Text reminders aren’t enough to lower blood pressure

Texts and remote monitoring via electronic pill bottles help keep medication adherence high for people with hypertension, but appear to do nothing to lower blood pressure, a new study shows.

About one in three Americans have high blood pressure, called hypertension, but only about half of them have their condition under control. A main reason is that many don’t consistently take their prescriptions, leading to heart attack, stroke, and other poor health outcomes.

“We had experience with electronic pill bottles to monitor adherence in the past, but they were expensive and sometimes technically challenging to administer to patients,” says Shivan Mehta, associate chief innovation officer at Penn Medicine and an assistant professor of medicine.

“For this study, we hypothesized that bidirectional—two-way, conversational—text messaging could have similar functionality but with better user experience. However, we did not see a difference in blood pressure for either method.”

The study included nearly 150 patients who take medication for their high blood pressure across four Philadelphia primary care practices. Researchers split participants into three groups: one received standard of care, one received electronic pill bottles that monitored their medication adherence, and the third group received automated text messages asking about medication adherence. Groups two and three also received daily text messaging prompting them to take their medications.

The electronic pill bottles recorded every time patients opened them and then transmitted that data to the researchers using Penn Medicine’s Way to Health automated technology platform.

Each day, participants received one of two text messages: One congratulating them for taking their medication the previous day (if the bottle detected that patients opened it), or another acknowledging that they didn’t take their medication the previous day (if they didn’t open it). Both messages featured a reminder to take the medication that day.

Participants using two-way text messaging were asked to respond “yes” or “no” to whether they took their medication. Automated messages also either congratulated them for taking their medication the day before or acknowledged that they hadn’t.

Adherence to medication was high among the study’s participants, both hovering near 80%. Despite the extra methods, the researchers found that both blood pressure levels and rates of adherence to blood pressure medication remained similar to patients in the control group—those who didn’t have the electronic pill bottles or the texting.

The blood pressure levels might not have improved because adherence levels didn’t increase enough, Mehta says. It’s also possible that the patients may have needed higher doses of their medications or new medications.

The study appears in the Journal of General Internal Medicine.

Source: Penn