Hypertension is the most common chronic medical condition and a major risk factor for cardiovascular and cerebrovascular disease worldwide. It is also the leading contributor to the global disease burden. High blood pressure accounted for more than 20% of all health loss in adults aged 70 years and older.⁶⁾ Lowering blood pressure is effective in reducing the cardiovascular disease risk for the hypertensive patients. Unfortunately, the real-world overall treatment and control rates of hypertension are unsatisfactory despite effective pharmacologic and non-pharmacologic therapies. In particular, the hypertension control rate among treated older hypertensive patients is lower than that of younger patients. Several factors are associated with these unfavorable results, include the use of suboptimal doses of medications, lack of patient engagement, poor compliance, and ineffective lifestyle modification.

Hypertension can be safely and effectively managed using a digital health platform, achieving better blood pressure control than that of traditional office-based care. Home blood pressure monitoring has advantages over traditional office-based blood pressure measurement and care, through a larger sample of blood pressure data, reducing misclassification to white-coat or masked hypertension, and an ability to take more timely action and course-correct therapy. It also effective in activating patient’s motivation and encouraging drug adherence. The current technology is accurate and easy to use, and home-based blood pressure measurements also better predict cardiovascular outcomes. A previous study showed that digital medicine-based management including blood pressure telemonitoring, medication management, and lifestyle recommendations via a clinical pharmacist and a health coach, was associated with better blood pressure control, with target goal achievement rates of 71% among the digital-medicine group and 31% among the usual-care group.⁷⁾ In addition, a meta-analysis investigated the effect of an interactive digital intervention for blood pressure management. They showed that the digital intervention group had lower blood pressures (−3.74/−2.37 mmHg, systolic and diastolic blood pressure, respectively) than those of the usual care group.⁸⁾ However, the sustainability and long-term clinical effectiveness of these interventions remain unclear.

Diabetes is present in 29.8% of Korean older adults aged over 65 years.⁹⁾ Diabetic patients have a 2-fold increased risk of dying than that among those younger than 80 years without diabetes. Diabetic vascular complications such as cardiovascular disease and cerebrovascular disease are the most serious problems associated with poor clinical outcome and increased healthcare costs. In addition, hypoglycemia is a treatment-related complication associated with increased mortality, especially among older adults. Recent data showed that hospital admission rates for hypoglycemia exceed those for hyperglycemia among older adults.¹⁰⁾ These data suggested that optimal glucose control is required in older people. However, diabetes management is often suboptimal in older people, especially those living in long-term care facilities.¹¹⁾

A digital approach can be an effective strategy for stable blood glucose control among elderly people. It can be useful for monitoring blood glucose level, providing suitable diet and/or exercise recommendations, and enhancing drug compliance. An age-friendly clinical decision support system using a mobile phone-connected glucometer and individualized text messaging resulted in better glycemic control with less hypoglycemia compared to usual care in older diabetic patients.¹²⁾

HF is associated with prolonged and frequent hospitalizations; thus, HF is responsible for a tremendous burden on healthcare systems. The prevalence of this condition increases markedly with age. HF is the most common diagnosis for hospital admission in patients aged 65 years and older in high-income countries.¹³⁾ In addition, up to 25% of patients hospitalized with HF are readmitted within 30 days.^14,15) Despite advances in the quality of acute and chronic HF disease management, knowledge gaps remain regarding effective interventions to support the transition of care for HF patients. In addition, HF patients are frequently associated with multimorbidity. Accordingly, it is difficult to manage the accompanying pathologic conditions. Polypharmacy is another issue in managing older HF patients.

Digital medicine can be helpful in the monitoring, prevention and early detection of the aggravation of HF, as well as the management of drug compliance. Several studies have investigated the role of mobile devices in managing HF. The majority of these studies utilized mobile health technology as part of an HF monitoring system, which typically included a device to measure blood pressure, weighing scale, and an electrocardiogram recorder. However, the impacts of the mHealth interventions on all-cause mortality, cardiovascular mortality, HF-related hospitalizations, length of stay, New York Heart Association functional class, left ventricular ejection fraction, quality of life, and self-care were inconsistent at best.¹⁶⁾ Although several small pilot studies showed beneficial results using telemonitoring in HF patients, a large trial using telephone-based monitoring failed to show a significant benefit in reducing death or hospitalization.¹⁷⁾

However, compliance, effective intervention, and monitoring are important factors in the management of HF patients. Furthermore, automatic, daily, implant-based, multiparameter telemonitoring can significantly improve clinical outcomes for patients with HF. Such telemonitoring is feasible and should be used in clinical practice.^18,19) Recently, a well-designed randomized controlled trial was published, which showed that structured remote patient management intervention could reduce the percentage of days lost due to unplanned cardiovascular hospital admissions and all-cause mortality.²⁰⁾ The limitation of current studies includes insufficient data regarding the effectiveness of the monitoring devices, well-designed patient monitoring and feedback systems, and patient compliance using those devices. Accordingly, more precise monitoring devices should be developed to effectively evaluate and detect the aggravation of HF in these patients.