Purpose of Review
This study aims to systematically review existing evidence on the effectiveness of mobile health technology (mHealth) interventions in addressing medication adherence among people with hypertension.
Twenty-one studies of mHealth interventions were included in the final review after systematic searching and screening of publications from 2000 to 2017 in PubMed, Web of Science, and Embase. Key features of the mHealth interventions include high intervention intensity, multifactorial components, and patient-centered approaches with tailored content and interaction. All studies found tendencies to improvement in medication adherence, but only 12 studies reported that the improvements were statistically significant in the intervention groups compared with the control groups. Twelve studies also found that mHealth interventions were beneficial for blood pressure control. None of the studies was conducted in a low-income country.
Our systematic review found evidence that mHealth interventions improved medication adherence and blood pressure control among people with hypertension. However, most studies were small in sample size and short in study duration, and not all results were statistically significant. Future research should focus on investigating the sustainability and generalizability of mHealth interventions.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Diastolic blood pressure
Randomized controlled trial
Systolic blood pressure
Short message services
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
WHO. A global brief on hypertension: silent killer, global public health crisis: World Health Day 2013. 2013.
IHME. Global Burden of Disease 2016. Available from: http://ghdx.healthdata.org/gbd-results-tool.
Bakris G, Sarafidis P, Agarwal R, Ruilope L. Review of blood pressure control rates and outcomes. J Am Soc Hypertens. 2014;8(2):127–41.
Irazola VE, Gutierrez L, Bloomfield GS, Carrillo-Larco RM, Dorairaj P, Gaziano T, et al. Hypertension prevalence, awareness, treatment, and control in selected communities of nine low- and middle income countries: results from the NHLBI/UHG Network of Centers of Excellence for Chronic Diseases. Glob Heart. 2016;11(1):47–59.
Joffres M, Falaschetti E, Gillespie C, Robitaille C, Loustalot F, Poulter N, et al. Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study. BMJ Open. 2013;3(8):e003423.
Mutua EM, Gitonga MM, Mbuthia B, Muiruri N, Cheptum JJ, Maingi T. Level of blood pressure control among hypertensive patients on follow-up in a regional referral hospital in Central Kenya. Pan Afr Med J. 2014;18
•• Vrijens B, Antoniou S, Burnier M, de la Sierra A, Volpe M. Current situation of medication adherence in hypertension. Front Pharmacol. 2017;8:100. This review provides an updated and thorough look into the situation of medication adherence among hypertensive patients, including the adherence level, consequences, and current methods to enhance adherence.
Vrijens B, Vincze G, Kristanto P, Urquhart J, Burnier M. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. BMJ. 2008;336(7653):1114–7.
Dragomir A, Côté R, Robert RL, Blais L, et al. Impact of adherence to antihypertensive agents on clinical outcomes and hospitalization costs. Med Care. 2010;48(5):418–25.
Bilal A, Riaz M, Shafiq NU, Ahmed M, Sheikh S, Rasheed S. Non-compliance to anti-hypertensive medication and its associated factors among hypertensives. J Ayub Med Coll Abbottabad. 2015;27(1):158–63.
Yue Z, Bin W, Weilin Q, Aifang Y. Effect of medication adherence on blood pressure control and risk factors for antihypertensive medication adherence. J Eval Clin Pract. 2015;21(1):166–72.
Kim E-Y, Han H-R, Jeong S, Kim KB, Park H, Kang E, et al. Does knowledge matter?: intentional medication nonadherence among middle-aged Korean Americans with high blood pressure. J Cardiovasc Nurs. 2007;22(5):397–404.
Alsolami F, Hou X-Y, Correa-Velez I. Factors affecting antihypertensive treatment adherence: a Saudi Arabian perspective. Clinical Medicine and Diagnostics. 2012;2(4):27–32.
Krousel-Wood M, Hyre A, Muntner P, Morisky D. Methods to improve medication adherence in patients with hypertension: current status and future directions. Curr Opin Cardiol. 2005;20(4):296–300.
Takiya LN, Peterson AM, Finley RS. Meta-analysis of interventions for medication adherence to antihypertensives. Ann Pharmacother. 2004;38(10):1617–24.
Kripalani S, Yao X, Haynes RB. Interventions to enhance medication adherence in chronic medical conditions: a systematic review. Arch Intern Med. 2007;167(6):540–9.
•• Cameron JD, Ramaprasad A, Syn T. An ontology of and roadmap for mHealth research. Int J Med Inform. 2017;100:16–25. This paper provides an updated ontological framework and roadmap for mobile health research, which can be used to assess and guide mHealth research.
•• Gandhi S, Chen S, Hong L, Sun K, Gong E, Li C, et al. Effect of mobile health interventions on the secondary prevention of cardiovascular disease: systematic review and meta-analysis. Can J Cardiol. 2017;33(2):219–31. This paper presents a meta-analysis about the effects of mHealth interventions on the secondary prevention of cardiovascular diseases, covering both English and Chinese literatures. The review identified increased adherence to medical therapy and increased awareness of many healthy lifestyles among cardiovascular patients, but did not find differences in some other aspects such as hospital readmission.
Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. J Med Internet Res. 2015;17(2):e52.
McLean G, Band R, Saunderson K, Hanlon P, Murray E, Little P, et al. Digital interventions to promote self-management in adults with hypertension systematic review and meta-analysis. J Hypertens. 2016;34(4):600.
•• Omboni S, Caserini M, Coronetti C. Telemedicine and m-health in hypertension management: technologies, applications and clinical evidence. High Blood Press Cardiovasc Prev. 2016;23(3):187–96. This paper provides a review on the situation of the application of eHealth in hypertension management, with a focus on telemedicine and mHealth technologies. The paper gives the introduction, benefits, and current trends in the application of such interventions.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
National Heart L, and Blood Institute. Study Quality Assessment Tools [cited 2018 Feb. 8th]. Available from: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools.
• Ahmed SF, Aiash H, Abdel-Wahid HA. Improving hypertension control via a Team-based Educational and Refill Monitoring (TERM) intervention, Sharjah, United Arab Emirates. World Family Medicine. 2016;14(7):8–15. Indicates the 21 papers that were included in the data extraction of the systematic review.
• Bengtsson U, Kjellgren K, Hallberg I, Lindwall M, Taft C. Improved blood pressure control using an interactive mobile phone support system. J Clin Hypertens. 2016;18(2):101–8. Indicates the 21 papers that were included in the data extraction of the systematic review.
• Bobrow K, Farmer AJ, Springer D, Shanyinde M, Yu LM, Brennan T, et al. Mobile phone text messages to support treatment adherence in adults with high blood pressure (SMS-Text Adherence Support [StAR]): a single-blind, randomized trial. Circulation. 2016;133(6):592–600. Indicates the 21 papers that were included in the data extraction of the systematic review.
• Brath H, Morak J, Kaestenbauer T, Modre-Osprian R, Strohner-Kaestenbauer H, Schwarz M, et al. Mobile health (mHealth) based medication adherence measurement—a pilot trial using electronic blisters in diabetes patients. Br J Clin Pharmacol. 2013;76:47–55. Indicates the 21 papers that were included in the data extraction of the systematic review.
• Buis L, Hirzel L, Dawood RM, Dawood KL, Nichols LP, Artinian NT, et al. Text messaging to improve hypertension medication adherence in African Americans from primary care and emergency department settings: results from two randomized feasibility studies. JMIR Mhealth Uhealth. 2017;5(2):e9. Indicates the 21 papers that were included in the data extraction of the systematic review.
• Davidson TM, McGillicuddy J, Mueller M, Brunner-Jackson B, Favella A, Anderson A, et al. Evaluation of an mHealth medication regimen self-management program for African American and Hispanic uncontrolled hypertensives. J Pers Med. 2015;5(4):389–405. Indicates the 21 papers that were included in the data extraction of the systematic review.
• Frias J, Virdi N, Raja P, Kim Y, Savage G, Osterberg L. Effectiveness of digital medicines to improve clinical outcomes in patients with uncontrolled hypertension and type 2 diabetes: prospective, open-label, cluster-randomized pilot clinical trial. J Med Internet Res. 2017;19(7):e246. Indicates the 21 papers that were included in the data extraction of the systematic review.
• Golshahi J, Ahmadzadeh H, Sadeghi M, Mohammadifard N, Pourmoghaddas A. Effect of self-care education on lifestyle modification, medication adherence and blood pressure in hypertensive adults: randomized controlled clinical trial. Adv Biomed Res. 2015;4:204. Indicates the 21 papers that were included in the data extraction of the systematic review.
• Kamal AK, Shaikh Q, Pasha O, Azam I, Islam M, Memon AA, et al. A randomized controlled behavioral intervention trial to improve medication adherence in adult stroke patients with prescription tailored Short Messaging Service (SMS)-SMS4Stroke study. BMC Neurol. 2015;15:212. Indicates the 21 papers that were included in the data extraction of the systematic review.
• Kang H, Park H-A. A mobile app for hypertension management based on clinical practice guidelines: development and deployment. JMIR Mhealth Uhealth. 2016;4(1):185–98. Indicates the 21 papers that were included in the data extraction of the systematic review.
• Khonsari S, Subramanian P, Chinna K, Latif LA, Ling LW, Gholami O. Effect of a reminder system using an automated short message service on medication adherence following acute coronary syndrome. Eur J Cardiovasc Nurs. 2015;14(2):170–9. Indicates the 21 papers that were included in the data extraction of the systematic review.
• Kim JY, Wineinger NE, Steinhubl SR. The influence of wireless self-monitoring program on the relationship between patient activation and health behaviors, medication adherence, and blood pressure levels in hypertensive patients: a substudy of a randomized controlled trial. J Med Internet Res. 2016;18(6):e116. Indicates the 21 papers that were included in the data extraction of the systematic review.
• Maslakpak MH, Safaie M. A comparison between the effectiveness of short message service and reminder cards regarding medication adherence in patients with hypertension: a randomized controlled clinical trial. Int J Community Based Nurs Midwifery. 2016;4(3):209–18. Indicates the 21 papers that were included in the data extraction of the systematic review.
• McGillicuddy, JW, Gregoski MJ, Brunner-Jackson BM, Weiland AK, Patel SK, Rock RA, et al. Facilitating medication adherence and eliminating therapeutic inertia using wireless technology: proof of concept findings with uncontrolled hypertensives and kidney transplant recipients. Proceedings of the conference on Wireless Health; 2012: ACM. Indicates the 21 papers that were included in the data extraction of the systematic review.
• McGillicuddy JW, Gregoski MJ, Weiland AK, Rock RA, Brunner-Jackson BM, Patel SK, et al. Mobile health medication adherence and blood pressure control in renal transplant recipients: a proof-of-concept randomized controlled trial. JMIR Res Protoc. 2013;2(2):e32-e. Indicates the 21 papers that were included in the data extraction of the systematic review.
• Migneault JP, Dedier JJ, Wright JA, Heeren T, Campbell MK, Morisky DE, et al. A culturally adapted telecommunication system to improve physical activity, diet quality, and medication adherence among hypertensive African-Americans: a randomized controlled trial. Ann Behav Med. 2012;43(1):62–73. Indicates the 21 papers that were included in the data extraction of the systematic review.
• Patel S, Jacobus-Kantor L, Marshall L, Ritchie C, Kaplinski M, Khurana PS, et al. Mobilizing your medications: an automated medication reminder application for mobile phones and hypertension medication adherence in a high-risk urban population. J Diabetes Sci Technol. 2013;7(3):630–9. Indicates the 21 papers that were included in the data extraction of the systematic review.
• Sieverdes J, Gregoski M, Patel S, Williamson D, Brunner-Jackson B, Rundbaken J, et al. mHealth medication and blood pressure self-management program in Hispanic hypertensives: a proof of concept trial. Smart Homecare Technol Telehealth. 2013;1:1–10. Indicates the 21 papers that were included in the data extraction of the systematic review.
• Varleta P, Akel C, Acevedo M, Salinas C, Pino J, Garcia A, et al. Mobile phone text messaging improves antihypertensive drug adherence in the community. Circulation. 2014;130 Indicates the 21 papers that were included in the data extraction of the systematic review.
• Wald DS, Bestwick JP, Raiman L, Brendell R, Wald NJ. Randomised trial of text messaging on adherence to cardiovascular preventive treatment (INTERACT trial). PloS One. 2014;9(12):e114268. Indicates the 21 papers that were included in the data extraction of the systematic review.
• Piette JD, Valverde H, Marinec N, Jantz R, Kamis K, de la Vega CL, et al. Establishing an independent mobile health program for chronic disease self-management support in Bolivia. Front Public Health. 2014;2:95. Indicates the 21 papers that were included in the data extraction of the systematic review.
Gary ML, Rebecca B, Kathryn S, Peter H, Elizabeth M, Paul L, et al. Digital interventions to promote self-management in adults with hypertension systematic review and meta-analysis. J Hypertens. 2016;16(1):1–14.
Yue Z, Li C, Weilin Q, Bin W. Application of the health belief model to improve the understanding of antihypertensive medication adherence among Chinese patients. Patient Educ Couns. 2015;98(5):669–73.
Yang S, He C, Zhang X, Sun K, Wu S, Sun X, et al. Determinants of antihypertensive adherence among patients in Beijing: application of the health belief model. Patient Educ Couns. 2016;99(11):1894–900.
Finitsis DJ, Pellowski JA, Johnson BT. Text message intervention designs to promote adherence to antiretroviral therapy (ART): a meta-analysis of randomized controlled trials. PLoS One. 2014;9(2):e88166.
Saffari M, Ghanizadeh G, Koenig HG. Health education via mobile text messaging for glycemic control in adults with type 2 diabetes: a systematic review and meta-analysis. Prim Care Diabetes. 2014;8(4):275–85.
We would like to thank Jingyu Tong, Mengsi Jiang, Shujun Fan, and Taylor Allen, who have provided great support during the process of developing this manuscript.
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards.
Shangzhi Xiong, Hudson Berkhouse, and Mary Schooler are co-first authors.
This article is part of the Topical Collection on Implementation to Increase Blood Pressure Control: What Works?
Appendix 2. Detailed Search Algorithm (Syntax) for Pubmed
This appendix provides detailed search algorithm (syntax) for the literature search on Pubmed. Analogous algorithms were used to search Embase and Web of Science.
The overall algorithm is: #1 AND #2 AND #3 AND #4
#1 (hypertension[Title/Abstract] OR hypertensive[Title/Abstract] OR hyperten*[Title/Abstract] OR “high blood pressure”[Title/Abstract] OR “blood pressure”[Title/Abstract] OR “escalated blood pressure”[Title/Abstract] OR “elevated blood pressure”[Title/Abstract] OR “abnormal blood pressure”[Title/Abstract])
#2 (medication[Title/Abstract] OR medicine[Title/Abstract] OR medical[Title/Abstract] OR regimen[Title/Abstract] OR drug[Title/Abstract] OR prescription[Title/Abstract])
#3 (Adherence[Title/Abstract] OR nonadherence[Title/Abstract] OR compliance[Title/Abstract] OR persistence[Title/Abstract] OR concordance[Title/Abstract] OR consistency[Title/Abstract] OR consistent[Title/Abstract])
#4 (mhealth[Title/Abstract] OR m-Health[Title/Abstract] OR “mobile health”[Title/Abstract] OR “cell phone”[Title/Abstract] OR “smart phone”[Title/Abstract] OR “text message”[Title/Abstract] OR SMS[Title/Abstract] OR “short messaging service”[Title/Abstract] OR tele-medicine[Title/Abstract] OR “mobile application”[Title/Abstract] OR eHealth[Title/Abstract] OR apps[Title/Abstract] OR application[Title/Abstract])
About this article
Cite this article
Xiong, S., Berkhouse, H., Schooler, M. et al. Effectiveness of mHealth Interventions in Improving Medication Adherence Among People with Hypertension: a Systematic Review. Curr Hypertens Rep 20, 86 (2018). https://doi.org/10.1007/s11906-018-0886-7
- Hypertension control
- Medication adherence
- Mobile health
- Systematic review