Text Message Intervention Improves Blood Pressure Medication Adherence

Yu Fang, PhD

Findings of a recent analysis revealed using text messaging and consultation to manage systolic blood pressure and improve medication adherence was effective, feasible, and acceptable among Chinese patients with hypertension.

Yu Fang, PhD, and a team of investigators assessed patients with hypertension in a two-arm cluster randomized controlled trial. The study was conducted in 8 community healthcare centers in Xi’an City, Shaanxi Province, China, and compared medication adherence and clinical outcomes, including systolic blood pressure and diastolic blood pressure between an intervention and control group.

Eligible patients were >18 years old and were diagnosed with hypertension and were using antihypertensive medications at the time of the study, had a blood pressure <220/120 mm Hg at enrollment, and had health records at 1 of the 8 centers included. Participants also needed a phone capable of receiving SMS text message.

The team recruited patients during their physical examination or physician consultation. The potential patients were screened and approached by the staff and a research assistant. Patients in the intervention and control groups both completed a baseline survey of demographics, clinical outcomes, medication complexity and adherence, side effects, patient behavior, and knowledge about hypertension.

The intervention was made up of 2 parts: personal consultations by trained pharmacy students and SMS text messages sent at three-day intervals. Those who were randomized into the intervention group were given a consultation of about 5 minutes to identify reasons for possible medication nonadherence. The investigators suggested patients with poor memory set an alarm on their phone along with keeping medications near their beds.

Pharmacy students were trained to take personal consultations. Training consisted of 3 parts: interactive discussion on measurements of medication adherence and their advantages and disadvantages, Morisky Training Test, and use of the Morisky Widget. The students were trained to detect patients with low adherence and identify the reasons behind it so they could offer advice to overcome nonadherence.

Text messages were unidirectional and sent at three-day intervals at 7 AM. The research team, a nurse coordinator, and a cardiologist developed the content of the messages to include helpful suggestions on the management of risk factors and motivation based on references. Messages included knowledge about blood pressure, lifestyle modifications and information on physical activity, dietary sodium reduction, normal blood pressure, complications of hypertension, healthy diet, smoking cessation, weight reduction, and strategies to cope with emotions. The messages also included suggestions for measures to improve adherence. Over 3 months, patients received 30 messages.

Those in the control group received a welcome text message and an end-of-trial message but did not have a personal consultation. The participants were given standard pharmaceutical care.

The primary outcomes included a mean change of blood pressure, medication adherence, and knowledge about hypertension at baseline and month 3. An additional outcome was whether patients had controlled blood pressure.

Overall, 445 patients with hypertension were assessed and 61 were excluded. The mean age was 68.5 years old in the intervention group and 69.4 years old in the control group. The sample was primarily female (69%).

Those in the intervention group showed significant improvements in systolic blood pressure (mean 134.5 mm Hg vs mean 140.7 mm Hg; P=.001) and medication adherence (mean 7.4 vs mean 7; P=.04) compared to those in the control group. Participants in the intervention group also showed significant improvements in knowledge about hypertension (mean 6.3 vs mean 5.9; P=.004) compared to the control group.

There were nonsignificant improvements in diastolic blood pressure.

The investigators suggested the importance of maximizing the potential of text messaging and consultation by increasing the acceptance and feasibility of mobile interventions. A cost-effectiveness analysis should be conducted, they concluded.

The study, “Efficacy of Text Messaging and Personal Consultation by Pharmacy Students Among Adults With Hypertension: Randomized Controlled Trial,” was published online in the Journal of Medical Internet Research.