Digital therapeutics: An effective, non-pharmacologic way to improve BP control

The digital HERB system proved successful in early-stage hypertension patients, which could lower their blood pressure and adopt positive lifestyle interventions.

Sleep condition, salt intake, alcohol reduction, exercise, body-weight control, and stress management are covered in the tool

A digital tool, the HERB system, showed to be successful in patients with early-stage hypertension. Participants were able to lower their blood pressure (BP) and implement positive lifestyle interventions1.

The International Society of Hypertension has highlighted the need for population-level initiatives to reduce the global burden of elevated BP, including diet and exercise recommendations and reducing salt intake. Digital therapeutics refers to an emerging branch of medicine that utilises technology-based software algorithms or applications. These digital therapeutics could be beneficial in improving BP level and control.

To test this, the HERB system was developed, a new interactive smartphone app designed to help users to make intensive and consistent lifestyle modifications to reduce BP. In the HERB app, 6 non-pharmacologic interventions were included: sleep condition, salt intake, alcohol reduction, exercise, body-weight control, and stress management. Patients in the intervention group measured their BP at home, and doctors were able to monitor the patient´s data on the web and interact with them when necessary. 

The prospective, randomised controlled HERB-DH1 study included participants aged 20 to <65 years who were diagnosed with essential hypertension (i.e. office SBP 140–179 mmHg, and/or DBP 90–109 mmHg). Their 24-hour SBP had to be ≥130 mmHg by ambulatory BP measurement at screening. All participants were antihypertensive mediation-naïve for more than 3 months. The digital therapeutics group (n=199) using the app and standard lifestyle modification was compared with a control group (n=191) that received standard lifestyle modification only. Antihypertensive drugs were available if needed according to the guidelines in both groups. The primary outcome was the change in 24-hour systolic BP by ABPM at 12 weeks. 

Patients in the app group also lost significantly more body weight

“At 12 weeks, there was a reduction of morning home SBP by 10.6 in the intervention group and by 6.2 in the control group, which was highly statistically significant,” emphasised Prof. Kazuomi Kario (Jichi Medical University, Japan). Although there were marked individual differences in patient´s response at 12 weeks, patients using the app were generally doing better than those in the control group. 

A subgroup analysis revealed that patients benefited from the app independent of age, sex, and BMI. Those with a 24-hour SBP by ABPM at baseline from ≥145 mmHg had a significantly better effect from the intervention than the others (P<0.001). The app adherence was always >95%. Patients in the app group also lost significantly more body weight and a lower percentage needed antihypertensive medication compared with the control group.

Prof. Kario concluded that the HERB-DH1 study highlighted that digital tools, such as the HERB system, have the potential to contribute to individual-level initiatives for patients with early-stage hypertension by facilitating the implementation and effectiveness of lifestyle modification messages and behaviours. 

1. Kazuomi K. Efficacy of digital therapeutics for essential hypertension (HERB-DH1 pivotal study). Late-breaking trials in hypertension, ESC Congress 2021, 27–30 August.