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Currently accepted at: JMIR mHealth and uHealth

Date Submitted: Dec 15, 2018
Open Peer Review Period: Dec 18, 2018 - Feb 12, 2019
Date Accepted: Mar 24, 2019
Date Submitted to PubMed: Mar 25, 2019
(closed for review but you can still tweet)

This paper has been accepted and is currently in production.

It will appear shortly on 10.2196/13153

The final accepted version (not copyedited yet) is in this tab.

An "ahead-of-print" version has been submitted to Pubmed, see PMID: 30905872

The Use of Wireless, Smartphone Application-Assisted Home Blood Pressure Monitoring Among Hypertensive Patients in Singapore: A Pilot Randomized Controlled Trial

  • Eui Whan Moon; 
  • John Carson Allen; 
  • Ngiap Chuan Tan; 
  • Tazeen Hasan Jafar



Reliable home blood pressure monitoring (HBPM) is essential to effective hypertension management, however manual recording is subject to under-reporting and inaccuracies. Mobile-health technologies hold great potential as HBPM tools, but fidelity of smartphone application (app) in HBPM has not been adequately assessed.


The primary aim of the trial was to compare the fidelity of the smartphone app to that of a handwritten logbook in making HBPM data available to clinicians at follow-up visits. Fidelity was defined as the percentage of scheduled BP recordings over a 3-week period that were properly recorded and reported to the clinic. The secondary aims were to investigate patient factors associated with HBPM fidelity and to determine the effect of monitoring duration on fidelity.


A two-arm, parallel, unblinded, randomized controlled pilot trial was conducted in a government polyclinic in Singapore. Hypertensive adults, ages 40-70 years who were on antihypertensive medication and owned a smartphone were recruited from clinic and randomized by a computer-generated randomization schedule to 3 weeks of HBPM using either a semi-automated process utilizing Bluetooth®-enabled BP monitor and a smartphone app or a fully-manual process utilizing a conventional handwritten logbook. The primary outcome was home BP recording fidelity.


Of the 80 patients randomized, 79 (Smartphone app, 38; Logbook, 41) were included in the final analysis. Although home BP recording fidelity was higher in the Smartphone app group, it did not differ significantly between study arms (Smartphone app, 66.7%; Logbook, 52.4%; P=.22). Chinese and Indian ethnicities were associated with higher fidelity (95% CI) by 35.6 (4.27, 66.9) and 45.0 (8.69, 81.3) points, respectively, in comparison to other ethnicities (P=.03); longer smartphone use increased fidelity on average 10.5 (0.83, 20.2) points per year of use (P=.03); number of apps on smartphone decreased fidelity at a rate of -0.32 (-0.58, -0.05) per app (P=.02); years of hypertension morbidity increased fidelity at a rate of 1.56 (0.03, 3.09) per year (P=.046); and the number of people working in the household decreased fidelity at a rate of -8.18 (-16.3, -0.08) points per additional working person (P=.048). The fidelity of the app was significantly higher in the first week (64.4%) compared to the second (55.1%, P=.001) and third (58.2%, P=.03) weeks of monitoring.


Amidst the increasing integration of health technologies into clinical practice, our study demonstrates the feasibility of smartphone app-assisted HBPM in hypertensive adults in the multi-ethnic population of Singapore. Our pilot study found no significant difference in mean BP recording fidelity between a smartphone app and a conventional hand-written logbook. However, the small sample size precludes definitive conclusions and highlights the need for a larger, adequately powered trial. Clinical Trial: NCT03209024


Please cite as:

Moon EW, Allen JC, Tan NC, Jafar TH

The Use of Wireless, Smartphone Application-Assisted Home Blood Pressure Monitoring Among Hypertensive Patients in Singapore: A Pilot Randomized Controlled Trial

JMIR mHealth and uHealth. (forthcoming/in press)

DOI: 10.2196/13153


PMID: 30905872

Download Accepted Manuscript PDF

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