Hypertension remains one of the most common and modifiable risk factors for cardiovascular disease across all age groups, especially in older adults.1 Optimal blood pressure management is increasingly contingent on patient engagement and is enhanced when digital technology, like telehealth, patient portals, and home monitoring systems, is employed.
While these tools have expanded opportunities for remote monitoring and patient-provider communication, they also assume patients possess a level of digital competency. Digital health literacy–the ability to access, understand, and effectively use digital health information and technologies–has emerged as an important yet often overlooked determinant of hypertension self-management.2
For cardiovascular nurses working at the frontlines of prevention and chronic disease management, recognizing and addressing digital health literacy barriers may be essential to improving hypertension outcomes among older adults. Improving digital health literacy may represent an important strategy for improving hypertension control and cardiovascular outcomes in older adults.2
What is Digital Health Literacy?
Digital health literacy refers to an individual’s ability to access, understand, evaluate, and use health information through digital technologies to make informed health decisions.3,4 One model by Norman and Skinner3 describes a context-specific framework for eHealth literacy which emphasizes the integration of health, computer, and science literacy.
Expanding on this concept, digital health literacy extends beyond basic computer skills and includes the capacity to navigate digital platforms, interpret health information presented online, and effectively use digital tools to support health management.4 As healthcare systems increasingly integrate digital technologies into routine care, digital health literacy has become an important component of patient engagement and chronic disease self-management.4
In hypertension care, many aspects of monitoring and communication now rely on digital tools. For example, telehealth visits allow patients to remotely connect with healthcare providers for follow-up appointments and blood pressure management. Patient portals provide secure online platforms where individuals can review laboratory results, send messages to their healthcare team, and access educational resources related to blood pressure control. In addition, remote blood pressure monitoring systems enable patients to measure their blood pressure at home and transmit readings electronically to their healthcare providers, allowing for more timely adjustments in treatment plans. Medication reminder applications can also support adherence by sending alerts that prompt patients to take prescribed antihypertensive medications at scheduled times.4
While these technologies offer significant opportunities to improve hypertension management, they also require patients to possess a certain level of digital competence. Older adults, who experience the highest prevalence of hypertension, may face challenges navigating digital platforms due to limited experience with technology, physical limitations such as impaired vision, or difficulty interpreting complex digital interfaces.1 As a result, digital health literacy has emerged as a critical factor influencing how effectively older adults engage with modern hypertension management strategies.
Why Digital Health Literacy Matters for Hypertension Management
Digital health literacy has become increasingly important in hypertension care as more aspects of management shift to digital platforms. Patients are now frequently asked to monitor and track their blood pressure at home, often using devices or apps that require uploading or sharing readings with their healthcare team. These data can guide treatment decisions between visits, but only when technology is used consistently and correctly.6
Communication is also increasingly digital. Patient portals allow patients to message providers, review care plans, and receive follow-up instructions, while telehealth visits have become a common approach for ongoing hypertension management. In addition, many patients rely on digital platforms to access information about medications, diet, and lifestyle changes. When used effectively, these tools can support engagement and improve monitoring.2
However, not all patients are equally prepared to navigate these systems. In particular, older adults may encounter challenges with accessing platforms, interpreting information, or completing basic digital tasks. These barriers can lead to missed communication, incomplete blood pressure data, reduced participation in care, and delayed management. As a result, patients with lower digital health literacy may be less engaged in self-management, which can contribute to poorer blood pressure control and less optimal outcomes.6
The Role of Cardiovascular Nurses
The American Nurses Association identifies the promotion and enhancement of health as components of the scope of practice for nurses. As healthcare becomes increasingly reliant on technology, the role of nurses as patient educators and advocates aligns with this charge, positioning nurses as key drivers in the advancement of digital health literacy.
By studying the role of nurses in the advancement of health literacy, the roles of nurses in the advancement of digital health literacy can be extrapolated. One scoping review by Wilandika et al describes three primary roles of nurses in fostering health literacy:
- Nurses function as caregivers by improving the health of patients through health promotion and the advancement of health literacy.
- Nurses facilitate the understanding of diseases and plans of care, improving patient self-management, fostering a healthy lifestyle, and subsequently, eliciting improvement in their quality of life
- By assessing patients’ and caregivers’ baseline knowledge and comfort with technology for example, clinical messaging portal, telehealth visits, and other digital health platforms, nurses can support patients along their healthcare continuum through targeted education with the goal of enhancing the knowledge, skill, and ability to employ e-health interventions.7
The importance of digital health literacy is exemplified by the incorporation of remote patient monitoring (RPM) in the management of hypertension. Kario5 supports the implementation of RPM through home blood pressure monitoring (HBPM); albeit situations necessitating nocturnal assessment should elicit the use of ambulatory blood pressure monitoring, which is the gold standard method for home monitoring.5,8
Key Considerations for Home Blood Pressure Monitoring Success
Use of Validated Devices
Although HBPM is the most cost-effective method of management, standardization is needed to elicit accurate values for clinical use. Upper-arm oscillometric blood pressure machines should undergo validation against in-office devices, and appropriateness of cuff size should be assessed to elicit accurate readings. ValidateBP offers a list of devices that are highly accurate.8,9
Resources to Support Patient Knowledge and Skill
Instructional information about the self-assessment of blood pressure should be provided through various modalities to meet the learning needs of diverse patients. PCNA offers a variety of resources for both healthcare professionals and patients that can help guide these clinical conversations as well as use as at-home guides. In reference to device preference, devices with the ability to transmit values to healthcare teams by route of secure telehealth platforms are preferred, supporting real-time monitoring and decision-making.5 .In the absence of this technology, it is important to emphasize the consistent use of tracking, whether through computer or phone apps, digital record-keeping, or written logs, all of which should be shared with healthcare professionals to effectively track hypertension and treatment effectiveness.
Understanding and Using Proper Measurement Methods
The American Heart Association has information available that can help guide patients about how to accurately assess blood pressure at home, including the location of cuff placement and arm positioning during assessment.8
Ongoing Touchpoints with Patients
Ensuring that patients understand the importance of, and consistently apply, proper techniques for measuring blood pressure at home, as well as making certain that blood pressure data is available to healthcare professionals, are critical steps to addressing hypertension.8 Conversations should take place at each clinical interaction to reinforce information, allow time for patient questions and re-teaching as needed, and provide ongoing support for patients and their ongoing efforts to effectively track their blood pressure.8
Hypertension management increasingly relies on digital tools that support monitoring, communication, and patient engagement. However, many older adults face meaningful barriers to effective use of these technologies, limiting their ability to fully participate in self-management. Addressing digital health literacy represents a practical and necessary opportunity to improve blood pressure control and reduce cardiovascular risk in the older adult population.
Cardiovascular nurses are uniquely positioned to bridge this gap by providing guidance, education, and support enabling patients to confidently engage with digital health technologies.
DNP, APRN, ANP-BC, FNP-BC
DNP, MBA, AE-C, APRN, FNP-C
