Personalized text message and checklist support for initiation of antihypertensive medication: the cluster randomized, controlled check and support trial

Objective: To assess whether the use of a checklist combined with text message support improves systolic blood pressure (SBP) control. Design and setting: A cluster randomized controlled trial in Finnish primary care. Interventions: Personalized text message support and a checklist for initiation of antihypertensive medication. Patients: 111 newly diagnosed hypertensive patients aged 30–75 years. Main outcome measures: The proportion of patients achieving 1) the office SBP target <140 mmHg or 2) the home SBP target <135 mmHg at 12 months. Results: 28% (n = 16) and 31% (n = 17) of patients in the intervention and control groups met the office SBP target, respectively (p = 0.51). The corresponding proportions were 36% (n = 18) and 42% (n = 21) for the home SBP target (p = 0.21). Office SBP decreased 23 mmHg (95% CI: 29–17) in the intervention group and 21 mmHg (95% CI: 27–15) in the control group (p = 0.61). Medication changes, number of antihypertensives at 12 months and health care utilization were similar in both study groups. Patients considered checklist and text message support useful and important. Conclusion: Only a small proportion of patients in the intervention and control groups reached their treatment target despite multiple health care contacts and medication changes. The study interventions did not improve SBP control. However, this study demonstrates new information about hypertension control, antihypertensive medication and health service utilization during the first treatment year.