Comparisons to previous work
hypertension
HYPERTENSION
The increase seen in the proportion of participants with a BP of less than 140/90 mmHg after 8 weeks indicates that an e-health intervention, such as the system used in this study, can be utilized in BP management in primary care. This adds to the evidence of the important role that e-health interventions can play in hypertension management [The improvement in the number of participants with a BP of less than 140/90 mmHg seen after 8 weeks and after 12 months was not substantial; more than half of the patients still had uncontrolled BP. The improvement is not very large but since hypertension is such an important cardiovascular risk factor, every step in the right direction is important. The result of this study reflects the difficulty to reach target BP levels. Future analysis may bring clarity to which patients are most likely to benefit from a digital intervention such as this one.The system addresses several barriers to the successful treatment of hypertension, with a primary focus on strengthening the patient's ability to self-manage the condition. It can be used by prescribing physicians to titrate antihypertensive treatment. Home BP monitoring is recommended over office BP monitoring for treatment titration as it is associated with better BP control [In previous studies, it has been concluded that self-monitoring of BP is effective in lowering BP when combined with counselling or education [There was a small decrease in the proportion of participants with a BP of less than 140/90 mmHg in the intervention group after 12 months compared with after 8 weeks; 47.1% compared with 48.8%. Lifestyle changes are known to be difficult to maintain over time [At 12 months, the intervention group still had a higher proportion achieving the primary outcome (47.1 versus 41.0%) but this difference was no longer statistically significant. Agreeing to partake in a hypertension trial may positively influence the participants’ lifestyle choices and motivation, even if randomized to the control group. Another possible explanation is that participants in the control group were indirectly affected by the intervention since the same participating healthcare professionals met with patients from both the intervention and the control group during the study. In a qualitative study with focus group interviews with participants in PERHIT, healthcare professionals reported that they deepened their understanding of hypertension management and found new ways to talk about BP when using the system [According to the ESC/ESH guidelines from 2018 [In the pilot study, where the same system was tested in a smaller setting, the observed effect was larger than in this study [The opportunity to receive motivational messages was declined by 17% of the participants in the intervention group. Our results indicate that BP control was positively affected by receiving motivational messages after 8 weeks of intervention but that the effect waned over time. Furthermore, it was no longer statistically significant after 10 additional months without intervention. Previous literature supports using text messages in hypertension management and a recent meta-analysis found that health education via one-way text messages can be effective in improving BP control [