Early blood pressure assessment after acute myocardial infarction: Insights using digital health technology

Rongzi Shan; Jie Ding; Daniel Weng; Erin M Spaulding; Shannon Wongvibulsin; Matthias A Lee; Ryan Demo; Francoise A Marvel; Seth S Martin

doi:10.1016/j.ajpc.2020.100089

Early blood pressure assessment after acute myocardial infarction: Insights using digital health technology

Am J Prev Cardiol. 2020 Sep:3:100089. doi: 10.1016/j.ajpc.2020.100089. Epub 2020 Sep 17.

Authors

Rongzi Shan^{1

2}, Jie Ding¹, Daniel Weng³, Erin M Spaulding^{1

4}, Shannon Wongvibulsin³, Matthias A Lee⁵, Ryan Demo⁵, Francoise A Marvel¹, Seth S Martin^{1

3

5}

Affiliations

¹ Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA.
² David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
³ Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Johns Hopkins University School of Nursing, Baltimore, MD, USA.
⁵ Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA.

Abstract

Objective: There is rising interest in digital health in preventive cardiology, particularly for blood pressure (BP) management. In a digital health study of early BP assessment following acute myocardial infarction (AMI), we sought to examine feasibility and the (1) proportion of post-AMI patients with controlled BP and hypotension, and (2) association between prior cardiovascular disease (CVD) and BP post-AMI.

Methods: In this substudy of the parent Myocardial infarction, COmbined-device, Recovery Enhancement (MiCORE) study, type 1 AMI patients were enrolled between October 2017 and April 2019. Participants self-monitored their BP through 30 days after hospital discharge using an FDA-approved wireless BP monitor connected with a smartphone application. Linear mixed-effects models assessed the association between prior CVD and BP trajectory post-discharge, adjusting for antihypertensive medications and a propensity score inclusive of CVD risk factors.

Results: Sixty-eight AMI patients (mean age 58 ± 10 years, 75% male, 68% white race, 68% history of hypertension, 24% prior CVD) provided 2638 measurements over 30 days. The percentage of BP control <130/80 mmHg was 59.6% (95% CI: 54.3-64.9%) and <140/90 mmHg was 83.7% (95% CI: 80.3-87.2%). The percentage of systolic BP <90 mmHg was 1.1% (95% CI: 0.17-2.0%) and the percentage of diastolic BP <60 mmHg was 3.9% (95% CI: 2.6-5.2%). Prior CVD was associated with 12.2 mmHg higher mean daily systolic BP during admission (95% CI: 3.5-20.9 mmHg), which persisted over follow-up. There was no association between prior CVD and diastolic BP.

Conclusion: The digital health program was feasible and ~40% of post-AMI patients who engaged in it had uncontrolled BP according to recent guideline cutpoints, while hypotension occurred rarely. The gap in BP control was especially large in patients in whom AMI represented recurrent CVD. These data suggest an opportunity for more aggressive secondary prevention early after MI as care models integrate digital health.

Keywords: Blood pressure; Digital health; Myocardial infarction; Secondary prevention; Smartphone.