This document discusses using mobile apps to help manage chronic conditions like diabetes and hypertension. It summarizes studies showing tight control of blood glucose, blood pressure, and other factors can significantly reduce health risks. However, blood pressure control may be even more important. The document advocates using phone cameras to easily track home blood pressure readings, which better predict health outcomes than office readings. It also discusses a trial where patients safely titrated their own antihypertensive medications using an app, maintaining control with fewer visits. The ideal prescription app would partner with physicians using a public, validated algorithm to safely adjust medications.

1. Take two apps and call me in
the morning
Prescribing code instead of pills, clinician
perspective

2.  Joel M Topf, MD
 @Kidney_boy
 @eajkd
 www.Pbfluids.com

3. Kidometer

4. KDIGO iPad app

7. UK Prospective Diabetes Study
An intensive glucose control policy HbA1c 7.0 % vs 7.9 %
reduces risk of
◦ any diabetes-related endpoints 12% p=0.030
◦ microvascular endpoints 25% p=0.010
◦ myocardial infarction 16% p=0.052
A tight blood pressure control policy 144/82 vs 154/87
mmHg reduces risk of
◦ any diabetes-related endpoint 24% p=0.005
◦ microvascular endpoint 37% p=0.009
◦ stroke 44% p=0.013
The benefit from tight glycemic
control is less than the benefit
from lousy blood pressure control

8. Blood pressure control is more
important blood sugar control

9. 525,600minutes in a year
minutes are
assessed with
office BP

10. Gold standard for blood pressure
assessment is 24-hour
ambulatory blood pressure
monitoring
Patient assessed home blood
pressures are more than twice
as correlated than physician
measured office blood
pressures.
Home 0.56
Office (MD) 0.21
Office (RN) 0.31
Little P, et al. BMJ. Aug 3 2002;325(7358):

11. Home blood pressure
readings are better than office
readings at predicting end-
organ damage (left ventricular
hypertrophy, atherosclerosis),
cardiovascular events and
total mortality

12. but this amazing technology is
useless if you forget your numbers…
…no patient ever
forgets her phone

13. Easiest blood pressure diary is
the camera phone
• No app to download
• You already know how to use it
• No cheating
• Time and date stamped

15. Can we go further?
 Patients titrate insulin based on blood
sugar
 Can patients titrate antihypertensive
medications based on blood
pressure?

17. 152.1
139
134.9
151.8
142.4
140.1
125
130
135
140
145
150
155
Baseline 6 Months 12 Months
Systolic Blood Pressure
Intervention Control
85
79.6
77.4
84.5
80.3
79.5
72
74
76
78
80
82
84
86
Baseline 6 Months 12 Months
Diastolic Blood Pressure

18. The intervention group
 more medications prescribed
(p=0.001)
◦ 0.3 at 6 months
◦ 0.4 at 12 months
 fewer clinic visits (NS)
◦ 3.2 visits versus 3.5 for the control group
 improved quality of life (NS)

20. PatientswithEvents(%)
0
5
10
15
20
Years Post-Randomization
0 1 2 3 4 5 6 7 8
Primary Outcome
Nonfatal MI, Nonfatal Stroke or CVD Death
HR = 0.88
95% CI (0.73-1.06)

22. We pay for tight blood
pressure control with acute
renal failure, hypotension and

23. What I want in a prescription app
 Public algorithm
 Partners with the physician to choose
the appropriate titration strategy
 Validated
 Approved