Text Messaging to Improve Hypertension Medication Adherence in African Americans

Hypertension is the leading cause of cardiovascular disease worldwide, and particularly burdensome for African Americans who are more susceptible to the condition than other racial groups. Despite evidence that medication can reduce the risk of myocardial infarction and stroke, only about half of patients diagnosed in the United States adhere to the use of medication to control their hypertension.

Mobile phones and text messages have become widely integrated into daily life, and may offer a simple way to enhance medication adherence as compared to traditional methods. This project developed and assessed an automated text message system named BPMED to improve medication management by helping people self-monitor adherence through reminders. The system was assessed among African Americans with uncontrolled hypertension, and included their perceptions of intervention effectiveness and satisfaction. It was theorized that individuals who used BPMED would have improved medication adherence, medication self efficacy, and blood pressure control.

The specific aims of this project were as follows:

• Utilize patient participant feedback in the development of a mobile phone text message system to improve adherence to antihypertensive medications. 
• Understand the effect of the newly developed text message system on changes in medication adherence, medication self-efficacy, and blood pressure from baseline to 1-month followup in African Americans with uncontrolled hypertension. 
• Assess participant perceptions of intervention effectiveness and satisfaction in order to guide further system refinement. 

Based on formative research, BPMED was developed to provide daily automated text message medication reminders at a time chosen by the participant over a 1-month intervention period. It also included eight educational messages based on hypertension management recommendations from the American Heart Association. Finally, a single-item weekly questionnaire asked participants to rate their satisfaction with BPMED.

A randomized controlled trial compared patients using BPMED to those receiving usual care. The results showed slight improvements in medication adherence and blood pressure after 1 month; however, the differences between the groups were not significant. Despite this, participants reported overwhelming satisfaction with BPMED, perceptions of greater adherence to antihypertensive medication regimens, and perceptions of overall health improvement. The research team hypothesized that the non-significant findings were largely attributed to the short trial and small sample size and recommended a longer-term and larger-scale randomized control trial of the BPMED be conducted.