Digital Health Interventions for Elderly Hypertensive Patients: Assessing the Impact of the Mobile Health Application on Medication Adherence and Quality of Life

Abstract

Background: Compliance with antihypertensive treatment decreases with age, compromising blood pressure (BP) control and health-related quality of life (HRQoL). This trial assessed whether adding standardized counseling with a formal smartphone app (Medisafe®) enhances compliance, HRQoL, and BP in older, non-adherent adults with hypertension.

Methods: In a parallel-group randomized controlled trial (5 months) at a tertiary hospital in Tamil Nadu, India, 691 outpatients were screened; 297 (43%) were non-adherent (MMAS-8<6), and 200 were randomly assigned to counseling alone (control, n=100) or counseling plus Medisafe (intervention, n=100). Primary outcomes were medication adherence (MMAS-8) and HRQoL (WHOQOL-BREF domains: Physical, Psychological, Social, Environment); secondary outcomes were systolic/diastolic BP (SBP/DBP). Groups were equivalent at baseline by demographic, regimen intensity, MMAS-8, WHOQOL-BREF, and BP (all p>0.05). Analyses were intention-to-treat.

Results: At 5 months, control was greater with Medisafe compared to control (MMAS-8 7.20±0.35 vs 6.50±0.39; between-group Δ=+0.70; p=0.017). HRQoL was better in all aspects in favor of the intervention: Physical 68.5±9.55 vs 62.04±8.53 (Δ=+6.46; p=0.043), Psychological 69.0±7.14 vs 61.58±8.09 (Δ=+7.42; p=0.018), Social 69.0±7.12 vs 60.91±9.41 (Δ=+8.09; p=0.033), Environment 68.0±5.67 vs 60.44±6.62 (Δ=+7.56; p=0.039). Reductions in BP were larger with Medisafe: SBP 131±7 vs 135±8 mmHg (Δ=−4; p=0.019) and DBP 83±8 vs 88±5 mmHg (Δ=−5; p=0.014).

Conclusions: Among older adults (65–80 years) with chronic non-adherence, the addition of a geriatric-sensitive smartphone application to counseling yielded consistent, clinically significant improvements in adherence to medication, multidomain HRQoL, and BP over 5 months. Evidence supports pragmatic implementation of mHealth in resource-scarce geriatric hypertension treatment and encourages longer-term trials using objective measures of adherence and cost-effectiveness studies.