Smartphone App for Medication Adherence and BP Control

Study Questions:

Does the Medisafe smartphone app improve self-reported medication adherence and blood pressure (BP) control?

Methods:

This was a two-arm, randomized clinical trial (Medication Adherence Improvement Support App For Engagement—Blood Pressure [MedISAFE-BP]). Participants were recruited through an online platform and were mailed a home BP cuff to confirm eligibility and to provide follow-up measurements. Inclusion criteria included uncontrolled hypertension, taking 1-3 antihypertensive medications, and subjects were randomized in a ratio of 1:1 to intervention or control. Intervention arm participants were instructed to download and use the Medisafe app, which includes reminder alerts, adherence reports, and optional peer support. Co–primary outcomes were change from baseline to 12 weeks in self-reported medication adherence, measured by the Morisky medication adherence scale (MMAS) (range 0-8, with lower scores indicating lower adherence), and change in systolic blood pressure (sBP).

Results:

Participants (n = 411; 209 in the intervention group and 202 controls) had a mean age of 52.0 years and mean body mass index of 35.5 kg/m2; 247 (60%) were female, and 103 (25%) were black. After 12 weeks, the mean (standard deviation [SD]) score on the MMAS improved by 0.4 (1.5) among intervention participants and remained unchanged among controls (between-group difference, 0.4; 95% confidence interval [CI], 0.1-0.7). The mean (SD) sBP at baseline was 151.4 (9.0) mm Hg and 151.3 (9.4) mm Hg, among intervention and control participants, respectively. After 12 weeks, the mean (SD) sBP decreased by 10.6 (16.0) mm Hg among intervention participants and 10.1 (15.4) mm Hg among controls (between-group difference, −0.5; 95% CI, −3.7 to 2.7; p = 0.78).

Conclusions:

Among individuals with poorly controlled hypertension, patients randomized to use a smartphone app had a small improvement in self-reported medication adherence, but no change in sBP compared with controls.

Perspective:

The availability of smartphone health apps has expanded quickly, with a recent study showing 160 medication adherence–specific health apps. While coaching for weight loss with internet apps is generally effective, it is surprising that this internet-based intervention was not. The study provides evidence for physicians and other health care providers to be certain that such recommendations are evidence based.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Hypertension

Keywords: Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Body Mass Index, Hypertension, Internet, Medication Adherence, Metabolic Syndrome X, Mobile Applications, Primary Prevention, Weight Loss


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