Impact of a multicomponent digital health and telemonitoring intervention on hypertension and diabetes control in cardiac patients: A randomized controlled trial

BACKGROUND: Digital health technologies are promising tools to improve cardiovascular risk factors. We evaluated the impact of a multicomponent digital health program-including a mobile app, home blood pressure (BP) monitor, wearable activity tracker, and telecoaching-on hypertension and diabetes control in cardiac outpatients. METHODS: In this pragmatic randomized controlled trial, 240 adults with cardiovascular disease and hypertension and/or type 2 diabetes were assigned to receive either the digital health program plus usual care or usual care alone for 6 months. Co-primary outcomes were change in systolic BP and hemoglobin A1c (HbA1c). Secondary outcomes included risk factor target achievement, medication adherence, and quality of life. RESULTS: A total of 228 patients (mean age 57 ± 12 years; 38% women) completed follow-up. At 6 months, the intervention group showed a greater reduction in systolic BP compared with controls (-11.2 ± 12.6 vs -5.1 ± 11.8 mmHg; adjusted mean difference -6.1 mmHg, 95% CI -9.3 to -2.9; p < 0.001). Among participants with diabetes (n = 142), HbA1c decreased by -0.7 ± 1.1% versus -0.3 ± 1.0% (adjusted mean difference -0.4%, 95% CI -0.7 to -0.1; p = 0.008). More intervention patients achieved BP < 130/80 mmHg (52% vs 34%, p = 0.01) and HbA1c <7% (48% vs 32%, p = 0.04). Physical activity improved significantly, with increased step counts. More benefit observed in patients with poorly controlled baseline risk factors. Medication adherence and quality-of-life scores improved significantly. CONCLUSIONS: A multicomponent digital health intervention significantly improved BP and glycemic control in cardiac outpatients, supporting integration of digital strategies into secondary cardiovascular prevention.