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The hypertension tool that’s proven to reduce BP levels

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Digital therapeutics work with doctors, in keeping with clinical guidelines for hypertension management, to share the load in implementing lifestyle changes among patients. An insight by Dr Sid Kolwankar, AVP – Clinical and Product, Wellthy Therapeutics

Hypertension is the number one health risk factor in India, according to a report by the Ministry of Health and Family Welfare1. It’s pegged to be the most common NCD with an estimated2 overall prevalence of 29.8 per cent in India with higher incidence in urban areas of 33.8 per cent. Moreover, hypertension contributes to an estimated 1.6 million deaths each year in the country.

Despite many advancements in pharmacotherapy, the burden of hypertension continues to grow. Part of the challenge is late diagnosis and healthcare access restrictions, but a growing factor is urbanisation which leads to people making poor lifestyle choices. The Government of India launched the India Hypertension Control Initiative in November 2017. The action plan is working towards a 25 per cent reduction in overall mortality from CVD, a 25  per cent relative reduction in the prevalence of raised blood pressure and a 30 per cent reduction in salt/sodium intake at a population-level.  

Lifestyle factors 

Lifestyle improvement has been recommended as a first line of treatment for hypertension management globally. Studies have proven that patients can show an improvement of 4-5 mm Hg decrease in systolic and diastolic respectively for each positive lifestyle change. According to the American Heart Association3, a diet low in sodium, saturated fat, and total fat and increase in fruits, vegetables, and grains may decrease systolic blood pressure by approximately 11 mm Hg.

But the unfortunate truth is that lifestyle change is hard to implement. Patients lack motivation, engagement and guidance to action non-pharmacological treatment plans4. Doctors can play a role here but they are strapped for time. Most doctors end up advising patients to ‘eat right, exercise and manage stress’ but are unable to hand-hold patients to see it through and effectively follow-up. 

Digital solutions

Digital therapeutics built on clinically-validated, condition-specific disease management guidelines play a role in building a holistic care plan that is aligned to doctors treatment plan. Trained disease educators act as an extension to the clinicians practice to lighten the load on the doctor by sharing tasks. Think of it as a tool that can be leveraged to support patients on how to prepare a well-balanced diet that’s low in salt, limit alcohol consumption, enjoy regular exercise regimes, cope with stress, and maintain a healthy weight, as per recommendations by the American Heart Association to control hypertension5.

Delivered via smartphone applications, these platforms are accessible to patients and work conveniently to build positive behaviour change. They reinforce the need to monitor blood pressure readings and adhere to medications as prescribed. 

In March, a digital therapeutics company presented their findings6 on how patients with hypertension were able to establish a significant reduction in blood pressure levels with the help of a digital therapeutic intervention. The abstract published at the World Cardiology Congress organised by the American College of Cardiology earlier this year was based on 66 participants who were diagnosed with hypertension and type 2 diabetes mellitus, and spent at least 12 weeks on the platform.   

After intervention, 47 per cent patients with stage 2 hypertension, achieved a mean reduction of 12.6 mmHg in SBP and of 8.7 mmHg in DBP. Their blood sugar levels also showed a positive reduction.  

Real world evidence is a gamechanger for the HCP fraternity to authenticate credibility and direct patients safely. The time is right for adoption of such support tools. Patient behaviour has changed. Today, patients are curious to learn, eager to act and willing to commit to a better lifestyle. They simply don’t know how. Prescription-grade digital therapeutics that offer continuous support are touted to be the future of chronic disease management with a specific use case in treating hypertension. 

References:

  1. https://nhm.gov.in/images/pdf/guidelines/nrhm-guidelines/stg/Hypertension_full.pdf
  2. https://www.ncbi.nlm.nih.gov/pubmed/24621804
  3. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/11/09/11/41/2017-guideline-for-high-blood-pressure-in-adults
  4. https://www.acc.org/~/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/Guidelines/2017/Guidelines_Made_Simple_2017_HBP.pdf
  5. https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.119.13437
  6. http://www.onlinejacc.org/content/75/11_Supplement_1/3583
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