SUN-264 - A Multi-Component Digital Program to Increase Blood Pressure Medication Adherence in African Americans

Background: Lack of BP medication adherence is a major factor leading to poor BP control, with adherence being lower among African Americans compared to whites, leading to significant health disparities. We developed Memento.HTN, a web-based clinic platform with SMS text messaging combing home BP monitoring (HBPM) to increase adherence to BP medication and evaluated its acceptability, feasibility and preliminary effectiveness to lower BP among African Americans with uncontrolled hypertension (HTN).

Methods: Memento.HTN is culturally tailored for African Americans, provides personalized pill and appointment reminders and motivational messages through SMS texting and is coupled with HBPM. A study pharmacist received a message when a subject did not log taking 3 consecutive doses of medication, and contacted them via text to assess adherence, provide encouragement, and answer questions

We recruited self-identified African Americans into a 6-week pilot study thru the online platform ‘User Interviews’. Inclusion criteria were uncontrolled BP (SBP >=130 or DBP >=80 mm Hg) and owning a mobile phone. Subjects signed into Memento.HTN with their mobile phones which provided access to text messages and were given a home BP monitor. The primary outcome was adherence to BP medication measured by a validated scale (0 low to 100 high adherence). The secondary outcomes were systolic (SBP) and diastolic (DBP). Online surveys were completed at start and end of study.

Results: 26 subjects met inclusion criteria and signed consent; 9 did not sign into the program or send baseline BP. The trial included 17 African American adults with HTN, age 32-67 mean 47 years, with 11 women and 6 men. Medication adherence increased significantly from mean +/- SD of 83 +/- 17 to 94 +/- 19 (p < 0.001). SBP fell significantly from 139 +/- 14 to 130 +/- 15 mm Hg (p < 0.05). There was no significant change in DBP.
Engagement rates were high, with 86% of participants responding to all automated text reminders to take medications. Satisfaction with Memento.HTN was 4.56/5 (1-5 Likert scale). The pharmacist reached out to 9/17 subjects when they had not logged taking 3 doses. 8 indicated adherence to all doses but failure to log; 1 reported nonadherence and with encouragement texting did not have any further issues.

Conclusion: Memento. HTN which couples culturally attuned text messaging with HBPM was acceptable, feasible to use, increased adherence to BP medication and was associated with lower SBP. 30% of those who consented did not further engage with the study. Some subjects join studies only to obtain a study device. As this pilot was conducted outside a health system, engagement may be higher if the program is recommended by their own clinical provider. This one arm pilot was small and short in duration and needs to be tested in an adequately powered RCT with longer duration.

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