A targeted behavioral economics-based mobile health intervention to improve medication adherence in patients with hypertension: A three-arm randomized controlled trial.

BACKGROUND

Non-adherence to antihypertensive therapy remains a major barrier to optimal blood pressure (BP) control. This study evaluated whether a multi-faceted medication adherence mobile application (mApp), with or without financial incentives (FI), improves adherence and BP compared with standard care.

METHODS

In this multicenter, randomized, open-label trial, outpatients with hypertension taking ≥4 pills/day were randomized to (A) mApp with FI, (B) mApp without FI, or (C) standard-of-care. Adherence was measured by Medication Event Monitoring System (MEMS) dispensers. Primary endpoint was median adherence at 90 days comparing A with C; the co-primary endpoint compared adherence during month 3 versus month 1. Secondary outcomes included self-reported adherence, office and ambulatory BP over 90 and 180 days.

RESULTS

Of 219 randomized participants, 176 (80.4%) completed the 90-day visit (median age 63 years; 23% women). Median adherence at 90 days was 95.6% in A and C (p=0.551). Median change in adherence from month 1 to month 3 was 0% in A and 1.6% in C (p=0.691). No significant differences were observed for BP. Self-reported adherence did not differ between groups, although within-group analyses showed improvement over time in A (p=0.001).

CONCLUSIONS

In outpatients with hypertension and unexpectedly high observed adherence and no substantial BP elevation at baseline, neither the mApp nor FI improved MEMS-measured adherence or BP. Future interventions should focus on identifying and engaging patients with low medication adherence and sufficient room for BP improvement, for whom digital strategies may have greater impact.