Reciprocal Relationship Between Cardiovascular Risk and Attainment of Blood Pressure and Cholesterol Targets in Users of a Mobile Health App

Voluntary users of mobile health (mHealth) apps indicate an interest in lowering cardiovascular disease (CVD) risk. It is unclear by which extent blood pressure (BP) or cholesterol treatment targets are achieved in such individuals. This study aimed to evaluate the attainment of guideline-recommended BP and cholesterol targets across different CVD risk categories among mHealth app users. We grouped users of the publicly available German mHealth app HerzFit, who donated their data for scientific evaluations, into individuals with “low-to-moderate risk”, “high risk” and “very high risk” of future CVD events. Risk factor control was assessed according to presence of antihypertensive or cholesterol-lowering treatment and achievement of guideline-recommended BP and cholesterol treatment targets. Individual data sets from 1,230 HerzFit users without CVD who provided BP and cholesterol levels were used for the analysis. 471 users were categorized as low (-to-moderate) risk (38.3%), 595 as high risk (48.4%), and 164 as very high risk (13.3%). Antihypertensive treatment was reported in 36.9% of low-risk individuals, 58.2% of high-risk individuals (p<0.001 vs. low), and 59.1% of very high-risk individuals (p<0.001 vs. low). Cholesterol-lowering therapy was present in 29.3%, 41.7% (p<0.001 vs. low), and 40.9% (p=0.01 vs. low), respectively. Use of high-intensity statins (9%) and statin-ezetimibe combinations (5%) was low across all risk groups. BP control was achieved in 79.0% of low-risk individuals, 65.4% of high-risk individuals (P<0.001 vs. low) and 48.2% of very high-risk individuals (p<0.001 vs. low). Respective numbers for cholesterol control were 30.4%, 12.8% (p<0.001 vs. low) and 11.0% (p<0.001 vs. low). Despite being treated more frequently, individuals at high or very-high risk achieved poorer BP and cholesterol control compared to individuals at low-to-moderate risk. Thus, effective medications are particularly underutilized in individuals at high risk for future CVD events, despite an expressed interest in management of cardiovascular health. BP indicates blood pressure, CVD cardiovascular disease. A total of 1,230 HerzFit users donated information on both BP and cholesterol levels. The majority of them was at high or very high risk of future CVD. Individuals at higher risk were more often treated for hypertension or hypercholesterolemia. However, risk factor control was poorer among individuals at higher risk compared to those at low-to-moderate risk. Cholesterol control was particularly poor and high intensity statin use low across all risk groups.