Do medication reminder systems improve blood pressure control?

Blood pressure control was not improved after 4 months of daily feedback to patients via either a pill bottle that tracked their use and sent a text, or a daily text that provided reinforcement and asked patients whether they had taken their medication that day. (LOE = 1b)

Mehta SJ, Volpp KG, Troxel AB, et al. Electronic pill bottles or bidirectional text messaging to improve hypertension medication adherence (Way 2 Text): a randomized clinical trial. J Gen Intern Med 2019;34(11):2397-2404.  [PMID:31396815]

Randomized controlled trial (single-blinded)

Self-funded or unfunded

Uncertain

Outpatient (primary care)

These investigators enrolled 151 adults with hypertension and out-of-range blood pressure measurements at the time of enrollment (average = 152 mmHg systolic) and at least one previous visit. The patients were randomized (allocation concealment uncertain) to continue with usual care or to receive 1 of 2 types of reminder. One reminder system consisted of a wireless pill bottle (AdhereTech) that monitored opening of the bottle and transmitted results to a central monitoring system. The system then sent a text to the patient the next day praising them (for opening the bottle) or admonishing them (if they didn't open the bottle) and prompting them to take the medication that day. The second reminder system consisted of a text asking patients to respond with whether or not they took their medicine that day. After 4 months, patients returned to their doctor for blood pressure measurement. As compared with the start of the study, systolic blood pressures dropped 4.7 mmHg in usual care group, 4.3 mmHg in the pill bottle group, and 4.6 mmHg in the text group, with no statistical differences with the reminders. Medication adherence in the reminder groups was less than 80%. Still, most patients liked the reminders and stated they would recommend them to others who are prescribed antihypertensives. The study had the power to find a 3.75 mmHg difference in blood pressure control if one existed.