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IntroductionHigh adherence to oral anticoagulants is essential for stroke prevention in patients with atrial fibrillation (AF). We developed a smartphone application (app) that pushes alarms for taking medication and measuring blood pressure (BP) and heart rate (HR) at certain times of the day. In addition to drug alarms, the habit of measuring one’s BP and HR may reinforce drug adherence by improving self-awareness of the disease. This pilot study aims to test the feasibility and efficacy of the smartphone app-based intervention for improving drug adherence in patients with AF.Methods and analysisA total of 10 university hospitals in Korea will participate in this randomised control trial. Patients with AF, being treated with edoxaban for stroke prevention will be included in this study. Total of 500 patients will be included and the patients will be randomised to the conventional treatment group (250 patients) and the app conditional feedback group (250 patients). Patients in the app conditional feedback group will use the medication reminder app for medication and BP check alarms. The automatic BP machine will be linked to the smartphone via Bluetooth. The measured BP and HR will be updated automatically on the smartphone app. The primary endpoint is edoxaban adherence by pill count measurement at 3 and 6 months of follow-up. Secondary endpoints are clinical composite endpoints including stroke, systemic embolic event, major bleeding requiring hospitalisation or transfusion, or death during the 6 months. As of 24t November 2021, 80 patients were enrolled.Ethics and disseminationThis study was approved by the Seoul National University Bundang Hospital Institutional Review Board and will be conducted according to the principles of the Declaration of Helsinki. The study results will be published in a reputable journal.Trial registration numberKCT0004754.

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From a nation-wide population-based cohort study comprised 237,592 patients with hypertension treated, we found that elevated on-treatment diastolic blood pressures (DBP) by the Seventh Report of Joint National Committee definition (systolic blood pressure [SBP] <140 mmHg with a DBP ≥90 mmHg) was associated a high risk of major cardiovascular events including mortality, while elevated DBP by the 2017 American College of Cardiology/ American Heart Association definition (SBP <130, DBP ≥80 mmHg) was only associated with a higher risk of stroke. The results of this study provide evidence of the value of an DBP target in subjects who have achieved SBP goals.