kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2014.14.1.1 kjhp-14-1 Original Article The Effectiveness of Short Term Mobile Phone Text Reminders in Improving Compliance among Hypertensive Patients LeeJung Ah 1 KimWoo Sang 1 BaeMoon Jung 1 KimYoung-Sik 1 OhHan Jin 2 LeeSang Yeoup 3 KimChul-Min 4 ShinDong Hyeok 5 HanSeong-Ho 6 ChoKyung-Hwan 7 Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Family Medicine, Kwandong University College of Medicine, Gangneung, Korea Department of Family Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea Department of Family Medicine, The Catholic University of Korea Seoul St. Mary's Hospital, The Catholic University College of Medicine, Seoul, Korea Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea Department of Family Medicine, Dong-A University College of Medicine, Busan, Korea Department of Family Medicine, Korea University Anam Hospital, Seoul, Korea ￭ Corresponding author：Young-Sik Kim, MD Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea Tel: +82-2-3010-3810, Fax: +82-2-3010-3815 E-mail: youngkim@amc.seoul.kr 01 2014 20 01 2014 14 1 1 8 18032014 28032014 Copyright © 2014 The Korean Society of Health Promotion and Disease Prevention 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 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.

 Hypertension Compliance Mobile phone text message References Prospective Studies Collaboration Age-specific relevance of usual blood pressure to vascular mortality: a metaanalysis of individual data for one million adults in 61 prospective studies Lancet 2002360 9349 190313 WHO Prevention of cardiovascular disease: guidelines for assessment and management of cardiovascular risk World Health Organization(WHO) 2007 http://whqlibdoc.who.int/pub-lications/2007/9789241547178_eng.pdf?ua=1 Korea Centers for Disease Control and Prevention Korea Health Statistics 2010: Korea National Health and Nutrition Examination Survey (KNHANES V-1) Available from: https://knhanes.cdc.go.kr/knhanes/index.do Egan BM Zhao Y Axon RN US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008 JAMA 2010303 20 204350 WHO Adherence to longterm therapies: evidence to action World Health Organization (WHO) 2003 http://whqlibdoc.-who.int/publications/2003/9241545992.pdf Grant RW Singer DE Meigs JB Medication adherence before an increase in antihypertensive therapy: a cohort study using pharmacy claims data Clin Ther 200527 6 77381 Cramer JA Benedict Á Muszbek N Keskinaslan A Khan ZM The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review Int J Clin Pract 200862 1 7687 Park JH Antihypertensive drug medication adherence of national health insurance beneficiaries and its affecting factors in Korea [dissertation] Seoul Seoul National University 2006 Korean. Choi NH Kim HK Lee HR Kim KS A Study of the Factors influencing the Compliance of Hypertensive Patients to Therapy -Centered on the Registered Patients of Hypertension in a Rural Clinic– Family physician 199112 10 112 DiMatteo MR Giordani PJ Lepper HS Croghan TW Patient adherence and Medical treatment outcomes: a metaanalysis Med Care 200240 9 794811 Touchette DR Burns AL Bough MA Blackburn JC Survey of medication therapy management programs under Medicare Part D J Am Pharm Assoc 200646 6 68391 Ministry of Health and Welfare National Health Plan 2020 http://www.mindbank.info/item/4070 Chen Z Fang L Chen L Dai H Comparison of an SMS text messaging and phone reminder to improve attendance at a health promotion center: a randomized controlled trial Journal of Zhejiang University SCIENCE B 20089 1 348 Korean Statistical Information Center The number of mobile phone subscriptions http://kosis.kr/statisticsList/statisticsL-ist_03List.jsp?vwcd=MT_RTITLE&parmTabId=M_03_01#Su bCont. Viswanathan H Lambert BL An inquiry into medication meanings, illness, medication use, and the transformative potential of chronic illness among African Americans with hypertension Research in Social and Administrative Pharmacy 20051 1 2139 Gohar F Greenfield SM Beevers DG Lip GY Jolly K Self-care and adherence to medication: a survey in the hypertension outpatient clinic BMC Complementary and Alternative Medicine 20088 4 Egan BM Lackland DT Cutler NE Awareness, knowledge, and attitudes of older Americans about high blood pressure: implications for health care policy, education, and research Arch Intern Med 2003163 6 6817 Lenfant C Chobanian AV Jones DW Roccella EJ Seventh report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7): resetting the hypertension sails Circulation 2003107 29934 The Korean Society of Hypertension 2004 Korean Hypertension Treatment Guidelines The Korean Society of Hypertension;2005. Oh JY Yang YJ Kim BS Kang JH Validity and Reliability of Korean Version of International Physical Activity Questionnaire (IPAQ) Short Form Korean J Fam Med 200728 7 53241 Kim HJ Paik HY Lee SY Shim JE Kim YS Salt usage behaviors are related to urinary sodium excretion in normotensive Korean adults Asia Pacific Journal of Clinical Nutrition 200716 1 1227 Pop-Eleches C Thirumurthy H Habyarimana JP Zivin JG Goldstein MP de Walque D Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders AIDS 201125 6 82534 Dick JJ Nundy S Solomon MC Bishop KN Chin MH Peek ME Feasibility and usability of a text message-based program for diabetes self-management in an urban African-American population Journal of Diabetes Science and Technology 20115 5 124654 Hussein WI Hasan K Jaradat AA Effectiveness of mobile phone short message service on diabetes mellitus management; the SMS-DM study Diabetes Res Clin Pract 201194 1 e246 Márquez Contreras E, de la Figuera von Wichmann M, Gil Guillén V, Ylla-Catalá A, Figueras M, Balaña M, at al Effectiveness of an intervention to provide information to patients with hypertension as short text messages and reminders sent to theirmobile phone (HTA-Alert) Aten Primaria 200434 8 399405 Park KA The related factors on medication adherence in elderly patients with hypertension or diabetes mellitus [dissertation] Daegu Kyungpook National University 2010 Korean. Kim HW Lee YJ Youn BB A follow up study for drop-out of hypertensive patients registered in a community hospital Family Physician 19867 1 111 Figures and Tables

General scheme of the study.

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)  

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

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

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

Values are presented as N (%).

Calculated by chi-squared test.

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)  

Values are presented as N (%).

Calculated by chi-squared test.

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

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

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