mHealth Intervention to Improve Hypertension Care in High-Risk Patients

BACKGROUND: The mGlide RCT (randomized controlled trial) evaluated whether a pharmacist-led, mobile health technology facilitated care model improves hypertension control in diverse populations. METHODS: We recruited adult English, Spanish, or Hmong-speaking patients with uncontrolled hypertension from a large health care system and smaller community clinics serving low-income patients. Participants were randomized 1:1 to mGlide or usual care. The 6-month intervention included daily blood pressure (BP) self-monitoring using a smartphone and wireless monitor, automated app-based data sharing, and responsive medication adjustment by a pharmacist-led provider-team. Comparison participants received a digital monitor. Outcomes included mean 6-month systolic BP (SBP), 12-month sustained BP control, 24-hour ambulatory BP and patient activation. RESULTS: A total of 395 participants (mean age, 66.9 years; 46.6% women; mean [SD] SBP, 143.4 [16.5] mm Hg) were randomized to mGlide (n=198) or usual care (n=197). Mean (SD) 6-month SBP (mm Hg) was lower in the mGlide arm (128.1 [13.9] versus 134.0 [16.0]). The adjusted mean difference between groups for the primary outcome of 6-month SBP favored mGlide: −5.8 mm Hg (95% CI, −8.6 to −3.0), sustained at 12 months (−5.7 mm Hg [−8.7 to −2.6]). The mGlide arm also had a 4.8 mm Hg ( P =0.014) lower 24-hour average ambulatory SBP. The 6-month intervention effect varied significantly by activation level, with a difference of −12.6 mm Hg (−20.5 to −4.8) SBP among the lowest versus −2.5 mm Hg (−6.5 to 1.6) among the highest activation level participants. CONCLUSIONS: A mobile health-facilitated care model with pharmacist-led medication adjustment was effective in lowering BP in diverse populations. Patients with low activation benefited more from the intervention; activation levels may inform efficient intervention selection. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03612271.