What patients are actually asked to do
Every instruction, reminder, and safety message a patient sees in the app, written out in full. Published so reviewers, partner clinics, and clinicians can read the patient side without an account.
All patient-facing content is delivered in both English and Spanish. No patients are enrolled today — the app is in validation, and these protocols are what a supervised pilot would run.
1 · Home blood-pressure monitoring protocol
Starting protocol
For the first monitoring period, every reading is averaged to set the patient's baseline.
- 2 readings per sitting, at least 1 minute apart
- Morning & evening — 4 readings per day
- 3 days per monitoring period (12 readings total)
Before each reading
- Empty your bladder
- Sit quietly for 5 minutes
- Back supported, feet flat on the floor
- Bare arm resting at heart level, correct cuff size
Once blood pressure is controlled and stable for several months, once a day, one day a week is enough.
A titration cycle is 14 days. The care team reviews the averaged home readings at the end of each cycle rather than reacting to single values, and patients see their cycle end date and progress ("checks this cycle: 8 of 12 expected") on the home screen. Readings that fall in a crisis band are routed immediately — see the patient decision tree for every triage branch.
2 · Reminders and outreach logic
Reminders are gentle and escalate slowly. Nothing is punitive, and nobody is removed from the program for missing readings.
- In-app prompts. The home screen shows how many readings are logged this cycle and prompts a reading when the patient is behind.
- Care-team note. When staff send a nudge, it appears at the top of the patient home screen as a short, personal note with a one-tap link to log a reading.
- Outreach ladder. Days of silence since the last reading trigger staff-led outreach at 7, 14, 21, 35 days — text/app reminder, then a phone call, then a care-team check on barriers (cuff problems, connectivity, health literacy), then a documented decision about continuing in the program.
- The counter resets on contact. Either a new reading or a completed outreach attempt restarts the clock, so patients are never called twice for the same gap.
- Symptom check-ins. A 30-second symptom check-in is requested every 6 months and before a scheduled provider visit.
3 · Motivational interviewing
Lifestyle support is built on motivational interviewing rather than instruction. The app never tells a patient what they must do; it asks what they want and helps them pick one small step.
- 1-minute check-in. Five short questions rank the 6 evidence-based levers and surface the top 1–3 with the largest expected drop for that patient.
- Levers offered: DASH-style eating (↓ ~11 mmHg), Regular physical activity (↓ 5–8 mmHg), Lower sodium (↓ 5–6 mmHg), Weight loss (if overweight) (↓ ~1 mmHg per kg), More potassium (↓ 4–5 mmHg), Moderate alcohol (↓ ~4 mmHg).
- When BP runs high, the same levers are re-surfaced with autonomy-preserving framing — "pick the area that feels most doable this week — you're in charge" — instead of a warning.
- Full guide. Open-ended change-talk prompts, up-front acknowledgment of common barriers, readiness and confidence rulers, a menu of tiny "one thing this week" steps, and a strengths-based affirmation after the patient commits.
- Patients choose the intensity. Three styles, changeable at any time on the home screen: Full guide (the complete coaching flow), Short reflection (a 3-step values / routine / affirmation check-in), and Minimal (a single acknowledgment tap, no questions).
- What the clinician sees. Which lever the patient chose and how often they engaged — never a transcript of their answers.
4 · Education and medication side-effect guidance
Every lever has its own plain-language education page covering why it works, what to do this week, and the realistic size of the effect. Alongside education, patients get explicit rules for what to do if a medication causes trouble — sorted by what action to take, not by drug name.
Stop the medicine and call 911
These are rare, but they are emergencies. Do not wait for the office to open.
- Losartan (ACE inhibitor / ARB)
Swelling of the lips, tongue, face, or throat; trouble breathing or swallowing
Stop the medicine and call 911 now. Do not take another dose.
- Any BP medicine
Fainting, chest pain, one-sided weakness, trouble speaking, or a severe sudden headache
Call 911 immediately, whatever your blood pressure reads.
Hold the next dose and call your provider's office today
Skip the next dose, then call. If you can't reach the office, go to urgent care the same day.
- Any BP medicine
Dizzy or lightheaded when you stand up, or a reading under 90/50
Hold the next dose and call today. Sit or lie down until it passes.
- Losartan / hydrochlorothiazide, spironolactone
Vomiting, diarrhea, or being unable to keep fluids down for more than a day
Hold these until you are eating and drinking normally, and call the office. Your kidneys need the fluid.
- Spironolactone
Muscle weakness, numbness or tingling, or a slow or irregular heartbeat
Hold the dose and call today — your potassium may need checking.
- Metoprolol XL (beta-blocker)
Pulse under 50, or feeling faint with a slow pulse
Hold the next dose and call today. Never stop a beta-blocker for several days on your own — it must be tapered.
Keep taking it — but tell us at your next contact
These are annoying, not dangerous. There is almost always another medicine that does the same job without them, so don't quietly stop — tell someone and we'll switch it.
- Losartan (ARB)
A dry, nagging cough
Report it — the class can be switched.
- Amlodipine
Swollen ankles or feet
Report it — the dose can be lowered or the medicine changed.
- Hydrochlorothiazide
Urinating more often, leg cramps, or gout flares
Report it — take the dose in the morning and we can adjust.
- Spironolactone
Breast tenderness or enlargement
Report it — there is an alternative.
- Metoprolol XL
Fatigue or vivid dreams
Report it — the dose or timing can change.
Never stop silently. Never stop a blood pressure medicine for more than one dose without telling someone. High blood pressure has no symptoms, so it is easy to feel fine while the pressure climbs back up. One held dose is safe; a week of held doses is not.