Hypertension management using mobile technology and home blood pressure monitoring: results of a randomized trial in two low/middle-income countries.
OBJECTIVE
Hypertension and other noncommunicable diseases represent a growing threat to low/middle-income countries (LMICs). Mobile health technologies may improve noncommunicable disease outcomes, but LMICs lack resources to provide these services. We evaluated the efficacy of a cloud computing model using automated self-management calls plus home blood pressure (BP) monitoring as a strategy for improving systolic BPs (SBPs) and other outcomes of hypertensive patients in two LMICs.


METHODS
This was a randomized trial with a 6-week follow-up. Participants with high SBPs (≥140 mm Hg if nondiabetic and ≥130 mm Hg if diabetic) were enrolled from clinics in Honduras and Mexico. Intervention patients received weekly automated monitoring and behavior change telephone calls sent from a server in the United States, plus a home BP monitor. At baseline, control patients received BP results, hypertension information, and usual healthcare. The primary outcome, SBP, was examined for all patients in addition to a preplanned subgroup with low literacy or high hypertension information needs. Secondary outcomes included perceived health status and medication-related problems.


RESULTS
Of the 200 patients recruited, 181 (90%) completed follow-up, and 117 of 181 had low literacy or high hypertension information needs. The median annual income was $2,900 USD, and average educational attainment was 6.5 years. At follow-up intervention patients' SBPs decreased 4.2 mm Hg relative to controls (95% confidence interval -9.1, 0.7; p=0.09). In the subgroup with high information needs, intervention patients' average SBPs decreased 8.8 mm Hg (-14.2, -3.4, p=0.002). Compared with controls, intervention patients at follow-up reported fewer depressive symptoms (p=0.004), fewer medication problems (p<0.0001), better general health (p<0.0001), and greater satisfaction with care (p≤0.004).


CONCLUSIONS
Automated telephone care management plus home BP monitors can improve outcomes for hypertensive patients in LMICs. A cloud computing model within regional telecommunication centers could make these services available in areas with limited infrastructure for patient-focused informatics support.
Ann Arbor VA Healthcare System, Ann Arbor, Michigan 48109-5429, USA. jpiette@umich.edu
John D
JD
Piette
Hema
H
Datwani
Sofia
S
Gaudioso
Stephanie M
SM
Foster
Joslyn
J
Westphal
William
W
Perry
Joel
J
Rodríguez-Saldaña
Milton O
MO
Mendoza-Avelares
Nicolle
N
Marinec
D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D002309:Cardiology; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003198:Computer Simulation; D016001:Confidence Intervals; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D006721:Honduras; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000517:prevention & control*; D007182:Income; D008297:Male; D008800:Mexico; D008875:Middle Aged; D018579:Patient Selection; D011203:Poverty; D011594:Psychometrics; D012959:Socioeconomic Factors; D017216:Telemedicine / Q000379:methods / Q000458:organization & administration*