Bobrow Kirsten, Farmer Andrew J, Springer David, Shanyinde Milensu, Yu Ly-Mee, Brennan Thomas, Rayner Brian, Namane Mosedi, Steyn Krisela, Tarassenko Lionel, Levitt Naomi
From Institute of Biomedical Engineering, Department of Engineering Science (K.B., D.S., T.B., L.T.) and Nuffield Department of Primary Care Health Sciences (K.B., A.J.F., M.S., L.-M.Y.), University of Oxford, UK; Chronic Disease Initiative for Africa, Cape Town, South Africa (K.B., K.S., N.L.); Division of Nephrology and Hypertension, Groote Schuur Hospital, Cape Town, South Africa (B.R.); University of Cape Town, South Africa (B.R.); Western Cape Province Department of Health, Cape Town, South Africa (M.N.); and Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, South Africa (N.L., K.B.).
Circulation. 2016 Feb 9;133(6):592-600. doi: 10.1161/CIRCULATIONAHA.115.017530. Epub 2016 Jan 14.
We assessed the effect of automated treatment adherence support delivered via mobile phone short message system (SMS) text messages on blood pressure.
In this pragmatic, single-blind, 3-arm, randomized trial (SMS-Text Adherence Support [StAR]) undertaken in South Africa, patients treated for high blood pressure were randomly allocated in a 1:1:1 ratio to information only, interactive SMS text messaging, or usual care. The primary outcome was change in systolic blood pressure at 12 months from baseline measured with a validated oscillometric device. All trial staff were masked to treatment allocation. Analyses were intention to treat. Between June 26, 2012, and November 23, 2012, 1372 participants were randomized to receive information-only SMS text messages (n=457), interactive SMS text messages (n=458), or usual care (n=457). Primary outcome data were available for 1256 participants (92%). At 12 months, the mean adjusted change in systolic blood pressure compared with usual care was -2.2 mm Hg (95% confidence interval, -4.4 to -0.04) with information-only SMS and -1.6 mm Hg (95% confidence interval, -3.7 to 0.6) with interactive SMS. Odds ratios for the proportion of participants with a blood pressure <140/90 mm Hg were 1.42 (95% confidence interval, 1.03-1.95) for information-only messaging and 1.41 (95% confidence interval, 1.02-1.95) for interactive messaging compared with usual care.
In this randomized trial of an automated adherence support program delivered by SMS text message in a general outpatient population of adults with high blood pressure, we found a small reduction in systolic blood pressure control compared with usual care at 12 months. There was no evidence that an interactive intervention increased this effect.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02019823. South African National Clinical Trials Register, number SANCTR DOH-27-1212-386; Pan Africa Trial Register, number PACTR201411000724141.
我们评估了通过手机短信系统（SMS）发送的自动治疗依从性支持对血压的影响。
在南非进行的这项实用、单盲、三臂随机试验（短信依从性支持[StAR]）中，高血压患者按1:1:1的比例随机分配至仅接收信息、交互式短信或常规护理组。主要结局是使用经过验证的示波装置测量的12个月时收缩压相对于基线的变化。所有试验人员均对治疗分配情况不知情。分析采用意向性分析。在2012年6月26日至2012年11月23日期间，1372名参与者被随机分配接受仅信息短信（n = 457）、交互式短信（n = 458）或常规护理（n = 457）。1256名参与者（92%）有主要结局数据。在12个月时，与常规护理相比，仅信息短信组收缩压的平均调整变化为-2.2 mmHg（95%置信区间，-4.4至-0.04），交互式短信组为-1.6 mmHg（95%置信区间，-3.7至0.6）。与常规护理相比，收缩压<140/90 mmHg的参与者比例的优势比，仅信息短信组为1.42（95%置信区间，1.03 - 1.95），交互式短信组为1.41（95%置信区间，1.02 - 1.95）。
在这项针对成年高血压普通门诊患者通过短信提供自动依从性支持项目的随机试验中，我们发现与常规护理相比，12个月时收缩压控制有小幅降低。没有证据表明交互式干预会增强这种效果。
网址：http://www.clinicaltrials.gov。唯一标识符：NCT02019823。南非国家临床试验注册，编号SANCTR DOH - 27 - 1212 - 386；泛非试验注册，编号PACTR201411000724141。
