The SMASH mHealth program significantly improved blood pressure control at 6 months compared to standard care among African American and Hispanic patients (94.4% vs 41.2%; p<0.003).
RCT (n=38)
Does an mHealth medication regimen self-management program improve blood pressure control in African American and Hispanic patients with uncontrolled hypertension?
A theory-guided mHealth self-management program significantly improved blood pressure control over 6 months in a minority population with uncontrolled hypertension.
Absolute Event Rate: 94.4% vs 41.2%
p-value: p=< 0.003
African Americans and Hispanics have disproportionate rates of uncontrolled essential hypertension (EH) compared to Non-Hispanic Whites. Medication non-adherence (MNA) is the leading modifiable behavior to improved blood pressure (BP) control. The Smartphone Medication Adherence Stops Hypertension (SMASH) program was developed using a patient-centered, theory-guided, iterative design process. Electronic medication trays provided reminder signals, and Short Message Service SMS messaging reminded subjects to monitor BP with Bluetooth-enabled monitors. Motivational and reinforcement text messages were sent to participants based upon levels of adherence. Thirty-eight African-American (18) and Hispanic (20) uncontrolled hypertensives completed clinic-based anthropometric and resting BP evaluations prior to randomization, and again at months 1, 3 and 6. Generalized linear mixed modeling (GLMM) revealed statistically significant time-by-treatment interactions (p < 0.0001) indicating significant reductions in resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) for the SMASH group vs. the standard care (SC) control group across all time points. 70.6% of SMASH subjects vs. 15.8% of the SC group reached BP control (< 140/90 mmH) at month 1 (p < 0.001). At month 6, 94.4% of the SMASH vs. 41.2% of the SC group exhibited controlled BP (p < 0.003). Our findings provide encouraging evidence that efficacious mHealth, chronic disease, medical regimen, self-management programs can be developed following principles of patient-centered, theory-guided design.
Davidson et al. (2015) conducted an RCT in uncontrolled essential hypertension (n=38). Smartphone Medication Adherence Stops Hypertension (SMASH) program vs. standard care was evaluated on BP control (< 140/90 mmH) at month 6 (p=< 0.003). The SMASH mHealth program significantly improved blood pressure control at 6 months compared to standard care among African American and Hispanic patients (94.4% vs 41.2%; p<0.003).