Hypertension is a major cause of cardiovascular disease worldwide and a major cause of morbidity and mortality in patients with chronic kidney disease (CKD). The Systolic Blood pressure Intervention Trial (SPRINT) demonstrated that blood pressure (BP) measurement techniques may have an impact on the achievement of outcomes. Home BP monitoring (HBPM) has several advantages over office BP recordings, including avoidance of white-coat reaction, ability to diagnose white-coat and masked hypertension, detection of BP variability, and better ability to predict cardiovascular morbidity and mortality, all of which commonly occur in CKD. The addition of telemonitoring and management support to HBPM allows remote monitoring, especially when close contact is difficult (e.g., patients in remote/rural areas, pandemic, natural disaster, or patients treated with home dialysis). Although there are few studies that have assessed the efficacy of home BP telemonitoring (HBPT) in patients with CKD, these studies suggest the benefits of HBPT for BP control and even limited evidence that it may improve kidney function. This review, using limited available evidence, assesses the roles of HBPT in patients with CKD, barriers to HBPT implementation in the care of patients with CKD, and discusses newer technologies that can be leveraged in the management of hypertension in patients with CKD.
{"title":"Telemonitoring in hypertension management for patients with chronic kidney disease: a narrative review","authors":"I. Okpechi, J. Ringrose, R. Padwal, A. Bello","doi":"10.20517/ch.2022.18","DOIUrl":"https://doi.org/10.20517/ch.2022.18","url":null,"abstract":"Hypertension is a major cause of cardiovascular disease worldwide and a major cause of morbidity and mortality in patients with chronic kidney disease (CKD). The Systolic Blood pressure Intervention Trial (SPRINT) demonstrated that blood pressure (BP) measurement techniques may have an impact on the achievement of outcomes. Home BP monitoring (HBPM) has several advantages over office BP recordings, including avoidance of white-coat reaction, ability to diagnose white-coat and masked hypertension, detection of BP variability, and better ability to predict cardiovascular morbidity and mortality, all of which commonly occur in CKD. The addition of telemonitoring and management support to HBPM allows remote monitoring, especially when close contact is difficult (e.g., patients in remote/rural areas, pandemic, natural disaster, or patients treated with home dialysis). Although there are few studies that have assessed the efficacy of home BP telemonitoring (HBPT) in patients with CKD, these studies suggest the benefits of HBPT for BP control and even limited evidence that it may improve kidney function. This review, using limited available evidence, assesses the roles of HBPT in patients with CKD, barriers to HBPT implementation in the care of patients with CKD, and discusses newer technologies that can be leveraged in the management of hypertension in patients with CKD.","PeriodicalId":93536,"journal":{"name":"Connected health","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74387262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite being the leading cause of global mortality, the hypertension control rate is astonishingly low, particularly in low- and middle-income countries. There is evidence that the mHealth approach is a potential platform for delivering interventions for hypertension management. Our recent study from Nepal also provided strong evidence for reducing blood pressure, improving control rate, and medication adherence. The objective of this paper is to document the real-world experience of designing and implementing a mHealth project in Nepal and relates them with the evidence from other similar Low- and Middle-Income Country (LMIC) settings. We learned that mHealth provides a unique opportunity to bridge the gap between providers and patients, send health education and reminder messages, secure patients' privacy, and make data management easier. We also encountered technological and financial barriers, unclear mHealth policy and guidelines, and low literacy levels, including digital literacy. As many of them are addressable, integrating mHealth provides a promising approach to hypertension management.
{"title":"Use of mHealth for management of hypertension in low and middle-income countries: opportunities and challenges","authors":"B. Bhandari, D. Neupane, P. Thapa, P. Pradhan","doi":"10.20517/ch.2022.17","DOIUrl":"https://doi.org/10.20517/ch.2022.17","url":null,"abstract":"Despite being the leading cause of global mortality, the hypertension control rate is astonishingly low, particularly in low- and middle-income countries. There is evidence that the mHealth approach is a potential platform for delivering interventions for hypertension management. Our recent study from Nepal also provided strong evidence for reducing blood pressure, improving control rate, and medication adherence. The objective of this paper is to document the real-world experience of designing and implementing a mHealth project in Nepal and relates them with the evidence from other similar Low- and Middle-Income Country (LMIC) settings. We learned that mHealth provides a unique opportunity to bridge the gap between providers and patients, send health education and reminder messages, secure patients' privacy, and make data management easier. We also encountered technological and financial barriers, unclear mHealth policy and guidelines, and low literacy levels, including digital literacy. As many of them are addressable, integrating mHealth provides a promising approach to hypertension management.","PeriodicalId":93536,"journal":{"name":"Connected health","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87944639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hypertension is the leading contributor to cardiovascular disease (CVD)-related deaths globally, with Africa being one of the World Health Organization regions with the highest prevalence of elevated blood pressure (BP). In sub-Saharan Africa (SSA), awareness, treatment, and control levels of hypertension remain low in both men and women and in different settings, including rural and urban areas. Important barriers to the management of hypertension in SSA are within health systems, usually overburdened by communicable and non-communicable diseases, acute medical conditions, and child and maternal healthcare. Health system-related challenges include the availability and cost of essential medicines and healthcare workforce constraints. At the patient level, individual barriers such as sociodemographic, economic, and psychosocial factors contribute significantly to the poor control of hypertension. Telemedicine presents a promising approach to improve the delivery of optimal care for individuals living with hypertension by serving as a connection between healthcare providers and patients. This may enhance access to isolated people living with hypertension, such as in rural areas. However, there is a concern that telemedicine may exacerbate some of the barriers to the management of hypertension in disadvantaged groups, such as those with limited access to digital technology, low education and literacy levels, and the ageing population. Therefore, the objective of this review is to summarize the current state of telemedicine use in the management of hypertension in SSA and discuss the challenges and opportunities to provide cost-effective, equitable, and sustainable access to digital health technology for people living with hypertension in SSA.
{"title":"Hypertension management in sub-Saharan Africa: an overview of challenges and opportunities for telemedicine","authors":"L. Gafane-Matemane, G. Mokwatsi, D. Boateng","doi":"10.20517/ch.2022.21","DOIUrl":"https://doi.org/10.20517/ch.2022.21","url":null,"abstract":"Hypertension is the leading contributor to cardiovascular disease (CVD)-related deaths globally, with Africa being one of the World Health Organization regions with the highest prevalence of elevated blood pressure (BP). In sub-Saharan Africa (SSA), awareness, treatment, and control levels of hypertension remain low in both men and women and in different settings, including rural and urban areas. Important barriers to the management of hypertension in SSA are within health systems, usually overburdened by communicable and non-communicable diseases, acute medical conditions, and child and maternal healthcare. Health system-related challenges include the availability and cost of essential medicines and healthcare workforce constraints. At the patient level, individual barriers such as sociodemographic, economic, and psychosocial factors contribute significantly to the poor control of hypertension. Telemedicine presents a promising approach to improve the delivery of optimal care for individuals living with hypertension by serving as a connection between healthcare providers and patients. This may enhance access to isolated people living with hypertension, such as in rural areas. However, there is a concern that telemedicine may exacerbate some of the barriers to the management of hypertension in disadvantaged groups, such as those with limited access to digital technology, low education and literacy levels, and the ageing population. Therefore, the objective of this review is to summarize the current state of telemedicine use in the management of hypertension in SSA and discuss the challenges and opportunities to provide cost-effective, equitable, and sustainable access to digital health technology for people living with hypertension in SSA.","PeriodicalId":93536,"journal":{"name":"Connected health","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76074898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Theodore R. Curran, Daniel J. McDuff, Xin Liu, Girish Narayanswamy, Chengqian Ma, Shwetak N. Patel, Eugene Yang
Telehealth has seen rapid adoption in the past three years as a direct result of the COVID-19 pandemic. Conventional methods for measurement of vital signs are neither optimized for remote care nor highly scalable. Blood pressure is a critical vital parameter that currently cannot be measured remotely. Cameras are versatile and capable sensors that can be repurposed to measure vital signs. In this article, we review the use of cameras for remote photoplethysmography and assessment of blood pressure. We discuss the principles behind this technology and the current evidence for blood pressure measurement. We also explore future applications and potential challenges to provide a roadmap for researchers, clinicians, and regulators who are considering this new technology.
{"title":"Camera-based remote photoplethysmography for blood pressure measurement: current evidence, clinical perspectives, and future applications","authors":"Theodore R. Curran, Daniel J. McDuff, Xin Liu, Girish Narayanswamy, Chengqian Ma, Shwetak N. Patel, Eugene Yang","doi":"10.20517/ch.2022.25","DOIUrl":"https://doi.org/10.20517/ch.2022.25","url":null,"abstract":"Telehealth has seen rapid adoption in the past three years as a direct result of the COVID-19 pandemic. Conventional methods for measurement of vital signs are neither optimized for remote care nor highly scalable. Blood pressure is a critical vital parameter that currently cannot be measured remotely. Cameras are versatile and capable sensors that can be repurposed to measure vital signs. In this article, we review the use of cameras for remote photoplethysmography and assessment of blood pressure. We discuss the principles behind this technology and the current evidence for blood pressure measurement. We also explore future applications and potential challenges to provide a roadmap for researchers, clinicians, and regulators who are considering this new technology.","PeriodicalId":93536,"journal":{"name":"Connected health","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78231210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. M. Ayyoubzadeh, Seyed Mehdi Ayyoubzadeh, Marzieh Esmaeili
Obtaining data is challenging for researchers, especially when it comes to medical data. Moreover, using medical data as there are concerns about privacy and confidentiality issues requires specific considerations. Generative models aim to learn data distribution via various statistical learning approaches. Among generative models, a machine learning-based approach named Generative Adversarial Networks (GANs) has proved their potential in the implicit density estimation of high dimensional data. Therefore, we suggest an approach that each healthcare organization, especially hospitals, could create and share their own GAN model, entitled Hospital-Based GANs (H-GANs), instead of sharing raw data of patients.
{"title":"Clinical data sharing using Generative Adversarial Networks","authors":"S. M. Ayyoubzadeh, Seyed Mehdi Ayyoubzadeh, Marzieh Esmaeili","doi":"10.20517/ch.2022.15","DOIUrl":"https://doi.org/10.20517/ch.2022.15","url":null,"abstract":"Obtaining data is challenging for researchers, especially when it comes to medical data. Moreover, using medical data as there are concerns about privacy and confidentiality issues requires specific considerations. Generative models aim to learn data distribution via various statistical learning approaches. Among generative models, a machine learning-based approach named Generative Adversarial Networks (GANs) has proved their potential in the implicit density estimation of high dimensional data. Therefore, we suggest an approach that each healthcare organization, especially hospitals, could create and share their own GAN model, entitled Hospital-Based GANs (H-GANs), instead of sharing raw data of patients.","PeriodicalId":93536,"journal":{"name":"Connected health","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76702780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ryan Chow, Bruce Forde, Rick Sawatzky, Astrid García Patiño, K. Tran, J. Bittman, N. Khan
Aim: Digital health for hypertension management holds potential for improving the quality of care but requires long-term patient engagement to track health data. We explored patient and hypertension specialist perceptions of clinical utility for data tracking including standardized patient-reported outcome measures (PROMs), home blood pressure (BP) measurement, and other health metrics. Methods: Participants reviewed general health status, patient satisfaction, and hypertension-specific PROMs. Semi-structured focus groups (n = 15) with nine patients with hypertension and six hypertension specialists were audio-recorded and thematically analyzed. Results: Key themes identified from patients included: (1) comfort and appreciation of home BP monitoring but only during important periods of hypertension care; (2) preference for tracking new symptoms and medication side effects; (3) patients perceived tracking other health measures including general PROMs, diet and exercise as less relevant to their care; and (4) visually represented BP trends evaluating associations with changes in other health parameters were perceived as useful. Key themes identified by hypertension specialists included: (1) concerns about patient digital literacy; (2) utilizing visual representations of long-term BP data trends for patient empowerment; and (3) unclear relevance of tracking medication adverse effects, PROMs, and other non-BP health metrics. Conclusion: Patients and hypertension specialists had similar perspectives for most aspects of data monitoring but differed in preference for a few aspects that were germane to patients, including monitoring medication adverse effects and symptoms. Including views on data tracking from both patients and providers are essential for designing digital tools to optimize hypertension management.
{"title":"Digital health technology and hypertension management: a qualitative analysis of patient and specialist provider preferences on data tracking","authors":"Ryan Chow, Bruce Forde, Rick Sawatzky, Astrid García Patiño, K. Tran, J. Bittman, N. Khan","doi":"10.20517/ch.2022.07","DOIUrl":"https://doi.org/10.20517/ch.2022.07","url":null,"abstract":"Aim: Digital health for hypertension management holds potential for improving the quality of care but requires long-term patient engagement to track health data. We explored patient and hypertension specialist perceptions of clinical utility for data tracking including standardized patient-reported outcome measures (PROMs), home blood pressure (BP) measurement, and other health metrics. Methods: Participants reviewed general health status, patient satisfaction, and hypertension-specific PROMs. Semi-structured focus groups (n = 15) with nine patients with hypertension and six hypertension specialists were audio-recorded and thematically analyzed. Results: Key themes identified from patients included: (1) comfort and appreciation of home BP monitoring but only during important periods of hypertension care; (2) preference for tracking new symptoms and medication side effects; (3) patients perceived tracking other health measures including general PROMs, diet and exercise as less relevant to their care; and (4) visually represented BP trends evaluating associations with changes in other health parameters were perceived as useful. Key themes identified by hypertension specialists included: (1) concerns about patient digital literacy; (2) utilizing visual representations of long-term BP data trends for patient empowerment; and (3) unclear relevance of tracking medication adverse effects, PROMs, and other non-BP health metrics. Conclusion: Patients and hypertension specialists had similar perspectives for most aspects of data monitoring but differed in preference for a few aspects that were germane to patients, including monitoring medication adverse effects and symptoms. Including views on data tracking from both patients and providers are essential for designing digital tools to optimize hypertension management.","PeriodicalId":93536,"journal":{"name":"Connected health","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90738139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ambulatory blood pressure measurement (ABPM) is the gold-standard method for blood pressure assessment. However, it is markedly underutilized, in part because legacy software provided with ABPM devices is archaic and inefficient. Herein, we illustrate an example of a recently developed cloud-based ABPM platform. Such a platform offers several distinct advantages: (1) the ability to guide users through the testing process; (2) synchronizing inputs of the technician, patient, physician, and administrative assistant so that testing can be successful and efficient; (3) providing guideline-concordant study interpretations that can be e-signed, reducing physician interpretation times; (4) enabling central expert oversight and peripheral deployment of testing, thereby increasing accessibility of quality testing; and (5) facilitating integration into electronic medical records, improving dissemination of results. It is envisioned that increased use of cloud-based ABPM platforms will lead to the expansion of quality ABPM testing, thus improving the care of patients with known or suspected hypertension.
{"title":"How a cloud based platform can make ambulatory blood pressure monitoring more efficient, accessible, and evidence based","authors":"R. Padwal, P. Wood, J. Ringrose","doi":"10.20517/ch.2022.01","DOIUrl":"https://doi.org/10.20517/ch.2022.01","url":null,"abstract":"Ambulatory blood pressure measurement (ABPM) is the gold-standard method for blood pressure assessment. However, it is markedly underutilized, in part because legacy software provided with ABPM devices is archaic and inefficient. Herein, we illustrate an example of a recently developed cloud-based ABPM platform. Such a platform offers several distinct advantages: (1) the ability to guide users through the testing process; (2) synchronizing inputs of the technician, patient, physician, and administrative assistant so that testing can be successful and efficient; (3) providing guideline-concordant study interpretations that can be e-signed, reducing physician interpretation times; (4) enabling central expert oversight and peripheral deployment of testing, thereby increasing accessibility of quality testing; and (5) facilitating integration into electronic medical records, improving dissemination of results. It is envisioned that increased use of cloud-based ABPM platforms will lead to the expansion of quality ABPM testing, thus improving the care of patients with known or suspected hypertension.","PeriodicalId":93536,"journal":{"name":"Connected health","volume":" 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91412060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hugo Saner, Narayan Schütz, P. Buluschek, Guillaume Du Pasquier, S. Morf, Marianne Frech, T. Nef
The COVID-19 pandemic created increased interest in monitoring patients at home to allow timely recognition of health deteriorations. Hospital care is particularly demanding in these patients because of the necessity for isolation to avoid further spread of the disease. Therefore, home care is a preferred treatment setting for these patients. This is, to our knowledge, the first report indicating the potential of an affordable, contactless, and unobtrusive ambient sensor system for the detection of signs of health deterioration in a patient with COVID-19 by a caregiver from a distance. Prospective data acquisition and correlation of the data with clinical events were obtained from an 81-year-old senior with COVID-19 before and, in particular, over a period of 10 days prior to hospitalization. Clinical signs included weakness, increased respiration rate, sleep disturbances, and confusion. The visualization of a combination of this information on a dedicated dashboard allowed the caregiver to recognize a serious health deterioration that required a lifesaving hospitalization. The potential of such ambient sensor systems to detect signs of serious health deterioration in patients with COVID-19 opens new opportunities for use in asymptomatic or oligosymptomatic patients who live alone and are sent back to their homes for isolation in quarantine after diagnosis.
{"title":"Detection of health deterioration in a COVID-19 patient at home: the potential of ambient sensor systems","authors":"Hugo Saner, Narayan Schütz, P. Buluschek, Guillaume Du Pasquier, S. Morf, Marianne Frech, T. Nef","doi":"10.20517/ch.2022.03","DOIUrl":"https://doi.org/10.20517/ch.2022.03","url":null,"abstract":"The COVID-19 pandemic created increased interest in monitoring patients at home to allow timely recognition of health deteriorations. Hospital care is particularly demanding in these patients because of the necessity for isolation to avoid further spread of the disease. Therefore, home care is a preferred treatment setting for these patients. This is, to our knowledge, the first report indicating the potential of an affordable, contactless, and unobtrusive ambient sensor system for the detection of signs of health deterioration in a patient with COVID-19 by a caregiver from a distance. Prospective data acquisition and correlation of the data with clinical events were obtained from an 81-year-old senior with COVID-19 before and, in particular, over a period of 10 days prior to hospitalization. Clinical signs included weakness, increased respiration rate, sleep disturbances, and confusion. The visualization of a combination of this information on a dedicated dashboard allowed the caregiver to recognize a serious health deterioration that required a lifesaving hospitalization. The potential of such ambient sensor systems to detect signs of serious health deterioration in patients with COVID-19 opens new opportunities for use in asymptomatic or oligosymptomatic patients who live alone and are sent back to their homes for isolation in quarantine after diagnosis.","PeriodicalId":93536,"journal":{"name":"Connected health","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89940204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In just over a half-century since the initiation of telemedicine, technological developments have created multiple options to shape how patients can access healthcare and interact with healthcare providers to better prevent and manage hypertension. In several high-income countries, patients are connecting to their healthcare providers online to book appointments, request prescriptions, see test results and engage in pro-active health management. Mounting evidence suggests that telemedicine and mobile health (mHealth) services can yield greater reductions in blood pressure when compared with usual care while also offering greater reach, efficiency, and potential cost-saving. A deeper examination of implementing such systems at scale in high-income countries shows varying approaches and levels of success. While research investigating the benefits of technology for blood pressure control in low- and middle-income countries is growing, in regions such as sub-Saharan Africa, economic and digital divides present major challenges to scaling such technology. Substantial national investments in infrastructure and skills development are needed alongside consultation with multiple stakeholders to ensure that technological advancements do not further drive health disparities in the region.
{"title":"Telemedicine for blood pressure control in low- and middle-income countries: the journey ahead","authors":"L. Ware","doi":"10.20517/ch.2022.16","DOIUrl":"https://doi.org/10.20517/ch.2022.16","url":null,"abstract":"In just over a half-century since the initiation of telemedicine, technological developments have created multiple options to shape how patients can access healthcare and interact with healthcare providers to better prevent and manage hypertension. In several high-income countries, patients are connecting to their healthcare providers online to book appointments, request prescriptions, see test results and engage in pro-active health management. Mounting evidence suggests that telemedicine and mobile health (mHealth) services can yield greater reductions in blood pressure when compared with usual care while also offering greater reach, efficiency, and potential cost-saving. A deeper examination of implementing such systems at scale in high-income countries shows varying approaches and levels of success. While research investigating the benefits of technology for blood pressure control in low- and middle-income countries is growing, in regions such as sub-Saharan Africa, economic and digital divides present major challenges to scaling such technology. Substantial national investments in infrastructure and skills development are needed alongside consultation with multiple stakeholders to ensure that technological advancements do not further drive health disparities in the region.","PeriodicalId":93536,"journal":{"name":"Connected health","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83865159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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