Specific hypertension smartphone application to improve medication adherence in hypertension: a cluster-randomized trial

• Published in: Current medical research and opinion 2019-01, Vol.35 (1), p.167-173
• Main Authors: Márquez Contreras, Emilio, Márquez Rivero, Sara, Rodríguez García, Elizabeth, López-García-Ramos, Lourdes, Carlos Pastoriza Vilas, José, Baldonedo Suárez, Agueda, Gracia Diez, Carmen, Gil Guillén, Vicente, Martell Claros, Nieves
• Format: Article
• Language: English
• Subjects: Aged; Antihypertensive Agents - therapeutic use; drug adherence; Female; Humans; Hypertension; Hypertension - drug therapy; Male; Medication Adherence; Middle Aged; Mobile Applications; Prospective Studies; Smartphone; smartphone app
• ISSN: 0300-7995; 1473-4877
• DOI: 10.1080/03007995.2018.1549026

Introduction: Digital interventions, such as smartphone applications (apps), are becoming an increasingly common way to support medication adherence and self-management in chronic illness. Aim: To evaluate the effectiveness of the intervention in pharmacological therapeutic adherence in mild to moderate arterial hypertension (AHT), through an app installed on a mobile phone, as well as the degree of control reached by the patient with this tool. Methods: Prospective, randomized controlled trial, full study and multicenter study. Four primary care centers participated. One hundred and fifty-four hypertensive patients under antihypertensive treatment were included. Two groups were established: a control group (CG) with usual intervention (n = 77) and an intervention group (n = 77) (IG), targeting hypertensive people who owned and regularly used a mobile smartphone, specifically using the app called AlerHTA to promote health education and reminder of appointments. There were three visits: initial, 6 and 12 months. Drug adherence was measured by electronic monitors (MEMSs). The primary outcomes were average daily percentage adherence between 80 and 100%, and AHT control. Results: A total of 148 patients finished the study. Mean age was 57.5 ± 9.9. Global adherence was 77.02% (CI = 70.25-83.79) and daily adherence was 74.32% (CI = 67.29-81.35%). Daily adherence was 93.15% and 86.3% in IG, and 70.66% and 62.66% in CG after 6 and 12 months respectively (p < .05). The percentage of uncontrolled patients was 28.3% (CI = 21.05-35.55%). The control of high blood pressure at 12 months was 17.8% and 38.6% for IG and CG respectively (p < .05). The number of patients needed to treat to avoid non-adherence (NNT) was 4.23 patients. Conclusions: The intervention with an app installed on the mobile phones of hypertensive patients favors pharmacological therapeutic adherence and improves the percentage of hypertensive patient control. Trial registration: Spanish Agency of Medicine: EPA-SP UN-HTA-2015-01.