Hypertension management using mobile technology and home blood pressure monitoring: results of a randomized trial in two low/middle-income countries
Open accessAbstract
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. Subjects and 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.
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In Piette's study, information messages prompted change in lifestyle.
“Information messages prompted change in lifestyle.”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [43]
In Piette's study, regular interaction resulted in the opportunity to engage with social support when needed.
“This regular interaction resulted in the opportunity to engage with social support when they needed it.”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [43]
In Piette's study, patients felt they had empathetic support, especially when they had problems.
“The patient felt they had empathetic support, especially when the patient had problems.”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [43]
In Piette's study, the intervention had greater effect on the subgroup of patients with low literacy.
“and the intervention did have greater effect on this subgroup of patients.”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [43]
In Piette's study, reminders and motivating education/advice information prompted engagement with a health worker and treatment supporter (relationship).
“In Piette’s study, reminders and motivating education/advice information prompted engagement with a health worker and treatment supporter (relationship).”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [43]
In Piette's study, the intervention was designed to meet the needs of patients with low literacy.
“In Piette’s study, the intervention was designed to meet the needs of patients with low literacy”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [43]
In Piette's study, the intervention led to a decrease in blood pressure, particularly in the subgroup.
“This led to a decrease in blood pressure, particularly in the subgroup.”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [43]
In Piette's study, disease management was made more visible because patients had to log onto the home-monitoring kit every day.
“Disease management was made more visible as the patient had to log onto the home-monitoring kit every day.”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [43]
In Piette's study, reading powerful practical messages motivated patients to reduce salt intake.
“By reading powerful practical messages, this motivated them to reduce salt intake for example.”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [43]
Piette's intervention was effective in decreasing blood pressure.
“Piette’s intervention was effective in decreasing blood pressure”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [43]
Infectious diseases and chronic diseases were the second most prevalent health outcomes, each with a frequency of 8 of 30 articles (27%).
“Infectious diseases and chronic diseases were the second most prevalent health outcomes, with a frequency of each of 8 of 30 (27%) articles [36,39-44,49-51].”
From Barriers to the Use of Mobile Health in Improving Health Outcomes in Developing Countries: Systematic Review (2019) · cites this paper as [51]
Two studies reported results of trials which included patients in both a LMIC and a UMIC (Mexico and Honduras, and India and China, respectively).
“Two studies [23, 24] reported results of trials, which included patients in both a LMIC and a UMIC (Mexico and Honduras, and India and China, respectively).”
From A systematic review of randomized controlled trials of mHealth interventions against non-communicable diseases in developing countries (2016) · cites this paper as [23]
Four interventions required the patients to record key parameters of their disease, e.g., the Peak Expiratory Flow Rate (PEFR) for patients with Asthma, the blood glucose level for patients with Diabetes or the blood pressure for patients with hypertension.
“Four interventions required the patients to record key parameters of their disease, e.g., the Peak Expiratory Flow Rate (PEFR) for patients with Asthma [28, 29], the blood glucose level for patients with Diabetes [27] or the blood pressure for patients with hypertension [23].”
From A systematic review of randomized controlled trials of mHealth interventions against non-communicable diseases in developing countries (2016) · cites this paper as [23]
Three studies dealt with diabetes, two with asthma patients, two with patients suffering from cardiovascular diseases, and one with patients having different NCDs including hypertension, asthma and diabetes.
“Three studies dealt with diabetes [25–27], two with asthma patients [28, 29], two with patients suffering from cardiovascular diseases, [23, 24] and one with patients having different NCDs [30], including hypertension, asthma and diabetes.”
From A systematic review of randomized controlled trials of mHealth interventions against non-communicable diseases in developing countries (2016) · cites this paper as [23]
Piette et al. found that their intervention providing personalized advice to hypertensive patients on the basis of their self-recorded blood pressure lowered systolic blood pressure in the intervention group, although this finding was significant only in a subgroup of 117 out of 181 participants with low literacy or high hypertension information needs.
“Piette et al. [23] found that their intervention providing personalized advice to hypertensive patients on the basis of their self-recorded blood pressure lowered systolic blood pressure in the intervention group, although this finding was significant only in a subgroup of 117 out of 181 participants with low literacy or high hypertension information needs.”
From A systematic review of randomized controlled trials of mHealth interventions against non-communicable diseases in developing countries (2016) · cites this paper as [23]
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- Authors
- Piette, J. D., Datwani, H., Gaudioso, S., Foster, S. M., Westphal, J., Perry, W., Rodríguez-Saldaña, J., Mendoza-Avelares, M. O., & Marinec, N.
- Affiliations
- University of Michigan (US)
- Remedi Medical Research and Development
- Yojoa Community Health Systems
- VA Ann Arbor Healthcare System (US)
- Corresponding author
- Piette, John D.
- Venue
- Telemedicine and e-Health
- Publisher
- SAGE Publications
- Published
- 2012-10
- Volume
- 18
- Issue
- 8
- Pages
- 613-620
- ISSN
- 1530-5627 (ISSN-L)
- 1556-3669
- PMC
- PMC4361160
- OpenAlex
- W2038461406
- Cited by
- 172
- References
- 32
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 14 · 2023: 5 · 2022: 10 · 2021: 15 · 2020: 23 · 2019: 14 · 2018: 12 · 2017: 20 · 2016: 15 · 2015: 15 · 2014: 10 · 2013: 1 · 2012: 2
- FWCI
- 15.90
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Telemedicine Journal and e-Health (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- U.S. Department of Veterans Affairs
- University of Michigan
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092926)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- antihypertensive therapy, home blood pressure monitoring, mobile health, cloud computing, low-middle income countries, systolic blood pressure, health literacy, drug-related problems, depressive symptoms, patient satisfaction, telemedicine
- MeSH terms
- Blood Pressure, Cardiology, Cardiovascular Diseases, Computer Simulation, Developing Countries, Female, Honduras, Humans, Hypertension, Income, Male, Mexico, Middle Aged, Poverty, Psychometrics, Socioeconomic Factors, Confidence Intervals, Telemedicine, Patient Selection, Blood Pressure Monitoring, Ambulatory, Developed Countries
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