| Journal Name | mHealth |
| Publication Year | 2021 |
| Volume | 8, 14 |
| Authors | Joshi, A., Kaur, M., Kaur, H., Rathi, S., Manikyarao, A., Joanna, J., Reddy, S., Myrtle, P., Fatima S., Kandamuru S., Idris B. |
Introduction
Hypertension has been identified as the leading modifiable risk factor for cardiovascular diseases such as stroke heart disease and premature death. Intake of a high sodium diet, low potassium intake, high body mass index, alcohol consumption, physical inactivity, and unhealthy diet can lead to an increased prevalence of hypertension (1).
Hypertension or “silent killer” is one of the major causes of premature deaths worldwide, affecting approximately 1.13 billion people. The prevalence of hypertension has proliferated globally during the past decades, specifically in low-and middle-income countries (2). Additionally, some of the Southeast Asian countries have also reported a significantly higher rate of uncontrolled hypertension (3). As with other low- and middle-income countries (LMICs), the prevalence of hypertension is high in India and is also a leading risk factor attributable to premature deaths, chronic diseases, and disability (4). Literature also reports that hypertension is attributed to 10.8% of all deaths in the country (5). The prevalence of hypertension in the Indian context is 30.7%, which affects 25–30% of middle-aged individuals in urban settings and 15–20% in rural settings of the country, on the other hand, it is also reported that these individuals have low hypertension awareness, treatment, and control (5,6).
The Eighth Joint National Committee (JNC 8) recommends pharmacologic treatment should be begun among adults younger than 60 years when blood pressure (BP) is 140/90 mmHg or higher (7). In 2018, European guidelines retained the earlier definition of hypertension (i.e., BP >140/90 mmHg). As per the European hypertension guidelines, South Asians are at the highest risk and most vulnerable to high BP levels along with the growing risk of diabetes mellitus (8). The latest revised American guidelines lowered the threshold to define hypertension as blood pressure of >130/90 mmHg (9,10). The fourth edition of the Indian Guidelines on Hypertension (IGH-IV) came out in the year 2019. The guidelines incorporated the recent changes in the diagnosis and management of hypertension and the changes in the target BP by the American College of Cardiology/American Heart Association (ACC/AHA). As per the guidelines, the diagnosis of hypertension should be based on a clinic blood pressure reading of >140/90 (11). For people at risk or patients having hypertension, the guidelines recommend frequent monitoring of blood pressure and tracking of non-pharmacologic measures such as the following of DASH diet, restriction of tobacco intake and alcohol intake, and reduction of body weight if needed, medication adherence, practicing of yoga and meditation (11,12). Attention needs to be given to developing methods for at-risk individuals and hypertensive patients to self-manage hypertension to reduce the complications. Lack of understanding of the relation between blood pressure, symptoms, and healthy lifestyle practices can lead to negative consequences of antihypertensive treatment (13).
Mobile health (mHealth) is widely used for health services and patient education. mHealth apps have been “prescribed” as part of the care for chronic illnesses by the UK Department of Health (14). In recent years, smartphones have become an essential part of our daily routine. The number of mobile cellular subscriptions is continually increasing every year. In 2016, there have been over seven billion users worldwide. Globally, the figure of internet users has increased 7 times between 2000 and 2015 from 6.5% to 43% (15). Globally there are about 3.6 billion smartphone users at present, and there is about an 8% increase in the number of smartphone users per year. In the global market, Android and iOS are the two dominating operating systems among the population (16). India is fast on the route of digitization and is predicted to reach 829 million smartphone users by 2022 (17). Android is the dominating OS in India accounting for 95.23% of the mobile operating systems (18). In 2019 India also became the leading market in terms of app downloads (17). Additionally, the number of medical apps downloaded increased by 90% in India during 2020, owing to COVID-19 (19).
There is a rapid increase in the popularity of the use of mobile healthcare apps in the self-management of various chronic diseases such as hypertension. Numerous types of interventions like tracking patient data, providing tailored self-management, and interactive communication are used to facilitate in self-care of diseases through smartphones. Two functions (I) measuring blood pressure and (II) managing records are considered to be the main function in any hypertension management apps (20). A systematic review conducted on content analysis for Blood Pressure apps highlighted recording of BP, feedback limiting to displaying graphical records, and exporting the values for better physician-patient communication to be the most common functions in the app (21).
The prevalence of chronic diseases across the developed world and now, in the developing world, is becoming an increasing burden. Therefore, the Health authorities are seeking to lower the burden by using technology to support and encourage self-care of chronic illnesses (22). People living in remote areas and the underserved population can utilize various technologies to overcome geographical barriers to seek healthcare. mHealth technologies such as smartphone applications can provide support in achieving universal health coverage by enhancing availability and accessibility to various healthcare services (23).
Since individuals with non-communicable diseases such as hypertension are turning to smartphone apps technologies for assistance there is a need to study the content and popularity of smartphone applications to avoid any negative effect on the condition (24). Assessing the functionalities of apps designed for consumers may help physicians recommend reliable and correct apps to promote self-management among patients.
The objective of our study was to review all the available apps related to hypertension/and high blood pressure and DASH Diet and investigate their main functional and analytical characteristics. Additionally, we aim to map how many apps meet the Self-Management Support (PRISMS) taxonomy. To the best of our knowledge, not many studies have analyzed all available apps; and considered functionality combinations in the Indian context.
