Randomized Pilot Study of a Behavioral Feedback Intervention to Improve Medication Adherence in Older Adults With Hypertension Using simple telehealth in primary care to reduce blood pressure: a service evaluation Take Control of Your Blood Pressure (TCYB) study: a multifactorial tailored behavioral and educational intervention for achieving blood pressure control. The Impact of a Multidisciplinary Information Technology–Supported Program on Blood Pressure Control in Primary Care Efficacy of a brief multifactorial adherence-based intervention in reducing blood pressure: a randomized clinical trial A multifaceted pharmacist intervention to improve antihypertensive adherence: a cluster-randomized, controlled trial (HAPPy trial). The veterans' study to improve the control of hypertension (V-STITCH): design and methodology. Text Messaging to Improve Hypertension Medication Adherence in African Americans From Primary Care and Emergency Department Settings: Results From Two Randomized Feasibility Studies Tailored Case Management for Diabetes and Hypertension (TEACH-DM) in a community population: study design and baseline sample characteristics. Patient education and provider decision support to control blood pressure in primary care: a cluster randomized trial. Improving Blood Pressure Control Through a Clinical Pharmacist Outreach Program in Patients With Diabetes Mellitus in 2 High-Performing Health Systems: The Adherence and Intensification of Medications Cluster Randomized, Controlled Pragmatic Trial Hypertension Intervention Nurse Telemedicine Study (HINTS): testing a multifactorial tailored behavioral/educational and a medication management intervention for blood pressure control. Electronic monitoring of adherence as a tool to improve blood pressure control. A randomized controlled trial. The Take Control of Your Blood pressure (TCYB) study: study design and methodology. Mobile Health Medication Adherence and Blood Pressure Control in Renal Transplant Recipients: A Proof-of-Concept Randomized Controlled Trial Evaluation of a pharmaceutical care program for hypertensive patients in rural Portugal. Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges
Background and Objectives : Older adults ' adherence to antihypertensive medications is far lower than what is considered necessary for clinical effectiveness , despite the risks for adverse cardiovascular events from uncontrolled blood pressure ( BP ) in the elderly . This pilot study tested a novel 8-week behavioral feedback intervention to improve antihypertensive medication adherence ( MA ) and BP control among older adults on existing treatment for hypertension . Methods : Adults 60 years old , or older taking at least 1 antihypertensive medication were r and omized to receive the nurse-delivered adherence intervention or usual care . Medication adherence was monitored continuously using electronic monitoring for 20 weeks . Intervention-group participants received biweekly MA and BP feedback , habit counseling , medication and disease education , a medication instruction card , and were given an electronic medication bottle cap with a digital display that provided daily adherence feedback during the 8-week intervention . Blood pressure was measured by a nurse at 12 and 20 weeks after r and omization . Adherence and BP outcomes were described using descriptive statistics and analyzed for between- and within-group differences using Mann-Whitney U tests . Results : Fifteen participants ( median age , 71 years ; 73 % female ) were eligible for r and omization . Participants took an average of 5.8 prescription medications and 2.93 over-the-counter medications per day . A nonsignificant difference was noted in baseline MA between groups . At the end of the intervention , the treatment group had better antihypertensive MA than did the control group ( median MA : 100 % vs 27.3 % , U = 5.00 , P = .013 ) . Systolic BP improved slightly in the intervention group during the study and was significantly different at week 12 ( median systolic BP : 130 vs 152 mm Hg ; U = 4.50 , P = .008 ) . Diastolic BP was largely unchanged over the course of the study . Conclusion : The results indicate that the intervention had a positive effect on MA . Additional testing is needed to further evaluate the intervention and its effect on adherence behavior and BP control Objectives This service evaluation examines how efficiently an innovative , simple and interactive blood pressure ( BP ) management intervention improves BP control in general practice . Design Prospect i ve service evaluation . Setting Ten volunteer general practitioner ( GP ) practice s in Stoke on Trent , UK . Participants Practice staff identified 124 intervention patients and invited them to participate based on two inclusion criteria : ( 1 ) patient has chronic kidney disease ( CKD ) stages 3 or 4 with BP persistently > 130/85 mm Hg or ( 2 ) patient is > 50 years-old ( without CKD stages 3–5 ) with BP persistently > 140/90 mm Hg despite prescribed antihypertensive medication . Three selected hypertensive control patients per intervention patient underwent usual clinical care ( n=364 ) . Interventions Intervention patients used ‘ Florence ’ , a simple , interactive mobile phone texting service with BP management intervention for 3 months , or for less time if their BP became controlled . Patients measured their BP , text their readings to Florence , received an immediate automatic response and had results review ed by their GP/ practice nurse at least weekly . Main outcome measures Baseline data including recent BP readings and medications were collected ; similar information was obtained for 6 months for both control and intervention patients . Average BP readings and medication usage were determined . Results At final data collection , five intervention patients had not yet completed the full programme . Control and intervention patients were well matched except that intervention patients had significantly greater baseline BP . Greatest BP reductions were among hypertensive intervention patients without CKD stages 3–5 . Intervention patients had significantly more BP readings and more changes in medication over the 3-month data collection period . Conclusions Simple telehealth is acceptable and effective in reducing patients ’ BP . In future , poorly controlled patients could be targeted to maximise BP reductions or broader use could improve diagnostic accuracy and accessibility for patients who struggle to regularly attend their GP surgery OBJECTIVE Evaluating a r and omized controlled trial involving a tailored behavioral intervention conducted to improve blood pressure control . METHODS Adults with hypertension from two outpatient primary care clinics were r and omly allocated to receive a nurse-administered behavioral intervention or usual care . In this ongoing study , patients receive the tailored behavioral intervention bi-monthly for 2 years via telephone ; the goal of the intervention is to promote medication adherence and improve hypertension-related health behaviors . Patient factors targeted in the tailored behavioral intervention include perceived risk of hypertension and knowledge , memory , medical and social support , patients ' relationship with their health care provider , adverse effects of medication therapy , weight management , exercise , diet , stress , smoking , and alcohol use . RESULTS The sample r and omized to the behavioral intervention consisted of 319 adults with hypertension ( average age=60.5 years ; 47 % African-American ) . A comparable sample of adults was assigned to usual care ( n=317 ) . We had a 96 % retention rate for the overall sample for the first 6 months of the study ( 93 % at 12 months ) . The average phone call has lasted 18min ( range 2 - 51min ) . From baseline to 6 months , self-reported medication adherence increased by 9 % in the behavioral group vs. 1 % in the non-behavioral group . CONCLUSION The intervention is easily implemented and is design ed to enhance adherence with prescribed hypertension regimen . The study includes both general and patient-tailored information based upon need assessment . The study design ensures internal validity as well as the ability to generalize study findings to the clinic setting s. PRACTICE IMPLICATION S Despite knowledge of the risks and acceptable evidence , a large number of hypertensive adults still do not have their blood pressure under effective control . This study will be an important step in evaluating a tailored multibehavioral intervention focusing on improving blood pressure control Background —Hypertension is a leading mortality risk factor yet inadequately controlled in most affected subjects . Effective programs to address this problem are lacking . We hypothesized that an information technology – supported management program could help improve blood pressure ( BP ) control . Methods and Results —This r and omized controlled trial included 223 primary care hypertensive subjects with mean 24-hour BP > 130/80 and daytime BP > 135/85 mm Hg measured with ambulatory monitoring ( ABPM ) . Intervention subjects received a BP monitor and access to an information technology – supported adherence and BP monitoring system providing nurses , pharmacists , and physicians with monthly reports . Control subjects received usual care . The mean ( ±SD ) follow-up was 348 ( ±78 ) and 349 ( ±84 ) days in the intervention and control group , respectively . The primary end point of the change in the mean 24-hour ambulatory BP was consistently greater in intervention subjects for both systolic ( −11.9 versus −7.1 mm Hg ; P<0.001 ) and diastolic BP ( −6.6 versus −4.5 mm Hg ; P=0.007 ) . The proportion of subjects that achieved Canadian Guideline target BP ( 46.0 % versus 28.6 % ) was also greater in the intervention group ( P=0.006 ) . We observed similar BP declines for ABPM and self-recorded home BP suggesting the latter could be an alternative for confirming BP control . The intervention was associated with more physician-driven antihypertensive dose adjustments or changes in agents ( P=0.03 ) , more antihypertensive classes at study end ( P=0.007 ) , and a trend toward improved adherence measured by prescription refills ( P=0.07 ) . Conclusions —This multidisciplinary information technology – supported program that provided feedback to patients and healthcare providers significantly improved blood pressure levels in a primary care setting Background Lowering blood pressure ( BP ) by antihypertensive ( AHT ) drugs reduces the risks of cardiovascular events , stroke , and total mortality . However , poor adherence to AHT medications reduces their effectiveness and increases the risk of adverse events . Objective To evaluate the effectiveness of a multifactorial adherence-based intervention in a primary care setting in lowering BP . Methods / design Multicenter parallel r and omized controlled trial . Thirty two nurses in 28 primary care centers of three Spanish regions . Patients aged 18–80 years , taking AHT drugs with uncontrolled BP ( n=221 ) were r and omized to a control group ( usual care ) or a multifactorial adherence-based intervention including nurse-led motivational interviews , pill reminders , family support , BP self-recording , and simplification of the dosing regimen by a pharmacist . Main outcome measures The primary outcome was 12-month blinded measure of systolic BP ( mean of three measurements ) . The secondary outcomes were 12-month diastolic BP and proportion of patients with adequately controlled BP . Results One hundred and fourteen patients were allocated to the intervention group and 109 to the control group . At 12 months , 212 ( 89 % ) participants completed the study . The systolic BP in the intervention group was 151.3 versus 153.7 in the control group ( P=0.294 ) . The diastolic BP did not differ between groups ( 83.4 versus 83.6 ) . Of the patients in the control group , 9.2 % achieved BP control versus a 15.8 % in the intervention group . The relative risk for achieving BP control was 1.72 ( 95 % confidence interval : 0.83–3.56 ) . Conclusion A multifactorial intervention based on improving adherence in patients with uncontrolled hypertension failed to find evidence of effectiveness in lowering systolic BP . Trial registration IS RCT N21229328 WHAT IS KNOWN AND OBJECTIVES About half of all patients taking antihypertensives discontinue treatment by 12 months . There is potential for substantial health gains at both individual and population levels through improved treatment adherence . The objective was to evaluate a community pharmacist intervention to improve adherence with antihypertensive medicines with a view to improving blood pressure ( BP ) control . METHODS DESIGN prospect i ve , non-blinded , cluster-r and omized , controlled trial . PARTICIPANTS adults with primary hypertension who obtained antihypertensives in the previous 6 months . Patients with poor refill adherence were preferentially identified with the help of a purpose -built software application . INTERVENTION package comprising BP monitor ; training on BP self-monitoring ; motivational interviewing ; medication use review ; prescription refill reminders . FOLLOW-UP six months . PRIMARY OUTCOME change in proportion self-reporting medication adherence . Secondary outcome : BP changes . RESULTS Participants ( n = 395 ; intervention - 207 ; control - 188 ) had a mean age of 66.7 years ; 51.1 % were males . The proportion of adherent participants increased in both groups but was not significantly different between groups [ 57·2 % to 63·6 % ( control ) vs. 60·0 % to 73·5 % ( intervention ) , P = 0·23 ] . The mean reduction in systolic BP was significantly greater in the intervention group ( 10·0 mmHg vs. 4·6 mmHg ; P = 0·05 ) . The proportion of patients who were non-adherent at baseline and adherent at 6 months was 22·6 % ( 95%CI 5·1 - 40·0 % ) higher in the intervention group ( 61·8 % vs. 39·2 % , P = 0·007 ) . Among participants with baseline  BP above target , reduction of systolic BP was significantly greater in the intervention group [ by 7·2 mmHg ( 95%CI 1·6 - 12·8 mmHg ) ; ( P = 0·01 ) ] . Among participants non-adherent at baseline and above target BP , the proportion reporting adherence at 6 months was significantly greater in the intervention group [ 56·8 % vs. 35·9 % , P = 0·039 ) . WHAT IS NEW AND CONCLUSION This community pharmacist intervention result ed in improved adherence to antihypertensive medication and reduced systolic BP BACKGROUND Among the 60 million Americans with hypertension , only approximately 31 % have their blood pressure ( BP ) under control ( < 140/90 mm Hg ) . Despite the damaging impact of hypertension and the availability of evidence -based target values for BP , interventions to improve BP control have had limited success . OBJECTIVES A r and omized controlled health services intervention trial with a split-plot design is being conducted to improve BP control . This 4-year trial evaluates both a patient and a provider intervention in a primary care setting among diagnosed hypertensive veterans . METHODS In a cluster-r and omization , 30 primary care providers in the Durham VAMC Primary Care Clinic were r and omly assigned to receive the provider intervention or control . The provider intervention is a patient-specific electronically generated hypertension decision support system ( DSS ) delivering guideline -based recommendations to the provider at each patient 's visit , design ed to improve guideline -concordant therapy . For these providers , a sample of their hypertensive patients ( n=588 ) was r and omly assigned to receive a telephone-administered patient intervention or usual care . The patient intervention incorporates patients ' need assessment s and involves tailored behavioral and education modules to promote medication adherence and improve specific health behaviors .  All modules are delivered over the telephone bi-monthly for 24 months . In this trial , the primary outcome is the proportion of patients who achieve a BP < or = 140/90 mm Hg at each outpatient clinic visit over 24 months . CONCLUSION Despite the known risk of poor BP control , a majority of adults still do not have their BP controlled . This study is an important step in testing the effectiveness of a patient and provider intervention to improve BP control among veterans in the primary care setting Background Hypertension ( HTN ) is an important problem in the United States , with an estimated 78 million Americans aged 20 years and older suffering from this condition . Health disparities related to HTN are common in the United States , with African Americans suffering from greater prevalence of the condition than whites , as well as greater severity , earlier onset , and more complications . Medication adherence is an important component of HTN management , but adherence is often poor , and simply forgetting to take medications is often cited as a reason . Mobile health ( mHealth ) strategies have the potential to be a low-cost and effective method for improving medication adherence that also has broad reach . Objective Our goal was to determine the feasibility , acceptability , and preliminary clinical effectiveness of BPMED , an intervention design ed to improve medication adherence among African Americans with uncontrolled HTN , through fully automated text messaging support . Methods We conducted two parallel , unblinded r and omized controlled pilot trials with African-American patients who had uncontrolled HTN , recruited from primary care and emergency department ( ED ) setting s. In each trial , participants were r and omized to receive either usual care or the BPMED intervention for one month . Data were collected in-person at baseline and one-month follow-up , assessing the effect on medication adherence , systolic and diastolic blood pressure ( SBP and DBP ) , medication adherence self-efficacy , and participant satisfaction . Data for both r and omized controlled pilot trials were analyzed separately and combined . Results A total of 58 primary care and 65 ED participants were recruited with retention rates of 91 % ( 53/58 ) and 88 % ( 57/65 ) , respectively . BPMED participants consistently showed numerically greater , yet nonsignificant , improvements in measures of medication adherence ( mean change 0.9 , SD 2.0 vs mean change 0.5 , SD 1.5 , P=.26 ) , SBP ( mean change –12.6 , SD 24.0 vs mean change –11.3 , SD 25.5 mm Hg , P=.78 ) , and DBP ( mean change –4.9 , SD 13.1 mm Hg vs mean change –3.3 , SD 14.3 mm Hg , P=.54 ) . Control and BPMED participants had slight improvements to medication adherence self-efficacy ( mean change 0.8 , SD 9.8 vs mean change 0.7 , SD 7.0 ) with no significant differences found between groups ( P=.92 ) . On linear regression analysis , baseline SBP was the only predictor of SBP change ;  participants with higher SBP at enrollment exhibited significantly greater improvements at one-month follow-up ( β=–0.63 , P<.001 ) . In total , 94 % ( 51/54 ) of BPMED participants agreed/strongly agreed that they were satisfied with the program , regardless of pilot setting . Conclusions Use of text message reminders to improve medication adherence is a feasible and acceptable approach among African Americans with uncontrolled HTN . Although differences in actual medication adherence and blood pressure between BPMED and usual care controls were not significant , patterns of improvement in the BPMED condition suggest that text message medication reminders may have an effect and fully powered investigations with longer-term follow-up are warranted . Trial Registration Clinical trials.gov NCT01465217 ; https:// clinical trials.gov/ct2/show/NCT01465217 ( Archived by WebCite at http://www.webcitation.org/6V0tto0lZ ) BACKGROUND Despite recognition of the benefits associated with well-controlled diabetes and hypertension , control remains suboptimal . Effective interventions for these conditions have been studied within academic setting s , but interventions targeting both conditions have rarely been tested in community setting s. We describe the design and baseline results of a trial evaluating a behavioral intervention among community patients with poorly-controlled diabetes and comorbid hypertension . METHODS Tailored Case Management for Diabetes and Hypertension ( TEACH-DM ) is a 24-month r and omized , controlled trial evaluating a telephone-delivered behavioral intervention for diabetes and hypertension versus attention control . The study recruited from nine community practice s. The nurse-administered intervention targets 3 areas : 1 ) cultivation of healthful behaviors for diabetes and hypertension control ; 2 ) provision of fundamentals to support attainment of healthful behaviors ; and 3 ) identification and correction of patient-specific barriers to adopting healthful behaviors . Hemoglobin A1c and blood pressure measured at 6 , 12 , and 24 months are co- primary outcomes . Secondary outcomes include self-efficacy , self-reported medication adherence , exercise , and cost-effectiveness . RESULTS Of 377 r and omized patients , 193 were allocated to the intervention and 184 to attention control .  The cohort is balanced in terms of gender , race , education level , and income . The cohort 's mean baseline hemoglobin A1c and blood pressure are above goal , and mean baseline body mass index falls in the obese range . Baseline self-reported non-adherence is high for diabetes and hypertension medications . Trial results are pending . CONCLUSIONS If effective , the TEACH-DM intervention 's telephone-based delivery strategy and nurse administration make it well-suited for rapid implementation and broad dissemination in community setting BACKGROUND Less than one third of the 65 million Americans with hypertension have adequate blood pressure ( BP ) control . This study examined the effectiveness of 2 interventions for improving patient BP control . METHODS This was a 2-level ( primary care provider and patient ) cluster r and omized trial with 2-year follow-up occurring among patients with hypertension enrolled from a Veterans Affairs Medical Center primary care clinic . Primary care providers ( n = 17 ) in the intervention received computer-generated decision support design ed to improve guideline concordant medical therapy at each visit ; control providers ( n = 15 ) received a reminder at each visit . Patients received usual care or a bimonthly tailored nurse-delivered behavioral telephone intervention to improve hypertension treatment . The primary outcome was proportion of patients who achieved a BP < 140/90 mm Hg ( < 130/85 for diabetic patients ) over the 24-month intervention . RESULTS Of the 816 eligible patients contacted , 190 refused and 38 were excluded . The 588 enrolled patients had a mean age of 63 years , 43 % had adequate baseline BP control , and 482 ( 82 % ) completed the 24-month follow-up . There were no significant differences in amount of change in BP control in the 3 intervention groups as compared to the hypertension reminder control group . In secondary analyses , rates of BP control for all patients receiving the patient behavioral intervention ( n = 294 ) improved from 40.1 % to 54.4 % at 24 months ( P = .03 ) ; patients in the nonbehavioral intervention group improved from 38.2 % to 43.9 % ( P = .38 ) , but there was no between-group differences at the end of the study . CONCLUSION The brief behavioral intervention showed improved outcomes over time , but there were not significant between group differences Background — Even in high-performing health systems , some patients with diabetes mellitus have poor blood pressure ( BP ) control because of poor medication adherence and lack of medication intensification . We examined whether the Adherence and Intensification of Medications intervention , a pharmacist-led intervention combining elements found in efficacy studies to lower BP , improved BP among patients with diabetes mellitus with persistent hypertension and poor refill adherence or insufficient medication intensification in 2 high-performing health systems . Methods and Results — We conducted a prospect i ve , multisite cluster r and omized pragmatic trial with r and omization of 16 primary care teams at 5 medical centers ( 3 Veterans Affairs and 2 Kaiser Permanente ) to the Adherence and Intensification of Medications intervention or usual care . The primary outcome was relative change in systolic BP ( SBP ) , comparing 1797 intervention with 2303 control team patients , from 6 months preceding to 6 months after the 14-month intervention period . We examined shorter-term changes in SBP as a secondary outcome . The mean SBP decrease from 6 months before to 6 months after the intervention period was ≈9 mm Hg in both arms . Mean SBPs of eligible intervention patients were 2.4 mm Hg lower ( 95 % CI : −3.4 to −1.5 ; P<0.001 ) immediately after the intervention than those achieved by control patients . Conclusions — The Adherence and Intensification of Medications program more rapidly lowered SBPs among intervention patients , but usual-care patients achieved equally low SBP levels by 6 months after the intervention period . These findings show the importance of evaluating in different real-life clinical setting s programs found in efficacy trials to be effective before urging their widespread adoption in all setting s. Clinical Trial Registration — URL : http:// clinical trials.gov . Unique identifier : NCT00495794 BACKGROUND Only 31 % of Americans with hypertension have their blood pressure ( BP ) under effective control . We describe a study that tests 3 different interventions in a r and omized controlled trial using home BP telemedicine monitoring . METHODS A sample of hypertensive patients with poor BP control at baseline ( N = 600 ) are r and omized to 1 of 4 arms : ( 1 ) control group -- a group of hypertensive patients who receive usual care ; ( 2 ) nurse-administered tailored behavioral intervention ; ( 3 ) nurse-administered medication management according to a hypertension decision support system ; ( 4 ) combination of the 2 interventions . The interventions are triggered based on home BP values transmitted via telemonitoring devices over st and ard telephone lines . The tailored behavioral intervention involves promoting adherence with medication and health behaviors . Patients r and omized to the medication management or the combined arm have their hypertension regimen changed by the study team using a vali date d hypertension decision support system based on evidence -based hypertension treatment guidelines and individualized to patients ' comorbid illnesses . The primary outcome is BP control : < or = 140/90 mm Hg ( nondiabetic ) and < or = 130/80 mm Hg ( diabetics ) measured at 6-month intervals over 18 months ( 4 total measurements ) . CONCLUSIONS Given the increasing prevalence of hypertension and our inability to achieve adequate BP control using traditional models of care , testing novel interventions in patients ' homes may improve access , quality , and outcomes BACKGROUND Poor adherence to antihypertensive drug regimens is believed to be a major contributor to treatment failure . Electronic monitoring of adherence may improve adherence and allow differentiation between those who are nonadherent and those who are pharmacologically nonresponsive . This study was design ed to evaluate the effectiveness of electronic monitoring of adherence in lowering blood pressure ( BP ) in comparison with usual care . METHODS A total of 258 patients with high BP despite use of antihypertensive medication were r and omly assigned to either continuation of usual care ( with adjustment in antihypertensive medication if necessary ) or to the introduction of electronic monitoring . Adherence to antihypertensive medication was monitored for 2 months without medication changes . The primary outcome measure was the proportion of patients who reached target BP levels after a 5-month follow-up period . RESULTS At 5 months , 50.6 % of the patients in the usual care group reached adequate BP , v 53.7 % in the electronic monitoring group ( P = .73 ) . The percentages of patients with drug additions or increases in dosage were higher in the usual care group compared with those in whom adherence was monitored ( P < .01 ) . CONCLUSION These data show that electronic monitoring in comparison to usual care results in similar BP control but leads to fewer drug changes and less drug use . This result is likely to be achieved by improving adherence . Hence a strategy that includes electronic monitoring has the potential to prevent unnecessary treatment escalation in patients with poor adherence BACKGROUND Among the 65 million Americans with hypertension , only approximately 31 % have their blood pressure under control ( < 140/90 mm/Hg ) . Despite the damaging impact of hypertension and the availability of evidence -based target values for blood pressure , interventions to improve blood pressure control have had limited success . OBJECTIVES A r and omized controlled health services intervention trial with a two by two design is being conducted to improve blood pressure control . This five-year trial evaluates two patient-directed interventions design ed to improve blood pressure control among patients diagnosed with hypertension in a community-based primary care setting . METHODS Patients are r and omized to one of four groups :  usual care , home blood pressure monitoring , tailored behavioral self-management intervention that is administered via telephone by a nurse , or a combination of the home blood pressure monitoring and tailored behavioral intervention . Patients receiving the home blood pressure monitoring are trained in the use of an electronic blood pressure measurement device , are asked to measure their blood pressure 3 times/week , and send in two-month blood pressure recordings throughout the 24-month study duration . The behavioral intervention incorporates patients ' need assessment s and involves tailored behavioral and education modules to promote medication adherence and improve specific health behaviors . A nurse delivers all behavioral self-management modules over the telephone bi-monthly for 24 months . The primary outcome is the proportion of patients who achieve control of their blood pressure based on evidence -based guidelines ( for patients without diabetes < 140/90 mm/Hg , for patients with diabetes < 130/80 mm/Hg ) evaluated at six-month intervals over 24 months ( five measurements ) using a r and om-zero sphygmomanometer . CONCLUSION Despite the known risk of poor blood pressure control , and the wide availability of effective treatment strategies , a majority of adults still do not have their blood pressure controlled . This study will be an important step in defining two explicit interventions to improve blood pressure control . To our knowledge , this study is the first to combine both a tailored behavioral self-management intervention and self-monitoring home blood pressure intervention to improve blood pressure control among patients in a primary care setting Background Mobile phone based programs for kidney transplant recipients are promising tools for improving long-term graft outcomes and better managing comorbidities ( eg , hypertension , diabetes ) . These tools provide an easy to use self-management framework allowing optimal medication adherence that is guided by the patients ’ physiological data . This technology is also relatively inexpensive , has an intuitive interface , and provides the capability for real-time personalized feedback to help motivate patient self-efficacy . Automated summary reports of patients ’ adherence and blood pressure can easily be uploaded to providers ’ networks helping reduce clinical inertia by reducing regimen alteration time . Objective The aim of this study was to assess the feasibility , acceptability , and preliminary outcomes of a prototype mobile health ( mHealth ) medication and blood pressure ( BP ) self-management system for kidney transplant patients with uncontrolled hypertension . Methods A smartphone enabled medication adherence and BP self-management system was developed using a patient and provider centered design . The development framework utilized self-determination theory with iterative stages that were guided and refined based on patient/provider feedback . A 3-month proof-of-concept r and omized controlled trial was conducted in 20 hypertensive kidney transplant patients identified as non-adherent to their current medication regimen based on a month long screening using an electronic medication tray . Participants r and omized to the mHealth intervention had the reminder functions of their electronic medication tray enabled and received a bluetooth capable BP monitor and a smartphone that received and transmitted encrypted physiological data and delivered reminders to measure BP using text messaging . Controls received st and ard of care and their adherence continued to be monitored with the medication tray reminders turned off . Providers received weekly summary reports of patient medication adherence and BP readings . Results Participation and retention rates were 41/55 ( 75 % ) and 31/34 ( 91 % ) , respectively . The prototype system appears to be safe , highly acceptable , and useful to patients and providers . Compared to the st and ard care control group ( SC ) , the mHealth intervention group exhibited significant improvements in medication adherence and significant reductions in clinic-measured systolic blood pressures across the monthly evaluations . Physicians made more anti-hypertensive medication adjustments in the mHealth group versus the st and ard care group ( 7 adjustments in 5 patients versus 3 adjustments in 3 patients ) during the 3-month trial based on the information provided in the weekly reports . Conclusions These data support the acceptability and feasibility of the prototype mHealth system . Further trials with larger sample sizes and additional biomarkers ( eg , whole blood medication levels ) are needed to examine efficacy and effectiveness of the system for improving medication adherence and blood pressure control  after kidney transplantation over longer time periods . Trial Registration Clinical trials.gov NCT01859273 ; http:// clinical trials.gov/ct2/show/NCT01859273 ( Archived by WebCite at http://www.webcitation.org/6IqfCa3A3 ) OBJECTIVES To evaluate the community pharmacist 's capacity to positively influence the results of antihypertensive drug therapy through a pharmaceutical care program and to determine what factors limit the program . DESIGN R and omized , controlled study . SETTING Private pharmacy caring for a semiliterate , rural Portuguese population . PATIENTS R and om sample of 100 patients with a diagnosis of essential hypertension who had been on drug treatment for less than 6 months . Patients were r and omly assigned to an intervention ( n = 50 ) or a control ( n = 50 ) group . INTERVENTION Individualized health promotion by a research pharmacist involving monthly appointments for 6 months to monitor blood pressure ; assess adherence to treatment ; prevent , detect , and resolve drug-related problems ( DRPs ) ; and encourage nonpharmacologic measures for blood pressure control . Control patients received traditional care . MAIN OUTCOME MEASURES Control of blood pressure ; decreases in systolic/diastolic blood pressure ; number of detected , resolved , and prevented DRPs . RESULTS From the initial sample of 100 patients , 41 patients in the intervention group and 41 patients in the control group completed the longitudinal study . After 6 months , prevalence of uncontrolled blood pressure decreased by 77.4 % in the intervention group ( P < .0001 ) and by 10.3 % in the control group ( P = .48 ) . Systolic blood pressure fell from a mean + /- st and ard deviation of 152 mm Hg + /- 23 mm Hg to 129 + /- 15 mm Hg in intervention patients and 148 + /- 16 mm Hg to 143 + /- 20 mm Hg in control patients ( P < .001 ) . Twenty-four of 29 ( 83 % ) detected actual DRPs were resolved . About 40 % of potential DRPs were prevented . CONCLUSION In this rural community , a pharmaceutical care program was associated with significant improvements in blood pressure control in hypertensive patients Background : Suboptimal utilisation of pharmacotherapy , non-adherence to prescribed treatment , and a lack of monitoring all contribute to poor blood ( BP ) pressure control in patients with hypertension . Objective : The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes , outcomes , and method ological challenges . Method : A prospect i ve , controlled study was undertaken within the Australian primary care setting . Community pharmacists were recruited to one of three study groups : Group A ( Control – usual care ) , Group B ( Intervention ) , or Group C ( Short Intervention ) . Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP , as well as addressing poor BP control through therapeutic adjustment and adherence strategies . Pharmacists in Group C delivered the shortened version of the service . Results : Significant changes to key outcome measures were observed in Group C : reduction in systolic and diastolic BPs at the 3-month visit ( P<0.01 and P<0.01 , respectively ) , improvement in medication adherence scores ( P=0.01 ) , and a slight improvement in quality of life ( EQ-5D-3L Index ) scores ( P=0.91 ) . There were no significant changes in Group B ( the full intervention ) , and no differences in comparison to Group A ( usual care ) . Pharmacists fed-back that patient recruitment was a key barrier to service implementation , highlighting the method ological implication s of screening . Conclusion : A collaborative , pharmacist-led hypertension management service can help monitor BP , improve medication adherence , and optimise therapy in a step-wise approach . However , blood pressure screening can effect behaviour change in patients , presenting method ological challenges in the evaluation of services in this context
The most commonly described determinants at the patient level were lack of education , lack of self-awareness , lack of self-efficacy , and forgetfulness .
Clinical inertia and an inadequate health workforce were the most commonly targeted determinants at the health care team and system level .
Taking medication , interactive patient-provider communication , self-measurement , and lifestyle management were the most cited patient behaviors at both levels .
Most of the DIs did not include support from peers or family members , despite its reported effectiveness and the rate of social media penetration .
Background Information on how behavior change strategies have been used to design digital interventions ( DIs ) to improve blood pressure ( BP ) control or medication adherence ( MA ) for patients with hypertension is currently limited .
Objective Hypertension is a major modifiable risk factor for cardiovascular diseases and can be controlled with appropriate medication .
Many interventions that target MA to improve BP are increasingly using modern digital technologies .
This systematic review was conducted to discover how DIs have been design ed to improve MA and BP control among patients with hypertension in the recent 10 years .