Buis Lorraine, Hirzel Lindsey, Dawood Rachelle M, Dawood Katee L, Nichols Lauren P, Artinian Nancy T, Schwiebert Loren, Yarandi Hossein N, Roberson Dana N, Plegue Melissa A, Mango LynnMarie C, Levy Phillip D
Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.
College of Nursing, Wayne State University, Detroit, MI, United States.
JMIR Mhealth Uhealth. 2017 Feb 1;5(2):e9. doi: 10.2196/mhealth.6630.
Hypertension (HTN) is an important problem in the United States, with an estimated 78 million Americans aged 20 years and older suffering from this condition. Health disparities related to HTN are common in the United States, with African Americans suffering from greater prevalence of the condition than whites, as well as greater severity, earlier onset, and more complications. Medication adherence is an important component of HTN management, but adherence is often poor, and simply forgetting to take medications is often cited as a reason. Mobile health (mHealth) strategies have the potential to be a low-cost and effective method for improving medication adherence that also has broad reach.
Our goal was to determine the feasibility, acceptability, and preliminary clinical effectiveness of BPMED, an intervention designed to improve medication adherence among African Americans with uncontrolled HTN, through fully automated text messaging support.
We conducted two parallel, unblinded randomized controlled pilot trials with African-American patients who had uncontrolled HTN, recruited from primary care and emergency department (ED) settings. In each trial, participants were randomized to receive either usual care or the BPMED intervention for one month. Data were collected in-person at baseline and one-month follow-up, assessing the effect on medication adherence, systolic and diastolic blood pressure (SBP and DBP), medication adherence self-efficacy, and participant satisfaction. Data for both randomized controlled pilot trials were analyzed separately and combined.
A total of 58 primary care and 65 ED participants were recruited with retention rates of 91% (53/58) and 88% (57/65), respectively. BPMED participants consistently showed numerically greater, yet nonsignificant, improvements in measures of medication adherence (mean change 0.9, SD 2.0 vs mean change 0.5, SD 1.5, P=.26), SBP (mean change -12.6, SD 24.0 vs mean change -11.3, SD 25.5 mm Hg, P=.78), and DBP (mean change -4.9, SD 13.1 mm Hg vs mean change -3.3, SD 14.3 mm Hg, P=.54). Control and BPMED participants had slight improvements to medication adherence self-efficacy (mean change 0.8, SD 9.8 vs mean change 0.7, SD 7.0) with no significant differences found between groups (P=.92). On linear regression analysis, baseline SBP was the only predictor of SBP change; participants with higher SBP at enrollment exhibited significantly greater improvements at one-month follow-up (β=-0.63, P<.001). In total, 94% (51/54) of BPMED participants agreed/strongly agreed that they were satisfied with the program, regardless of pilot setting.
Use of text message reminders to improve medication adherence is a feasible and acceptable approach among African Americans with uncontrolled HTN. Although differences in actual medication adherence and blood pressure between BPMED and usual care controls were not significant, patterns of improvement in the BPMED condition suggest that text message medication reminders may have an effect and fully powered investigations with longer-term follow-up are warranted.
Clinicaltrials.gov NCT01465217; https://clinicaltrials.gov/ct2/show/NCT01465217 (Archived by WebCite at http://www.webcitation.org/6V0tto0lZ).
高血压（HTN）在美国是一个重要问题，据估计，年龄在20岁及以上的7800万美国人患有这种疾病。在美国，与高血压相关的健康差异很常见，非裔美国人患这种疾病的患病率高于白人，而且病情更严重，发病更早，并发症更多。药物依从性是高血压管理的一个重要组成部分，但依从性往往很差，忘记服药常常被认为是一个原因。移动健康（mHealth）策略有可能成为一种低成本且有效的改善药物依从性的方法，而且覆盖面广。
我们的目标是确定BPMED的可行性、可接受性和初步临床效果，BPMED是一种旨在通过全自动短信支持来提高未控制高血压的非裔美国人药物依从性的干预措施。
我们对从初级保健和急诊科招募的未控制高血压的非裔美国患者进行了两项平行、非盲的随机对照试验。在每项试验中，参与者被随机分配接受为期一个月的常规护理或BPMED干预。在基线和一个月随访时亲自收集数据，评估对药物依从性、收缩压和舒张压（SBP和DBP）、药物依从性自我效能和参与者满意度的影响。对两项随机对照试验的数据分别进行分析并合并。
共招募了58名初级保健参与者和65名急诊科参与者，保留率分别为91%（53/58）和88%（57/65）。BPMED参与者在药物依从性（平均变化0.9，标准差2.0对平均变化0.5，标准差1.5，P = 0.26）、收缩压（平均变化-12.6，标准差24.0对平均变化-11.3，标准差25.5 mmHg，P = 0.78）和舒张压（平均变化-4.9，标准差13.1 mmHg对平均变化-3.3，标准差14.3 mmHg，P = 0.54）测量方面始终显示出数值上更大但不显著的改善。对照组和BPMED参与者在药物依从性自我效能方面有轻微改善（平均变化0.8，标准差9.8对平均变化0.7，标准差7.0），组间无显著差异（P = 0.92）。在线性回归分析中，基线收缩压是收缩压变化的唯一预测因素；入组时收缩压较高的参与者在一个月随访时改善显著更大（β = -0.63，P < 0.001）。总体而言，94%（51/54）的BPMED参与者同意/强烈同意他们对该项目满意，无论试验设置如何。
使用短信提醒来提高药物依从性对于未控制高血压的非裔美国人是一种可行且可接受的方法。尽管BPMED与常规护理对照组在实际药物依从性和血压方面的差异不显著，但BPMED组的改善模式表明短信药物提醒可能有效果，有必要进行更长期随访的充分有力的研究。
Clinicaltrials.gov NCT01465217；https://clinicaltrials.gov/ct2/show/NCT01465217（由WebCite存档于http://www.webcitation.org/6V0tto0lZ）
