Journal List > Korean J Health Promot > v.14(1) > 1089825

Lee, Kim, Bae, Kim, Oh, Lee, Kim, Shin, Han, and Cho: The Effectiveness of Short Term Mobile Phone Text Reminders in Improving Compliance among Hypertensive Patients

Abstract

Background

For the effective management of hypertension, drug adherence and life style modification are important. We investigated the effects of mobile phone text‐message reminders on compliance and life style modification in patients with hypertension.

Methods

The study was performed at family medicine outpatient clinics at 15 hospitals in South Korea from July 2008 to June 2010. Study subjects included 1,449 patients who were all prescribed candesartan cilexetil. Patients were randomly divided into two groups‐ mobile phone text‐message reminder group and control group. In the reminder group, contents of text messages were recommendations for antihypertensive adherence, exercise, low salt diet, and reduction of weight and alcohol. In the control group, the date of next visit was sent at 10 week. Mobile phone text-messages were sent at 2, 4, 6, 8 and 10 weeks by the coordinating center. Thereafter, they were followed up for 12 weeks. Chi-square test was performed to compare compliance and performance indexes of the two groups.

Results

The reminder group had 719 (49.6%) patients vs. 730 (50.4%) patients in the control group. Attendance rate were 92.8% for the reminder group and 94.7% for the control group (P=0.14). 94.7% of the reminder group and 94.0% of the control group took their medication regularly (P=0.59). The target blood pressure was attained in 75.8% of the reminder group and 75.4% of the control group (P=0.87). Similarly, rates of weight loss, decreased alcohol use, increased physical activity and a low salt diet showed no significant differences between the two groups.

Conclusions

In our study, mobile phone text reminders did not show to have any significant positive effect on the management of hypertension.

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Figure 1.
General scheme of the study.
kjhp-14-1f1.tif
Table 1–1.
Baseline characteristics of the subjectsa
Variables Text message reminder (n=719) Control (n=730) Pb
Sex
  Man 309 (43.0) 296 (40.4) 0.350
 Woman 410 (57.0) 434 (59.4)  
Age, y 59.7±10.7 58.7±10.3 0.100
 <50 135 (18.8) 127 (17.4) 0.100
 50–59 213 (29.6) 256 (35.1)  
 60–69 241 (33.5) 240 (32.9)  
 ≥70 130 (18.1) 107 (14.6)  
Monthly income, million Korean Won
 <200 170 (25.8) 141 (21.4) 0.170
 200–399 204 (30.9) 219 (33.2)  
 ≥400 286 (43.3) 299 (45.4)  
Education, y      
 <12 12 188 (27.5) 263 (38.4) 183 (26.2) 276 (39.5) 0.850
 >12 233 (34.1) 239 (34.3)  
Marital status      
 Married 585 (84.1) 612 (86.2) 0.260
 Not married 111 (15.9) 98 (13.8)  
Smoking
 None-smoker 473 (66.4) 463 (64.3) 0.310
 Ex-smoker 145 (20.4) 170 (23.6)  
 Smoker 94 (13.2) 87 (12.1)  
Alcohol use      
 None-drinker 438 (62.5) 454 (63.9) 0.570
 Drinker 263 (37.5) 256 (36.1)  
Degree of physical activity
 Inactive 280 (40.1) 312 (43.8) 0.240
 Minimally active 269 (38.5) 270 (37.9)  
 Health enhancing (vigorous) 149 (21.4) 130 (18.3)  
Body mass index, kg/m2 25.5±3.4 25.3±5.5 0.420
Blood pressure, mmHg      
 <140 and <90 294 (42.9) 305 (43.9) 0.720
 ≥140 or ≥90 391 (57.1) 390 (56.1)  
Habit of salt intake      
 Normal intake 398 (55.7) 405 (56.3) 0.850
 High intake 316 (44.3) 315 (43.7)  

a Values are presented as N (%) or mean±SD.

b Calculated by chi-squared test or Student's t-test.

Table 1–2.
Baseline characteristics of the subjectsa
Variables Text message reminder (n=719) Control (n=730) Pb
Family history of disease      
 Hypertension 330 (47.7) 326 (46.4) 0.620
 Diabetes mellitus 150 (21.7) 149 (21.2) 0.840
 Stroke 128 (18.5) 139 (19.8) 0.540
 Heart disease 79 (11.4) 90 (12.8) 0.430
Comorbidity 398 (58.2) 385 (55.6) 0.320
 Diabetes mellitus 155 (22.7) 138 (20.0) 0.220
 Hyperlipidemia 335 (49.2) 323 (47.0) 0.410
 Heart disease 14 (2.1) 11 (1.6) 0.530
 Cerebrovascular disease 13 (1.9) 12 (1.7) 0.820
History of having taken antihypertensive agents      
 Yes 480 (68.0) 474 (65.5) 0.300
 No 226 (32.0) 250 (34.5)  
Concurrently prescribed medication 496 (72.3) 499 (72.2) 0.970
 Antihypertensive agents taking with candesartan cilexetil 264 (38.5) 253 (36.7) 0.470
 Antidiabetic agents 143 (20.9) 127 (18.4) 0.250
 Serum lipid lowering agents 338 (49.3) 310 (44.9) 0.100
 Antiplatelet agents 161 (23.5) 177 (25.7) 0.360
 Other cardiovascular medications 10 (1.5) 5 (0.7) 0.190

a Values are presented as N (%).

b Calculated by chi-squared test.

Table 2.
Comparison of compliance and performance index between mobile phone text-message reminder group and control groupa
Variables Text message reminder (n=719) Control (n=730) Pb
Attendance      
 Yes 605 (92.8) 631 (94.7) 0.140
 No 47 (7.2) 35 (5.3)  
Drug adherence      
 ≥80% 612 (94.7) 616 (94.0) 0.590
 <80% 34 (5.3) 39 (6.0)  
Controlled blood pressurec      
 Yes 500 (75.8) 508 (75.4) 0.870
 No 160 (24.2) 166 (24.6)  
Weight lossd      
 Yes 40 (6.6) 43 (6.9) 0.800
 No 568 (93.4) 576 (93.1)  
Reduced alcohol usee      
 Yes 68 (11.1) 68 (11.0) 0.940
 No 542 (88.9) 550 (89.0)  
Increased regular exercisee      
 Yes 123 (18.8) 117 (17.5) 0.550
 No 531 (81.2) 550 (82.5)  
Reduced dietary sodium intakee      
 Yes 219 (33.4) 205 (30.8) 0.300
 No 430 (65.7) 459 (68.9)  

a Values are presented as N (%).

b Calculated by chi-squared test.

c Controlled blood pressure was defined as blood pressure being controlled as systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg.

d A significant weight loss was defined as weight loss more than 3% compared to initial weight.

e Reduced alcohol use, increased regular exercise and reduced dietary sodium intake were evaluated by a questionnaire.

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