• Shivan J Mehta, Kevin G Volpp, Andrea B Troxel, Susan C Day, Raymond Lim, Noora Marcus, Laurie Norton, Sophia Anderson, and David A Asch.
• Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. shivan.mehta@uphs.upenn.edu.
• J Gen Intern Med. 2019 Nov 1; 34 (11): 2397-2404.

BackgroundPoor medication adherence contributes to inadequate control of hypertension. However, the value of adherence monitoring is unknown.ObjectiveTo evaluate the impact of monitoring adherence with electronic pill bottles or bidirectional text messaging on improving hypertension control.DesignThree-arm pragmatic randomized controlled trial.PatientsOne hundred forty-nine primary care patients aged 18-75 with hypertension and text messaging capabilities who were seen at least twice in the prior 12 months with at least two out-of-range blood pressure (BP) measurements, including the most recent visit.InterventionsPatients were randomized in a 1:2:2 ratio to receive (1) usual care, (2) electronic pill bottles for medication adherence monitoring (pill bottle), and (3) bidirectional text messaging for medication adherence monitoring (bidirectional text).Main MeasuresChange in systolic BP during the final 4-month visit compared with baseline.Key ResultsAt the 4-month follow-up visit, mean (SD) change values in systolic blood pressure were - 4.7 (23.4) mmHg in usual care, - 4.3 (21.5) mmHg in the pill bottle arm, and - 4.6 (19.8) mmHg in the text arm. There was no significant change in systolic blood pressure between control and the pill bottle arm (p = 0.94) or the text messaging arm (p = 1.00), and the two intervention arms did not differ from each other (p = 0.93).ConclusionsDespite good measured adherence, neither feedback with electronic pill bottles nor bidirectional text messaging about medication adherence improved blood pressure control. Adherence to prescribed medications was not improved enough to affect BP control or it was not the primary driver of poor control.Trial Registrationclinicaltrials.gov (NCT02778542).

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