What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=174). Intervention: EpxHypertension (SMS and phone-based system). Primary outcome: Change in systolic blood pressure at 12 weeks for patients with baseline SBP ≥140 mm Hg (95% CI -14.5 to -7.2, p=<.001).

July 27, 2017Open Access

Assessing the Utility of a Novel SMS- and Phone-Based System for Blood Pressure Control in Hypertensive Patients: Feasibility Study

Q: What are the key findings of this study?

EpxHypertension reduced systolic blood pressure by 10.8 mm Hg over 12 weeks in patients with a baseline systolic blood pressure of 140 mm Hg or higher.

Key Result

EpxHypertension reduced systolic blood pressure by 10.8 mm Hg over 12 weeks in patients with a baseline systolic blood pressure of 140 mm Hg or higher.

Study Design

Type

Cohort (n=174)

Multicenter

Structured PICO

Does an automated SMS- and phone-based system reduce blood pressure in patients with hypertension?

Population

174 patients diagnosed with hypertension from a community clinic in St Louis

Intervention

Epharmix's EpxHypertension, an automated call or text messaging system to monitor patient-reported blood pressures with physician notification for elevated readings, used for 12 weeks

Outcome

Change in mean systolic and diastolic blood pressures at 12 weekssurrogate

An automated SMS- and phone-based blood pressure monitoring system is feasible and associated with significant blood pressure reductions in patients with uncontrolled baseline hypertension.

Main Result

p-value: p=<.001

Limitations

No standard-of-care comparison group
Baseline demographic data were not collected
All data were self-reported
Patients used their own home BP monitors without additional training
Did not delineate specifically how providers responded to the new information

Abstract

BACKGROUND: Although hypertension (HTN) is a major modifiable risk factor for arterial damage, blood pressure (BP) remains poorly controlled in the hypertensive population. Telemedicine is a promising adjunct intervention that may complement traditional therapies and improve adherence rates; however, current approaches have multiple barriers to entry, including the use of relatively expensive Bluetooth devices or the dependence on smart phone utilization, which tend to exclude low-income and more elderly populations. OBJECTIVE: The aim of this study was to design and implement a new phone call- and short message service text messaging-based intervention, Epharmix's EpxHypertension, in a quality improvement project that demonstrates the feasibility of this system for BP control in a family medicine setting. METHODS: We recruited 174 patients from a community clinic in St Louis from a database of patients diagnosed with HTN. An automated call or text messaging system was used to monitor patient-reported BPs. If determined to be elevated, physicians were notified by an email, text, or electronic medical record alert. Mean systolic BPs (SBPs) and diastolic BPs (DBPs) were compared at the beginning and end of 12 weeks. RESULTS: After 12 weeks on the system, patients with a baseline SBP of 140 mm Hg or higher reduced SBP by 10.8 mm Hg (95% CI -14.5 to -7.2, P<.001) and DBP by 6.6 mm Hg (95% CI -9.9 to -3.4, P=.002), but no significant changes were observed in overall BPs and BPs in the group with baseline SBP less than 140 mm Hg. CONCLUSIONS: EpxHypertension provides a viable means to control HTN in patients with high baseline BPs despite previous therapy. This community implementation study demonstrates the feasibility of implementing EpxHypertension across a primary care setting without the need for smartphones or Bluetooth-linked BP cuffs. Future studies should evaluate its effectiveness in a randomized control trial compared with standard of care.

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