JMIR Publications

ABSTRACT

Background:

Hypertension is one of the leading risk factors for ischemic heart diseases and the problem is more severe in developing countries. Unfortunately, about 20% to 50% of patients with chronic diseases have been non-adherent to their drug therapy. Short message service (SMS) and pharmacy student leading consultation has the potential to help patients manage their blood pressure (BP).

Objective:

Our intention was to assess the effectiveness, feasibility and acceptability of SMS and consultation to manage BP among Chinese hypertensive patients.

Methods:

We conducted two-arm cluster randomized controlled trial among hypertensive patients in Xi’an City, Shaanxi Province, China and recruited 384 patients from 8 community health-care centers (CHCs). Patients were randomized into intervention group to be intervened by SMS and consultation or control group to receive usual care for 3 months. We sent SMS at 3-day intervals and collected data which included demographics, clinical outcomes, medication complexity, side effects, patient behavior, knowledge, BP and medication adherence at baseline and BP, medication adherence and knowledge at 3-month follow-up.

Results:

We assessed 445 hypertensive patients and excluded 61 patients who were not eligible or not filled out their questionnaires. The mean age of patients was 68.5 years (SD 7.9) in the intervention group and 69.4 years (SD 9.7) in the control group and the sample was primarily female (69.0%, 265/384). Patients in the intervention group showed significant improvements in systolic blood pressure (SBP) (mean 134.5 mmHg, SD 15.5 vs. mean 140.7 mmHg, SD 15.2, P=0.001), medication adherence (mean 7.4, SD 1.2 vs. mean 7, SD 1.3, P=0.04) and knowledge (mean 6.3, SD 0.9 vs. mean 5.9, SD 1.2, P=0.004). In measures of diastolic blood pressure (DBP), the two arms showed non-significant improvements (mean 78.2 mmHg, SD 9.0 vs. mean 77.2 mmHg, SD 10.3, P=0.51). In total, 176 patients had controlled BP at three-month follow-up (98 in intervention group vs. 78 in control group), but it was non-significant (P=0.08).

Conclusions:

Use of SMS and consultation to manage SBP and improve medication adherence is effective, feasible and acceptable among Chinese hypertensive patients, although significant difference was not observed in terms of DBP. It is important to maximize the potential of SMS and consultation by increasing the feasibility and acceptance of mobile interventions and conduct cost-effectiveness analysis on this method.