A smartphone-guided secondary prevention digital health application reduces systolic blood pressure in patients with chronic coronary syndrome and insufficient blood pressure control

Philip Düsing ^1* Stephan H Schirmer ² Sebastian Schäfer ³ Alexander Krogmann ⁴ Jan-Malte Sinning ⁵ Nikos Werner ⁶ Florian Bönner ⁷ Alexander Sedaghat ⁸ Cornelius Müller ⁹ Irina Eckardt ¹ Georg Nickenig ¹ Andreas Zietzer ¹

• ¹ Heart Center, University Hospital Bonn, Bonn, North Rhine-Westphalia, Germany
• ² Kardiopraxis Schirmer, Kaiserslautern, Germany
• ³ Praxis Rheingalerie Rodenkirchen, Cologne, Germany
• ⁴ Kardio-Lev, Leverkusen, Germany
• ⁵ Department of Cardiology, St. Vinzenz Hospital, Cologne, Germany
• ⁶ Krankenhaus der Barmherzigen Brüder Trier, Trier, Rhineland-Palatinate, Germany
• ⁷ University Hospital of Düsseldorf, Düsseldorf, North Rhine-Westphalia, Germany
• ⁸ Rhein-Ahr-Cardio, Praxis für Kardiologie, Bad-Neuenahr, Germany
• ⁹ Kardio Bonn, Bonn, Germany

Background: Chronic coronary syndrome (CCS) leads to high morbidity and mortality despite therapeutic advances in recent decades. Several modifiable risk factors, including increased blood pressure (BP), significantly contribute to cardiovascular risk in CCS. Therefore, optimal secondary prevention includes managing BP through lifestyle changes and pharmacological therapy. The CHANGE study aimed to provide evidence for optimizing secondary prevention in CCS patients using a smartphone application. Methods: The CHANGE-Study is a prospective, randomized, controlled trial performed in 9 centers in Germany. Patients with CCS were randomly allocated to either a control or an intervention group. The intervention group received the “Vantis | KHK und Herzinfarkt” digital health application and standard care. The control group received standard care alone. From the original cohort, subgroups of patients with systolic BP ≥140 mmHg (n=44), ≥130 mmHg (n=89) and diastolic BP ≥90 mmHg (n=28) were analyzed for BP reduction after 12 weeks. Results: In patients with systolic BP ≥140 mmHg, the intervention group showed a reduction in systolic BP by 15.5 mmHg (+-16.7 mmHg, p=0.0001), which was greater compared to the control group (6.0 +- 13.0 mmHg, p=0.058). This observation was consistent in patients with systolic BP ≥130 mmHg at baseline. No significant differences between both groups were observed in diastolic BP reduction in patients with diastolic BP ≥90 mmHg. Conclusion: The CHANGE study documents that a smartphone-guided digital health application positively affects systolic BP in CCS patients. This study underlines the potential of digital interventions in cardiology to improve secondary prevention.