Discussion
hypertension, cardiovascular disease
SECONDARY, HYPERTENSION, CARDIOVASCULAR DISEASE
To our knowledge, this study is the first randomized controlled trial to assess mHealth intervention to improve cardiovascular factors and promote healthier lifestyle behaviors among individuals at high risk of cardiovascular disease in low-resource rural settings in China. This study aimed to evaluate the effects of mobile phone-based intervention on BP control, waist and hip circumference, self-reported hypertension compliance, self-efficacy, and quality of life. Our findings show that compared with local usual primary care, mHealth BP monitoring intervention resulted in significant improvements in SBP and other cardiovascular factors. Compared with usual community-based management of hypertension patients, mHealth intervention patients had greater controlled SBP, waist and hip circumference. Moreover, the intervention also improved some aspects of self-reported hypertension compliance and self-efficacy, and appeared to have an acceptable level of quality of life.The results of this randomized control trial showed that the wearable BP wristband and app-based management could decreased SBP by 8.52 (19.73) mm Hg (95% CI, −12.89 to −1.64 mm Hg; Unique features of our study were the significant improvement in self-reported hypertension compliance and self-efficacy with corresponding reductions in SBP. In our study, readings from the home-based BP monitoring wearable devices were used to evaluate trial outcomes. A possible explanation might be that the reductions in BP from baseline to the 12 weeks of follow-up that we observed in both the control and intervention group were resulted from fluctuations in these home BP monitoring readings, and that the magnitude of these fluctuations was larger than the hypothesized effect from the smartphone application (It is interesting to note a net reduction in the waist circumference, while, no changes were seen in levels of hip circumference. It might be related to the amount of exposure to the intervention domains defined by the patients during motivational suggestion, following the autonomy support on the basis of principle. Thus, target behavior including reduction of high-sugar and high-fat foods intake was most commonly chosen during motivational home visit or counseling calls. In line with our findings, Partridge et al. (How could home-based BP monitoring wearable devices enhance the quality of life for patients with hypertension? While the wearable devices we tested has received high usability scores? It may be the reason that patients with hypertension in low-resource rural settings have needs that differ from those with other conditions (Several limitations should be considered of this trial. The sample size was small and included only 6 primary care centers, and excluded those had no smartphones, which may contributed discrepancies in participant baseline characteristics and lack of power to detect differences of the secondary and subgroup analyses outcomes between two groups. Also, the hypertension compliance, self-efficacy and SF-12 questionnaires were all self-reported measurements, therefore we cannot conclude the findings to a broader population. In addition, the trial was not double-blinded, which may lead to an effect on the reporting bias such as recall error, social desirability or other subjective outcomes. However, BP recordings were measured by automated wearable devices with a standard protocol, which was unlikely to have been biased. Lack of information on long-term intervention effects, reimbursement mechanisms, and return on investment have been revealed as barriers to trail implementation (