Treating Hypertension Beyond Genomics . . . Personalised care and technology in focus

Author: Dr Patrick Gladding

Treating the world’s largest ‘silent killer’ extends well beyond drug intervention, guidelines and textbook literature. Here Ascot Cardiology Group Cardiologist Dr Patrick Gladding provides insight into technological advances in blood pressure monitoring and ECG sensitivities, and the key role personalisation plays in effectively treating patients with hypertension.

“Personalised medicine is more than genomics, it’s also wireless medicine, telemedicine and personalised care,” says Dr Gladding.

Looking towards mobile health, below are a few of the key players in blood pressure monitoring devices that are taking a turn on the global stage.


Tracking steps and heart rate

  • The Fitbit tracks heart rate and allows for continuous pulse monitoring.
  • Apple iWatch monitors heart rate, posture, calories burned based on position.
  • On a comparison scale, the Polar watch, followed by iWatch and then Fitbit are the most accurate at estimating heart rate, but may be unreliable in patients with atrial fibrillation.
  • What is underappreciated is that the Fitbit or iWatch on itself cannot make a patient lose weight. However showing patients personalised information, such as genetic risk scores and feedback via a wearable may be the way to motivate change.


Omron . . . Project Zero

  • Touted as the ‘Miles Davis’ of blood pressure cuffs, the Project Zero wristband is Omron’s solution to the traditional arm cuff – but with the same principles. It’s the first wearable device to track both fitness and blood pressure – and tell the time.
  • When patients want to check their blood pressure, they press a button on the watch and information is stored and can then be sent via an app to the patient or doctor.
  • Project Zero claims to be as accurate as any doctor’s machine – within +/- 3 millimetres of mercury – and has been granted FDA clearance and validation from the European Society of Hypertension.

“This is a watch basically, that does not monitor continuous blood pressure but intermittent blood pressure,” says Dr Gladding. “As it’s a watch blood pressure monitor you need to hold it up at heart level if it’s being used – but it’s also quite small which is convenient.”


Personalised Care . . . A human approach to patients

Aside from drugs and technological advances, hypertension treatment also walks avenues on a personal level. The human touch.

An exploratory study into the quality of care as a contributing factor to blood pressure reduction was carried out in 1986, and its results have resonated across the medical field.

“It is probably one of the first titles in a journal that said ‘personalised’,” says Dr Gladding. “This wasn’t genomics or anything fancy, it was just treating two groups of people in different fashions.”

The study played out with 46 uncontrolled (greater than or equal to 140/90mm Hg), medically treated hypertensive patients receiving more personalised care, contrasted with 36 usual-care patients (10/7 vs 2/2mm Hg means for systolic and diastolic blood pressure reduction).

The personalised care group:

  • Were greeted by their names.
  • Were shown their blood pressure recordings.
  • Told that they could manage their blood pressure at home.
  • Were involved in the decision making process.

The usual-care group:

  • Had an office-corporate-style approach.
  • Were whisked in through the door.
  • Briskly had blood pressure taken.
  • Were handed a prescription and told to take it.
  • Were whisked back out the door.

“Those in the personalised care group actually had lower blood pressures by a large amount – like 9mm Hg,” explains Dr Gladding. “So, just treating people nicely works and you don’t even need to give them a drug.”


ECG Advances . . . Technology right out of space

Hypertension is the world’s biggest risk factor for cardiovascular disease, therefore detailing more about a patient’s cardiac age is beneficial for reasons well beyond just-another-number. Recent electrocardiography findings have revealed accurate ‘heart age’ diagnosis is useful to both patients and doctors for implementing lifestyle changes and for those who present heart troubles and symptoms, but test negative for cardiac pathology.

Specifically, a study detailed in the Journal of Personalised Care, ‘Predicting “Heart Age” Using Electrocardiography’, demonstrated this point. The study proposed a potentially more straightforward approach to ECG measurements, using a Bayesian approach. The principal goal was to predict a patient’s ‘heart age’ based on ECG outputs only after they were given a thumbs-up that (clinically and by advanced ECG) that their disease status was “negative”.

Interestingly findings from the analysis revealed that just because a person has a risk factor does not mean that he/she also has heart disease. Results also demonstrated that in subjects with heart disease, it’s expected that most will have a higher predicted ‘heart age’ than ‘body age.’ In the high-endurance athletes monitored, 56.25% of them had higher predicted ‘heart ages’ than ‘body ages.’

The topic of ECG insensitivity has long circulated the medical field. Thus, validation of a wi-fi-based ECG system has been heartily embraced by Ascot Cardiologists.

“It’s about the size of a phone – and actually connects to your phone so you can see the ECG onscreen – and it is about half the cost of the more expensive models,” says Dr Gladding. “It does all this big data analysis – pattern recognition– it identifies different diseases – and it also gives you an electrical age for your heart.”

This new ECG technology provides cardiologists and doctors with an overview of a patients ‘global self.’ The technology (cloud-based) collects data of a patient’s genome, highlighting the interconnections and interactions between different aspects of his/her genome, for example, are they higher in certain factors related to coronary artery disease and hypertension thus providing clues towards the best treatment options for that patient.

“This is technology that has spun out of the space industry but is available to anyone who wants it because it’s on the internet,” says Dr Gladding. “It gives you this wonderful graphic printout and you can look up over a thousand different parameters on the ECG. The patients I’ve shown this, love it.”


Stay tuned for a new Antihypertension App!

A recent global competition to create the best algorithm to individualise the intensiveness of antihypertensive treatment has opened doors for a new hypertension app. Investigators from the recent SPRINT trial headed the competition and released all the individual patient data from the trial onto the internet. Over 160 contestants entered and three were awarded prizes for their work. One of these algorithms has now been built into an app, which in the near future we will be able to use to truly personalise treatment for each of our patients. Watch this space!

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