assessors recorded technical app information and app features. App features included the ability of the app to register age, gender, height, weight, time, and date of blood pressure reading, measurement site eg, left or right arm , and measurement position eg, sitting or standing.

We also registered the presence of a reminder function, analysis functions, data export, wireless transfer of measurement data from a blood pressure monitor, and whether user data were password-protected. Based on national and international guidelines for the management of hypertension [ 9 , 19 - 24 ] and recommendations from the literature addressing the management of hypertension [ 25 - 28 ], we selected 6 key app features that are essential for self-management. In addition, we searched the app descriptions in the app stores for the involvement of medical experts in the development of the app.

Furthermore, we searched PubMed and Google Scholar in March to determine whether the apps were trialed or evaluated with results published in peer-reviewed journals. The quality of the apps was evaluated using a standard assessment protocol based on the Mobile App Rating Scale MARS [ 29 ], a questionnaire that measures app quality using 23 questions divided into 4 objective categories engagement, functionality, aesthetics, and information quality and 1 subjective category.

Each question was rated on a 5-point scale 1-inadequate, 2-poor, 3-acceptable, 4-good, 5-excellent. The MARS overall score was calculated by averaging the means of the 4 objective categories. Afterwards 10 randomly selected apps were used for training purposes. The assessors discussed each item of the MARS scale and reached consensus on the scores during the training.

After these 10 apps, the assessors did not discuss any apps and rated them independently. We calculated the scores of the MARS separately per assessor and averaged the scores at total level. The distributions of the scores were checked for normality. Based on the ICC guidelines developed by Shrout and Fleiss [ 30 ], we used a 2-way mixed effects, average measures model with a consistency of agreement definition [ 31 ].

Cronbach alpha was used to assess the internal consistency reliability ie, the extent to which all items in a scale measure the same concept of the MARS [ 32 ]. Descriptive statistics were used to summarize and evaluate the app features. Differences in proportions were tested using chi-square tests. To determine whether specific characteristics were associated with quality scores, MARS scores of apps with and without the a priori selected characteristics were compared using independent sample t tests.

Pearson correlation coefficients were calculated to compare the MARS overall scores with star ratings obtained from the app stores of Android and iOS. Only apps with 10 or more user ratings were included in this analysis.

Blood Pressure Monitoring Journal: A Hypertension Diary and Activity Log

A total of apps were identified using the search terms. Screening on app titles and descriptions in the app stores resulted in potentially eligible apps. Further assessment, performed after downloading and testing of the selected apps, resulted in the inclusion of apps, of which were Android apps and 80 iOS apps. Some apps were available on both platforms so were included twice in this study. Figure 1 illustrates the selection procedure. The app characteristics are summarized in Table 1.

The majority of the apps included Android apps were more often free compared to iOS apps However, iOS apps were more often free of advertisements compared to Android apps Less than half of the apps tracked personal background data, with the exception of weight tracking in Android apps. Only a small proportion of apps recorded how the blood pressure measurements were performed measurement side, Compared to iOS apps, Android apps more often recorded measurement side Only 2 apps did not register time and date of the measurement.

A reminder function was present in The latter was more often available in iOS apps than in Android apps A total of 26 apps, of which 15 were Android and 11 iOS, contained 5 predefined key features. A total of apps were developed by commercial 31 or unknown developers. Only 2 apps Heartkeeper and Blood pressure monitoring for pregnancy were developed by universities or nongovernmental organizations. Of all apps included, only 3. None of the apps was trialed or evaluated with results published in a peer-reviewed journal. The MARS overall and subscale scores were normally distributed.

On a scale from 1 to 5, the mean MARS score for the 4 objective categories was 2. Subjective quality scored 2. Of the 5 categories, functionality received the highest score Android 3. The complete list is available in Multimedia Appendix 1.

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Table 3 shows the quality scores comparison for apps with and without each characteristic. Incorporation of all characteristics resulted in higher quality scores except for pricing, in-app advertisements, and local data storage. The 5 apps with the highest MARS overall scores per platform are listed in Multimedia Appendix 2 together with their characteristics. All apps in the top 5 for each platform were free. In this study, we observed a lower MARS overall score compared to other reviews focusing on apps for other self-management aspects [ 33 - 35 ].

However, comparable to our study, functionality was previously reported as the objective category with the highest MARS score [ 33 , 35 ]. Our results also showed that some of the app features have a large influence on the overall quality score. The app features with the most positive influence on the app quality score are the ability of using the cloud for data storage, wireless data upload from blood pressure meters, ability to export data, ability to analyze data, ability to send reminders, and ability to record personal data, such as age and weight.

If present, the latter feature makes it easier and more convenient to measure and record blood pressure. Only approximately a quarter of the apps in our study had a reminder function, but reminder features can be very important in facilitating adherence [ 36 , 37 ]. The authors of a previous study on hypertension apps reported similar results [ 38 ]. Only 2 apps were developed by a university or nongovernmental organizations and none of the apps was evaluated with results published in the literature.

This, combined with the low scores for information on the MARS scale, suggests the lack of involvement from medical experts in the process of app development, which was also reported in previous studies [ 39 - 42 ]. The high MARS scores for functionality combined with the low MARS scores for information suggests that most apps function well but lack important information. This lack of information may result into incorrect use of the app eg, incorrect interpretation of blood pressure readings, resulting in potential nonadherence to therapy by users who are not sufficiently literate in digital health.

Therefore, health apps should be validated before use. Another explanation may be that the MARS is not a perfect instrument to assess these features. There were no differences in quality scores between paid and free apps, which has also been reported previously [ 35 ]. Notably, the top 5 apps, identified by the highest MARS overall scores, were all free of charge.

PatientsLikeMe is a well-known example. This platform is free of charge and very useful, but user data is sold [ 43 ].

Blood Pressure Companion

That may explain why these apps are offered free of charge in the app stores by the app developers. We did not observe a correlation between the star ratings and the MARS overall scores. However, it is difficult to assess reliability of star ratings in app stores, since the criteria and qualifications of assessors are not always clear. For example, reviewers may leave ratings that do not reflect their true opinions or only selected users leave a rating selection bias.

The authors of a recent study on app store user ratings and reviews of a blood pressure app Instant Blood Pressure reported that these types of ratings were unreliable [ 44 ]. In this study, we identified a large number of apps ineligible for self-management and many apps of poor quality.

These apps may potentially be harmful to users. Apps providing patients with erroneous information or apps that do not do what they are supposed to do are examples of such harmful apps. At the American Medical Association interim meeting in , Executive Vice President James Madara mentioned a blood pressure app that failed at high rates in detecting elevated blood pressure and yet was one of the most frequently downloaded health apps for 2 years [ 45 ]. It is important to separate good apps from the harmful ones and to stimulate the development of high quality apps.

It is important to regulate the development of health apps internationally, because apps are available in multiple national app stores. Therefore, setting up an international institute to regulate the development of health apps or certifying health apps may be necessary. HON assesses the quality of health information online and provides certification to websites with reliable health information [ 46 ]. A major strength of this study is that we searched the 2 main app stores systematically using 15 search terms in English and Dutch and included both paid and free apps.

This resulted in a large number of apps that were first screened on titles and descriptions in the app stores. All apps identified through this process were assessed by 2 independent reviewers. In addition, we assessed the quality of the apps objectively using MARS [ 29 ], which has previously been used to evaluate app quality in several app reviews [ 35 , 47 , 48 ].

Free Blood Pressure Chart and Printable Blood Pressure Log

This review was limited to Dutch app stores, and we included apps in English or Dutch only. It is possible that other national app stores may contain a larger, smaller, or different assortment of apps. Although it is not feasible to search all national app stores from a single country, most apps are released worldwide and are not country-specific. Furthermore, we limited our search to the major app platforms Android and iOS. In addition, we excluded apps that need a prescription by a health care provider or permission for use from the developer.

Therefore, we may have missed potentially eligible apps, but these are not generally available to the target population. Another limitation was the compatibility of apps. As a large variety of mobile phones with several software versions are available in the markets, some apps may not have been compatible with the devices used in this study. However, it is not feasible to assess all apps using a large spectrum of mobile phones.

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We used the most recent software versions to ensure the maximum stability and safety. Mobile apps may be a useful tool for self-management for patients with hypertension. In addition, mobile apps could be used to provide information to patients and increase awareness about blood pressure—related health issues among patients. Also, many mobile apps can export blood pressure data, which could be used by health care providers to make more informed decisions regarding treatment [ 50 , 51 ].

Furthermore, patients will be more involved in their own treatment through the use of high-quality, dedicated mobile apps. Therefore, health care providers should stimulate the use of mobile apps by patients with hypertension. In that case, however, they have to be sure that the apps used by their patients do not contain any misleading or harmful information.

App reviews could be a suitable instrument to separate the useful apps from the harmful ones. Nevertheless, a practical guideline for app reviews is not available. Therefore, it is crucial to develop an international guideline for performing app reviews. Even losing 10 pounds can help to lower your blood pressure. Set your weight loss goal with My Diet Coach and track your progress. The app has a pictorial weight tracker so that you can visually see your weight decreasing. My Diet Coach provides motivating tips and quotes and rewards you when you are successful.

Sleep Cycle is a smart alarm clock that analyzes your sleep patterns and wakes you up in your lightest phase of sleep. Waking up in the lightest sleep phase will help you to wake up feeling well rested and relaxed. Adults are recommended to have between 7 and 9 hours of sleep per day. It is thought that sleeping for under the recommended hours is associated with an increase in blood pressure. The deepest sleep stage functions to restore our physical and mental health. Disruption of deep sleep may have an adverse effect on blood pressure and contribute to high blood pressure.

Using Sleep Cycle can help you to set aside those all-important 7 hours of sleep and wake you up without disrupting your deepest sleep phase. Smoke Free is based on more than 20 evidence-based techniques to help you quit smoking. The app shows you how much money you have saved by not smoking, how many cigarettes you have not smoked, and the time you have been smoke-free. The app details how much of your life you have regained and shows how your health is improving.

You can identify trends in your cravings by using a map to see where they occur, notes to view patterns, and a graph to see them going down. The app also provides tips on how to deal with them. While smoking is not a direct cause of high blood pressure, smoking increases your risk of having a heart attack or stroke. Smoking and high blood pressure both narrow the arteries. Therefore, if you smoke and have high blood pressure, your arteries may narrow at a faster rate and significantly raise your risk for heart disease. Calm is a meditation and mindfulness app with the goal of reducing anxiety , stress, and sleep problems through their guided meditation programs.

The programs are perfect for both those who have never meditated before and those at an intermediate or advanced level. The direct link between stress and blood pressure is still being studied, but what we do know is that stressful situations can lead to temporary elevations in blood pressure. Repeated spikes in blood pressure can build up and may eventually contribute to high blood pressure. Using Calm can help you to manage your stress levels and lower your chances of experiencing repeated short-term blood pressure increases. Meditations come in a variety of durations so that you can find the perfect one to fit your schedule.

Breathing Zone provides a mindful breathing exercise to slow down your breathing rate, calm you down, and make you feel relaxed. Breathing Zone aims to "change your life one breath at a time. Breathing exercises that feature in yoga and meditation have shown some success in helping to treat high blood pressure, and research has demonstrated that taking six deep breaths over a period of 30 seconds reduced systolic blood pressure when compared with sitting quietly.

International Journal of Telemedicine and Applications

Breathing Zone is an easy-to-use app that requires you to do nothing more strenuous than breathing in and out. There are no complicated settings or breathing patterns to master. Qardio is the ultimate heart health tracker. Its makers boast that the app can track more metrics than any other health app available right now. Qardio can track your blood pressure, weight, and electrocardiogram. You can also keep tabs on heart rate, irregular heartbeat, body mass index BMI , weight, body composition, calories, skin temperature, and steps. The app is easy to set up and connects to any Qardio device.

Both your heart health and weight management progress are viewable through charts, statistics, and trends. It is simple to instantly share your data with friends, family, and doctor. Among other factors, maintaining a healthy weight, eating a balanced diet, reducing salt intake, and drinking alcohol in moderation can help to prevent high blood pressure. HealthWatch is a scientifically designed nutrition app that can help you to achieve those dietary goals.

Begin by selecting a health and wellness goal, such as blood pressure. The app's algorithm will then generate a personalized nutritional plan and provide you with daily reports on your nutrition status. The HealthWatch app enables you to monitor more than 30 nutrients in a database of more than , foods and supplements. With the app, you can track your intake of calories while ensuring that you get all the nutrients you need to function at your best.

Challenges in Blood Pressure Self-Measurement

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Optional Comments max. Send securely. Message sent successfully The details of this article have been emailed on your behalf. By Hannah Nichols. Fact checked by Jasmin Collier. Blood pressure apps are designed to help you track, monitor, and manage your blood pressure. Do you have high blood pressure? You might, based on new guidelines.