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Links between blood pressure and medication intake, well-being, stress, physical activity and symptoms reported via a mobile phone-based self-management support system: a cohort study in primary care
  1. Charles Taft1,2,
  2. Inger Hallberg2,3,
  3. Ulrika Bengtsson1,2,
  4. Karin Manhem4,5,
  5. Karin Kjellgren1,2
  1. 1 Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  2. 2 Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  3. 3 Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
  4. 4 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  5. 5 Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
  1. Correspondence to Dr Charles Taft; charles.taft{at}


Objectives To explore relationships between patients’ self-monitoring of blood pressure (BP) and their concurrent self-reports of medication intake, well-being, stress, physical activity and symptoms.

Design This study is a secondary analysis of a prospective study exploring the 8-week effectiveness of a mobile phone-based self-management support system for patients with hypertension.

Setting Four primary healthcare centres situated in urban and suburban communities in Sweden.

Participants 50 patients undergoing treatment for hypertension.

Primary and secondary outcome measures Associations between systolic (SBP) and diastolic blood pressure (DBP) and 10 self-report lifestyle-related variables were analysed using linear mixed effects modelling.

Results Medication intake, better well-being, less stress and greater physical activity were associated variously with lower same-day SBP and DBP. The single strongest association was found between medication intake and SBP, where failure to take medications was associated with an estimated 7.44 mm Hg higher SBP. To a lesser degree, medication intake was also associated with DBP, where DBP was 4.70 mm Hg higher in cases where medications were not taken. Well-being and stress were consistently associated with SBP and DBP, whereas physical activity was associated with only SBP. None of the symptoms—dizziness, headache, restlessness, fatigue or palpitations—were significantly associated with BP.

Conclusions Our findings that BP was associated with patients’ BP management behaviours and experiences of well-being and stress, but not symptoms suggest that enabling persons with hypertension to monitor and track their BP in relation to medication intake, physical activity, well-being, stress and symptoms may be a fruitful way to help them gain first-hand understanding of the importance of adherence and persistence to treatment recommendations.

Trial registration number NCT01510301; Pre-results.

  • hypertension
  • self-management
  • adherence
  • self-reports
  • symptoms

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  • Contributors CT: designed the study, performed data analyses and drafted and revised the paper. He is guarantor. IH: designed the study, monitored data collection and revised the paper. UB: designed the study, monitored data collection and revised the paper. KM: drafted and revised the paper. KK: initiated the project, designed the study and drafted and revised the paper. She is guarantor. All authors have approved the submitted manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The work was supported by the Gothenburg Centre for Person-Centred Care (GPCC) in Sweden and performed in collaboration with the LETStudio, a strategic initiative for promoting interdisciplinary research within the Learning Sciences at the University of Gothenburg that addresses issues of knowledge, learning, communication and expertise in contemporary society. The GPCC is funded by the Swedish Government’s grant for Strategic Research Areas, Care Sciences (Application to Swedish Research Council nr 2009-1088), and co-funded by the University of Gothenburg, Sweden. The GPCC was not involved in any aspect of the study design; the collection, analysis and interpretation of data; the writing of the report or the decision to submit the article for publication.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Regional Ethics Board in Gothenburg, Sweden (study code 551-09 and T-100-12).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Patient-level data may be obtained by contacting the corresponding author. There are no additional data available for data sharing. Consent for data sharing was not obtained from participants but the presented data are anonymised and risk of identification is low.

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