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

Abstract

BackgroundAlthough 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.ObjectiveThe 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.MethodsWe 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.ResultsAfter 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.ConclusionsEpxHypertension 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.

Text Messaging and Home Blood Pressure Monitoring for Patients with Uncontrolled Hypertension: Proposal for a Feasibility Pilot Randomized Controlled Trial

“…Preliminary studies have shown that SMS text messaging and HBPM can be effective in promoting medication adherence and BP control [8][9][10][11]. When HBPM is used in the surveillance of hypertension, it is more cost effective than office visits in the long run, as it reduces the number of unnecessary return visits and antihypertensive drugs administered to chronic users [12].…”

An alternative method of biomedical signal transmission through the GSM voice channel

“…Although using the GPRS channel eases the transmission (due to the simplicity of implementation), the internet connection stability on a mobile device varies with location, and disconnections from the internet may occur more often than a voice call. Another method to send the data in specified time intervals is via short message service (SMS) [4,[6][7][8][9][10]. However, SMS-based data transmission does not support any continuous connection and data are transmitted at some certain intervals [11].…”