Hypertension affects about one in four Canadian adults, and can cause complications such as cardiovascular disease, kidney disease and death1 2,3. Research shows that self-monitoring blood pressure (BP) 4, self-management and self-adjustments of medications 5, and M-Health based support groups 6 can achieve reductions in blood pressure.
The apps reviewed allow for BP self-monitoring and varying degrees of analysis against user-input factors such as medication taken. Data can easily be shared with family docs in multiple formats. Two major gaps in all of the apps are they do not instruct users on how to correctly take BP or alert them when to seek immediate medical attention. In addition, they are limited in terms of education, support groups or lifestyle strategies for the management of BP.
It should be noted that apps claiming to measure BP via the smart phone do not have FDA approval for use as a medical device nor extensive validation studies to prove their accuracy 7. Fortunately none of the apps we reviewed claim this. Two of the apps are interoperable with certified BP cuffs which simplifies data entry, a feature which results in more consumer downloads7. We did not test any certified BP cuffs.
Blood Pressure Companion
This is decent app to record and analyze BP. The app allows sharing data with the primary care provider. Notes can be entered to track how different factors may influence BP. The app is fairly usable, though a beginner smart phone user may find it difficult to manipulate the graphs section. Unfortunately preset thresholds are not in line with any guidelines on BP categorization. In addition, identical colours are used in multiple ways, confusing meaning. It is not possible to connect to a certified BP cuff. PHI is collected but only stored on the local device and not reachable by the developers. There is good tech support but FAQ is rather poor.
Data can be exported (cvs, pdf) or synced with Apple HealthKit. There is no education about hypertension, and limited FAQ to allow the user to learn the app. The user can set goals but this is not graphed. Free text notes are allowed to aid in the analysis of BP.
BP thresholds are customizable, but not preset according to guidelines. In addition, there is no alert for hypertensive crisis. Users can track BP, HR and Wt, but there are no instruction on how to measure BP. Nothing is said of the developers and there is no HCP endorsement.
Navigations elements are consistently located. Data input can be tedious with up to five windows to complete recording, and there is no interoperability with a certified BP cuff. Buttons used to customize graphs are inconsistently located. Colours on graphs are used inconsistently.
Privacy & Security+-
A privacy statement does not exist. An email sent back in response stated the data was only saved to the local device and not reachable by the developers. DOB, Wt, Ht, gender, phone number and email are collected. There is password protection.
The app is small and performs well. The app was released in 2011 and updated in 2016. The developers have released 25 other medical and non-medical apps. Tech support responds in one to two business days but again, there is no app specific FAQ section.
The app is available for a small cost, on Apple devices and in English only. Small fonts may be difficult for older users. The FAQ available, though not specific to the app, likely requires greater than Grade 8 literacy.
Blood Pressure Monitor – Family Lite
This is a decent app to record and analyze BP. Notes and medications can be input allowing for analysis of factors influencing BP. Preset thresholds are not in line with any guidelines on BP categorization. The app allows sharing data with the primary care provider and is not burdensome in a clinical encounter. It is user friendly but the graphs can be hard to read and the stats page contains too much detail. Unfortunately there is no interactivity with a certified BP cuff. PHI is collected and can be stored on servers outside Canada. Third parties may have access to it in order to provide the service although the data is not sold. FAQ is helpful and accessible via the app, but tech support is not very responsive.
There is some customization, allowing the user to shorten the data entry form. Both notes and medications can be added for extra ability to analyze. Reminders can be set to take BP. There is no education about hypertension. Data can be shared in pdf and cvs formats.
BP thresholds are customizable but not guideline based. The premium version would allow input certain lab values related to diabetes and dyslipidemia. The developers are not identified and there is endorsement by a healthcare provider. The app does not connect to a certified BP cuff.
Data input occurs on one screen and navigation is quite simple. The charts are difficult to read due to odd scales and occasional inaccurate plotting. The user needs to rotate the phone to zoom into the graph, which is not intuitive. The stats page is confusing with too many numbers.
Privacy & Security+-
The privacy statement is easily accessible but long. PHI such as email, age and gender are collected, but not sold to third parties without consent. Also stated is that information may be transferred and maintained on servers outside Canada, which means it is subject to different privacy laws. There is no password.
The app size is large but performance is fine. The developers have been around since 2012 and they have built two other health apps. Tech support takes longer than two business days but FAQ is available from the app. The last update was 2015.
The app is free but a small price buys comprehensive data input and no advertisements. The app is available in multiple languages for Apple devices. FAQ may require greater than Grade 8 level literacy. Fonts tend to be small which may be troublesome for older users.
Blood Pressure (SmartBP)
This is a decent app to record and analyze BP. Users can input tags and notes to track how different factors affect their BP. Preset BP thresholds are similar to similar to CHEP thresholds, and colours demarcate the various ranges consistently. The user can change these to reflect their own target BP. The app allows sharing data with the primary care provider. The app is fairly usable although it takes some time to learn more advanced functions like the filters. It is also interoperable with certified BP devices (including Withings Wireless BP monitor) making for efficient data entry, but the cuff has not been tested in this review. Unfortunately, PHI is not kept on internal memory and is accessible, though not sold, to third parties. The FAQ is relatively comprehensive, delving into education around hypertension. There is good tech support.
The app allows basic analysis of BP and can remind users to measure their BP. Data can be shared via cvs and pdf and also synced to Apple HealthKit and Microsoft Health Vault. BP thresholds can be customized and there is basic hypertension education on the website.
BP thresholds are preset similarly to CHEP guidelines, but provides no alert for hypertensive crisis. Users can track BP, HR, Wt and BMI, but there are no instructions on how to measure BP. Physicians were involved in the development of the app but none have endorsed it.
The app is interoperable with certified BP cuffs. Colours consistently represent what category the BP falls into with respect to CHEP guidelines and graphs are easily read. Basic data can be entered in one screen. Navigational elements are placed inconsistently at the top and bottom of the screens.
Privacy & Security+-
The privacy statement is accessible although long. PHI such as DOB, gender, height, weight and name are collected. Third parties can have access to PHI in order to deliver the service, but it is not sold. There is a biometric passcode on iPhone (not Android) but it appears finicky.
The application is large, but performance is fine. The company has been in business since 2012, but does not make any other apps. The last updates were in 2016 and 2015 for iPhone and Android, respectively. Tech support responds in one to two business days and FAQ is easily accessible.
The app is available for free. It can be used on Apple and Android devices and is available in multiple languages. The FAQ section may require greater than Grade 8 level literacy. Fonts tend to be small which may be problematic for older users.
iBP Blood Pressure
This is a decent app for users to record and analyze their BP. BP thresholds are in line with CHEP guidelines, and colours demarcate the various ranges consistently. The app allows sharing data with the primary care provider. The app is fairly usable, though it takes some time to learn the navigation. It is interoperable with certified BP devices (including Withings Wireless BP monitor) making for efficient data entry, but the cuff has not been tested in this review. PHI is collected and shared with third parties, but unclear if ever sold. Email addresses are collected for the purpose of sending exported data; it is unclear how this can be used by third parties. The FAQ is accessible from the app and the website and there is good tech support.
Data can be shared by pdf and csv format and synced to Apple HealthKit. Information displayed on graphs and fields to enter during data input can be customized. BP thresholds may be customized. There is no education about hypertension. Free text notes can aid in the analysis of BP.
The app uses preset thresholds similar to CHEP guidelines, but there is no warning of hypertensive crisis. Users can track BP, HR and Wt but there are no instructions on how to measure BP. There is no endorsement by a healthcare provider but the developer is identified.
The app is interoperable with a certified BP cuff for ease of data entry. The icons and buttons are familiar though it is difficult to understand how to use some of the data entry fields, such as medications. Colours consistently represent BP thresholds.
Privacy & Security+-
The privacy statement was sent by email after being asked. It is not easy to read. The PHI collected is BP, HR, Wt, but this information can be accessible by third parties. It is not clear if it is ever sold. The app allows for password protection.
The application is small and performs well. iBP was released in 2009 and updates were published in 2016 and 2014 for iPhone and Android respectively. Tech support responds in one to two business days and a detailed FAQ is available through the website and the app.
The app is available at a small cost and can be used on both Apple and Android devices. It is available in multiple languages. FAQ may require greater than Grade 8 level literacy. In addition, the fonts tend to be small which can be problematic for older users.
Blood Pressure (My Heart)
This is a great app to record and analyze BP. It is highly customizable in terms of language, colours and advanced vs simple views. There is no interoperability with a certified BP cuff, but data entry is simple enough from a single screen. Preset BP thresholds are similar to those defined in the CHEP guidelines. Users can use preset or develop their own filters based on user input tags, time ranges and BP thresholds to develop a solid understanding of what affects their BP. Graphs are easily viewed and can be zoomed into and out of based on touch. The app allows data sharing data with the primary care provider. It is highly user friendly and customizable. PHI is stored only on the device which simplifies privacy concerns. FAQ and tech support are helpful. This app is a must try for pre-hypertensive and hypertensives on Android.
The app is highly customizable allowing for simple vs advanced views and different languages. Advanced filters using time range, BP thresholds and tags allow for detailed analysis. Reminders can be set to take BP. Data can be shared via csv and pdf. There is no way to set a target BP.
Preset BP thresholds are defined similarly to CHEP guidelines. User can track BP, HR and Wt. The app prompts users when medication may be necessary, but no alert for hypertensive crisis or instructions on how to take BP. The developer is identified, but there is no healthcare provider endorsement.
Very user friendly, providing a brief tutorial as navigational elements appear due to increased user data. Data is easily input from one screen. Colours demarcate BP thresholds consistently. The graphs are intuitively zoomed into and out of by touch. Unfortunately, the app is not interoperable with a BP cuff.
Privacy & Security+-
The privacy statement is accessible on the website and easily read. Data is kept on the local device while usage data and cookies can be shared with google analytics. You can easily disable this from the settings menu. There is no password.
The app is small, performs well and has been downloaded two million times. It was last updated in 2016. The FAQ is very easy to read with multiple images breaking up the text. Tech support takes one to two business days. The developer has built five other apps since 2013.
The app is available for free on Android and is available in multiple languages. FAQ is relatively easy to read, especially with many explanatory images breaking up the text. There are some smaller fonts in the log and chart areas but input fields are fairly large.
What Experts Say
Watch our interview with leading specialist Dr. Campbell regarding Hypertension.
The Consumer’s Association calls it the nation’s “other” drug problem: the large number of people who just don’t take the drugs prescribed for chronic conditions. In fact, the U.S.-based organization reports that in one large-scale study – 77,000 adults – three-quarters of respondents had not filled a prescription, taken less than the recommended amount, skipped a dose or forgotten to take it. Another study found that 25 to 50 per cent of persons prescribed medication for high blood pressure, diabetes or high cholesterol stopped taking it within a year.
Here’s what patients in one study said:
“I was afraid of the medication, because I was told that once I started to take it I would have to take it all my life”.
“I think that has to be damaging to some part of my body”.
“I don’t like them (medicines), they have lots of side effects, they can make you sick… I think that I might get worse instead of better”.
“My problem is that I forget to take my medication during the day when I don’t have it right beside me”. “I’ve stopped taking the tablets when I’ve felt like it, sometimes for a fortnight or three weeks just to see”.
“If my blood pressure feels more controlled, I’ve reduced the dose myself”.
“I’m really tired … I’ve been taking medication for thirty-one years now and I’m fed up so sometimes I say I’m just going to stop taking it for a while”.
Patients also tend to believe common myths, according to the American Heart Association. They say because they feel fine, they don’t have to worry about high blood pressure or that, once their readings are normal, they can stop taking medication.
- Padwal RS, Bienek A, McAlister FA, Campbell NR, Program ORTFotCHE. Epidemiology of hypertension in Canada: an update. Canadian Journal of Cardiology. 2016;32(5):687-694.
- Kannel WB. Blood pressure as a cardiovascular risk factor: prevention and treatment. Jama. 1996;275(20):1571-1576.
- Yusuf S, Hawken S, Ôunpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The Lancet. 2004;364(9438):937-952.
- McManus DD, Lee J, Maitas O, et al. A novel application for the detection of an irregular pulse using an iPhone 4S in patients with atrial fibrillation. Heart Rhythm. 2013;10(3):315-319.
- McManus RJ, Mant J, Haque MS, et al. Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial. Jama. 2014;312(8):799-808.
- Logan AG, Irvine MJ, McIsaac WJ, et al. Effect of home blood pressure telemonitoring with self-care support on uncontrolled systolic hypertension in diabetics. Hypertension. 2012;60(1):51-57.
- Kumar N, Khunger M, Gupta A, Garg N. A content analysis of smartphone–based applications for hypertension management. Journal of the American Society of Hypertension. 2015;9(2):130-136.