Automated Text Message-Based Program to Improve Uncontrolled Blood Pressure in Primary Care Patients: A Randomized Clinical Trial

• Published in: Journal of general internal medicine : JGIM 2024-12
• Main Authors: Bressman, Eric, Profka, Klea, Norton, Laurie, Clark, Kayla, Mahraj, Katy, Walker, Zakiya, Reid-Bey, Leslie, Girard, Anthony, Rareshide, Charles, Xu, Lin, Zhu, Jingsan, Putt, Mary, Volpp, Kevin G, Morgan, Anna U
• Format: Article
• Language: English
• ISSN: 0884-8734; 1525-1497; 1525-1497
• DOI: 10.1007/s11606-024-09225-4

Suboptimal control of BP is common, although safe and effective treatments are widely available. Conventional management relies on office visits, but this can be an inefficient path to medication optimization. To assess the effectiveness of an intensive, 6-month remote BP management program among patients with uncontrolled hypertension. A two-arm randomized clinical trial which ran from January to July 2023 at two primary care practices with an in-clinic BP measurement at the end of the intervention. Established adult patients (ages 21-80) of study practices with uncontrolled hypertension (two measurements > 140/90 in the prior 12 months) and an active prescription for at least one anti-hypertensive agent. Participants received automated text messages prompting them to check their BP weekly for 6 months. An RN and APP monitored BP data entered by the participant. The automated platform escalated any out-of-normal range readings or needs to the program staff. The primary outcome was change in SBP from baseline to the end-of-study measurement. Enrollment and engagement measures were collected for the intervention arm. Of the 300 participants, the mean (SD) age was 63 (± 12.2) years; 133 (44.3%) were male and 167 (55.7%) were female; 154 (51.5%) self-identified as Black and 120 (40.1%) White; and 119 (39.7%) were insured by Medicare and 41 (13.7%) by Medicaid. The change in SBP at 6 months among those who completed the end-of-study measurement was - 14.66 mmHg (95% CI - 19.95, - 9.36) in the intervention arm and - 10.87 mmHg (95% CI - 18.04, - 3.69) in the control arm (p = 0.39). Within the intervention arm, 97 participants (64.7%) completed all enrollment steps, and these participants submitted BPs 72.8% of the weeks. Participants in the intervention arm had a greater number of medication changes (0.81 vs 0.57 in the control arm, p = 0.01) over the study period. In this randomized clinical trial of a 6-month automated text messaging program, there was no significant difference in the change in SBP among participants in each arm. ClinicalTrials.gov Identifier: NCT05571410.