The SMASH smartphone-enabled self-management program significantly reduced systolic blood pressure compared to enhanced standard care at 9 months (121.8 vs. 145.7 mmHg; p<0.01).
RCT (n=54)
randomly assigned
Does a culturally tailored smartphone-enabled medical regimen self-management program reduce systolic blood pressure in Hispanic adults with uncontrolled hypertension?
A culturally tailored smartphone-enabled self-management program significantly improved systolic blood pressure control and medication adherence over 9 months in Hispanic adults with uncontrolled hypertension.
Absolute Event Rate: 121.8% vs 145.7%
p-value: p=<0.01
Background: Uncontrolled hypertension (HTN) and medication nonadherence are more prominent among Hispanics compared to non-Hispanic whites and African Americans. Advances in wireless health technology enable real-time monitoring of medication adherence (MA) and blood pressure (BP), facilitating timely patient–provider communication including tailored reinforcement/motivational feedback to patients and quicker titration changes by providers. The purpose of the current study was to conduct a 9-month smartphone-enabled efficacy trial addressing MA and BP control among Hispanic adults with uncontrolled HTN and poor MA. Methods: The research design was a 9-month, two-arm efficacy trial including an experimental (Smartphone Med Adherence Stops Hypertension, SMASH) group and an enhanced standard care (ESC) group. SMASH participants utilized a SMASH app which interfaced with a Bluetooth-enabled BP monitor for BP self-monitoring and an electronic medication tray. The ESC participants received text messages including links to PDFs and brief video clips containing healthy lifestyle tips for attention control. Results: Participants were 54 Hispanic adults (mean age: 46.5 years) with uncontrolled HTN. They were randomly assigned to either the SMASH (n = 26) or ESC group (n = 28). At baseline, no participants had controlled systolic BP (SBP). Baseline group averages for SBP between the SC and SMASH groups did not differ (150.7 and 152.3 mmHg, respectively; p = 0.53). At the 1, 3, 6, and 9-month time points, SBP averages were significantly lower in the SMASH versus SC groups (month 1: 125.3 vs. 140.6; month 3: 120.4 vs. 137.5, month 6: 121.2 vs. 145.7 mmHg; month 9: 121.8 vs. 145.7, respectively; all p-values <0.01). At months 3, 6, and 9 there was a significant difference between the percentage of participants meeting the 7th Joint National Committee cutoffs for SBP control in the SC and SMASH groups (month 3: 62.5 vs. 92.0%; month 6: 57.9 and 94.4%, month 9: 27.8 and 92.3%, respectively; all p-values ≤0.01). Average medical regimen adherence, as indicated by timestamped medication intake and BP monitoring for the SMASH group, ranged from 89.1 to 95.2% across the 9-month trial. Conclusion: Our findings indicate that our culturally tailored smartphone-enabled medical regimen self-management program may be an effective solution for the promotion of MA, resulting in statistically and clinically significant reductions in SBP among Hispanic adults with uncontrolled HTN.
Chandler et al. (2019) conducted an RCT in uncontrolled hypertension (n=54). Smartphone Med Adherence Stops Hypertension (SMASH) program vs. Enhanced standard care (ESC) was evaluated on Systolic blood pressure at 9 months (mmHg) (p=<0.01). The SMASH smartphone-enabled self-management program significantly reduced systolic blood pressure compared to enhanced standard care at 9 months (121.8 vs. 145.7 mmHg; p<0.01).