Background Hypertension is a major cause of cardiovascular disease, which is the leading cause of premature death. People with hypertension who do not comply with recommended treatment strategies have a higher risk of heart attacks and strokes, leading to hospitalization and consequently greater health care costs. The smartphone, which is now ubiquitous, offers a convenient tool to aid in the treatment of hypertension through the use of apps targeting lifestyle management, and such app-based interventions have shown promising results. In particular, recent evidence has shown the feasibility, acceptability, and success of digital interventions in changing the behavior of people with chronic conditions. Objective The aim of this study was to systematically compile available evidence to determine the overall effect of smartphone apps on blood pressure control, medication adherence, and lifestyle changes for people with hypertension. Methods This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. Databases were searched to identify randomized controlled trials related to the influence of an app-based intervention in people with hypertension. Data extracted from the included studies were subjected to a meta-analysis to compare the effects of the smartphone app intervention to a control. Results Eight studies with a total of 1657 participants fulfilled the inclusion criteria. Pooled analysis of 6 studies assessing systolic blood pressure showed a significant overall effect in favor of the smartphone intervention (weighted mean difference –2.28, 95% CI –3.90-0.66). Pooled analysis of studies assessing medication adherence demonstrated a significant effect (P<.001) in favor of the intervention group (standard mean difference 0.38, 95% CI 0.26-0.50) with low heterogeneity (I2=0%). No difference between groups was demonstrated with respect to physical activity. Conclusions A smartphone intervention leads to a reduction in blood pressure and an increase in medication adherence for people with hypertension. Future research should focus on the effect of behavior coaching apps on medication adherence, lifestyle change, and blood pressure reduction.

Background Studies report high in-hospital mortality of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) especially for those requiring admission to an intensive care unit. Recognizing factors associated with mortality in these patients could reduce health care costs and improve end-of-life care. Methods This retrospective study included AECOPD patients admitted to the respiratory intensive care unit of a tertiary hospital in Beijing from Jan 1, 2011 to Dec 31, 2018. Patients demographic characteristics, blood test results and comorbidities were extracted from the electronic medical record system and compared between survivors and non-survivors. Results We finally enrolled 384 AECOPD patients: 44 (11.5%) patients died in hospital and 340 (88.5%) were discharged. The most common comorbidity was respiratory failure (294 (76.6%)), followed by hypertension (214 (55.7%)), coronary heart disease (115 (29.9%)) and chronic heart failure (76 (19.8%)). Multiple logistic regression analysis revealed that independent risk factors associated with in-hospital mortality included lymphocytopenia, leukopenia, chronic heart failure and requirement for invasive mechanical ventilation. Conclusions The in-hospital mortality of patients with acute COPD exacerbation requiring RICU admission is high. Lymphocytes < 0.8 × 109/L, leukopenia, requirement for invasive mechanical ventilation, and chronic heart failure were identified as risk factors associated with increased mortality rates.

Background Patients with severe acute exacerbations of chronic obstructive pulmonary disease often have a poor prognosis. Biomarkers can help clinicians personalize the assessment of different patients and mitigate mortality. The present study sought to determine if the lymphocyte count could act as a risk factor for mortality in individuals with severe AECOPD. Methods A retrospective study was carried out with 458 cases who had severe AECOPD. For analysis, patients were divided into two groups on the basis of lymphocyte count: < 0.8 × 109/L and ≥ 0.8 × 109/L. Results Patients who fulfilled the criteria for inclusion were enrolled, namely 458 with a mean age of 78.2 ± 8.2 years. Of these patients, 175 had a low lymphocyte count. Compared to patients with normal lymphocyte counts, those with low counts were older (79.2 ± 7.4 vs. 77.5 ± 8.6 years, p = 0.036), had lower activities of daily living scores on admission (35.9 ± 27.6 vs. 47.5 ± 17.1, p < 0.001), and had a greater need for home oxygen therapy (84.6 vs. 72.1%, p = 0.002). Patients with low lymphocytes had higher mortality rates during hospitalization (17.1 vs. 7.1%, p = 0.001), longer hospital stay (median [IQR] 16 days [12–26] vs. 14 days [10–20], p = 0.002) and longer time on mechanical ventilation (median [IQR] 11.6 days [5.8–18.7] vs. 10.9 days [3.8–11.6], p < 0.001). The logistic regression analysis showed lymphocyte count < 0.8 × 109/L was an independent risk factor associated with in-hospital mortality (OR 2.74, 95%CI 1.33–5.66, p = 0.006). Conclusion Lymphocyte count could act as a predictor of mortality in patients with severe AECOPD.