Automated text reminders to take blood pressure medications do not improve hypertension control

Reference

Mehta SJ, Volpp KG, Troxel AB, et al. Electronic pill bottles or bidirectional text messaging to improve hypertension medication adherence (Way 2 Text): a randomized clinical trial. J Gen Intern Med 2019;34(11):2397-2404.

Synopsis

These investigators enrolled 151 adults with hypertension and out-of-range blood pressure measurements at the time of enrollment (average = 152 mmHg systolic) and at least one previous visit. The patients were randomized (allocation concealment uncertain) to continue with usual care or to receive 1 of 2 types of reminder. One reminder system consisted of a wireless pill bottle (AdhereTech) that monitored opening of the bottle and transmitted results to a central monitoring system. The system then sent a text to the patient the next day praising them (for opening the bottle) or admonishing them (if they didn't open the bottle) and prompting them to take the medication that day. The second reminder system consisted of a text asking patients to respond with whether or not they took their medicine that day. After 4 months, patients returned to their doctor for blood pressure measurement. As compared with the start of the study, systolic blood pressures dropped 4.7 mmHg in usual care group, 4.3 mmHg in the pill bottle group, and 4.6 mmHg in the text group, with no statistical differences with the reminders. Medication adherence in the reminder groups was less than 80%. Still, most patients liked the reminders and stated they would recommend them to others who are prescribed antihypertensives. The study had the power to find a 3.75 mmHg difference in blood pressure control if one existed.