Very few patient-centered, theory-guided programs for medication adherence and blood pressure control have been conducted in kidney transplant recipients.
Objective—
To evaluate preliminary indications of sustainability of improved blood pressure in kidney transplant recipients 12 months after completion of a 3-month randomized controlled trial of a mobile health pilot program to improve blood pressure and medication adherence.
Participants and Design—
A total of 18 of the 19 trial participants were contacted and all consented to inclusion in the retrospective analysis of their medical records showing their clinic-recorded systolic blood pressures at 3, 6, and 12 months following participation in the 3-month trial of a medical regimen self-management intervention.
Results—
A significant group difference in systolic blood pressure was observed longitudinally, indicating that the intervention group, as compared with the standard-care group, exhibited lower clinic-measured systolic blood pressures at the 12-month posttrial follow-up visit (P = .01). At 12-month follow-up, success in establishing and sustaining control of systolic blood pressure (<131 mm Hg) was greater in the intervention group (50%) than in the control group (11%).
Conclusion—
Patients in the intervention group continued to exhibit lower systolic blood pressure than did patients in the control group 12 months after the trial ended, suggesting that the intervention may have a durable impact on blood pressure control that most likely reflects sustained medication adherence. These findings will aid in the development of an adequately powered randomized controlled trial to address the sustainable impact of the intervention program on medication adherence and blood pressure control.
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References
1.
NeippMKaravulBJackobsS. Quality of life in adult transplant recipients more than 15 years after kidney transplantation. Transplantation. 2006;81(12):1640–1644.
LambKELodhiSMeier-KriescheHU. Long-term renal allograft survival in the United States: a critical reappraisal. Am J Transplant. 2011;11(3):450–462. doi:10.1111/j.1600-6143.2010.03283.x.
4.
DenhaerynckKDobbelsFCleemputI. Prevalence, consequences, and determinants of nonadherence in adult renal transplant patients: a literature review. Transpl Int. 2005;18(10):1121–1133.
5.
WadeiHMTextorSC. Hypertension in the kidney transplant recipient. Transplant Rev (Orlando). 2010;24(3):105–120. doi:10.1016/j.trre.2010.02.001.
6.
TakemotoSKPinskyBWSchnitzlerMA. A retrospective analysis of immunosuppression compliance, dose reduction and discontinuation in kidney transplant recipients. Am J Transplant. 2007;7(12):2704–2711.
7.
DewMADiMartiniAFDe Vito DabbsA. Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation. Transplantation. 2007;83(7):858–873.
8.
RussellCConnVAshbaughC. Taking immunosuppressive medications effectively (TIMELink): a pilot randomized controlled trial in adult kidney transplant recipients. Clin Transplant. 2011;25(6):864–870. doi:10.1111/j.1399-0012.2010.01358.x.
9.
McGillicuddyJWGregoskiMJWeilandAK. 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. doi:10.2196/resprot.2633.
10.
McGillicuddyJWGregoskiMJBrunner-JacksonBM. Facilitating medication adherence and eliminating therapeutic inertia using wireless technology: proof of concept findings with uncontrolled hypertensives and kidney transplant recipients. J Assoc Comp Mach. 2012:1–9.
11.
JamesPAOparilSCarterBL. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–520.
12.
USRDS. USRDS 2013 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Ann Arbor, MI: USRDS; 2013.
13.
DiazJMGichIBonfillX. Prevalence evolution and impact of cardiovascular risk factors on allograft and renal transplant patient survival. Transplant Proc. 2009;41(6):2151–2155.
14.
Fernandez FresnedoGFranco EsteveAGomez HuertasE. Ambulatory blood pressure monitoring in kidney transplant patients: RETENAL study. Transplant Proc. 2012;44(9):2601–2602.
15.
KasiskeBLAnjumSShahR. Hypertension after kidney transplantation. Am J Kidney Dis. 2004;43(6):1071–1081.
16.
PonticelliCCucchiariDGrazianiG. Hypertension in kidney transplant recipients. Transpl Int. 2011;24(6):523–533. doi:10.1111/j.1432-2277.2011.01242.x.
17.
AhmedJOzorioVFarrantMVan Der MerweW. Ambulatory vs office blood pressure monitoring in renal transplant recipients. J Clin Hypertens. 2015;17(1):46–50. doi:10.1111/jch.12448.
18.
PaolettiEGherziMAmidoneMMassarinoFCannellaG. Association of arterial hypertension with renal target organ damage in kidney transplant recipients: the predictive role of ambulatory blood pressure monitoring. Transplantation. 2009;87(12):1864–1869.
19.
CzyzewskiLWyzgalJKolekA. Evaluation of selected risk factors of cardiovascular diseases among patients after kidney transplantation, with particular focus on the role of 24-hour automatic blood pressure measurement in the diagnosis of hypertension: an introductory report. Ann Transplant. 2014;19:188–198.
20.
Opelz G, Dohler B, Collaborative Transplant Study. Improved long-term outcomes after renal transplantation associated with blood pressure control. Am J Transplant. 2005;5(11):2725–2731.
21.
CramerJABenedictAMuszbekNKeskinaslanAKhanZM. The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review. Int J Clin Pract. 2008;62(1):76–87.
22.
DusingR. Overcoming barriers to effective blood pressure control in patients with hypertension. Curr Med Res Opin. 2006;22(8):1545–1553.
23.
Krousel-WoodMJoyceCHoltE. Predictors of decline in medication adherence: results from the cohort study of medication adherence among older adults. Hypertension. 2011;58(5):804–810.
24.
TaberDJSrinivasTMPilchNA. Are thiazide diuretics safe and effective antihypertensive therapy in kidney transplant recipients?Am J Nephrol. 2013;38(4):285–291.
25.
ThomasBTaberDJSrinivasTR. Hypertension after kidney transplantation: a pathophysiologic approach. Curr Hypertens Rep. 2013;15(5):458–469. doi:10.1007/s11906-013-0381-0.
26.
LowJKWilliamsAManiasECrawfordK. Interventions to improve medication adherence in adult kidney transplant recipients: a systematic review. Nephrol Dial Transplant. 2015;30(5):752–761.
27.
De GeestSSchafer-KellerPDenhaerynckK. Supporting medication adherence in renal transplantation (SMART): a pilot RCT to improve adherence to immunosuppressive regimens. Clin Transplant. 2006;20(3):359–368.
28.
AgarwalRBillsJEHechtTJLightRP. Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analysis. Hypertension. 2011;57(1):29–38.
29.
GlynnLGMurphyAWSmithSMSchroederKFaheyT. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev. 2010;(3):CD005182.
30.
CappuccioFPKerrySMForbesLDonaldA. Blood pressure control by home monitoring: meta-analysis of randomised trials. BMJ. 2004;329(7458):145.
31.
BashshurRLShannonGWSmithBR. The empirical foundations of telemedicine interventions for chronic disease management. Telemed J E Health. 2014;20(9):769–800.
32.
SivakumaranDEarleKA. Telemonitoring: use in the management of hypertension. Vasc Health Risk Manag. 2014;10:217–224.
33.
MargolisKLAscheSEBergdallAR. Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. JAMA. 2013;310(1):46–56. doi:10.1001/jama.2013.6549.
34.
KrishnaSBorenSABalasEA. Healthcare via cell phones: a systematic review. Telemed J E Health. 2009;15(3):231–240.
35.
DemonceauJRupparTKristantoP. Identification and assessment of adherence-enhancing interventions in studies assessing medication adherence through electronically compiled drug dosing histories: a systematic literature review and meta-analysis. Drugs. 2013;73(6):545–562.
36.
ChandakAJoshiA. Self-management of hypertension using technology enabled interventions in primary care settings. Technol Health Care. 2015;23(2):119–128.
37.
McGillicuddyJWWeilandAKFrenzelRM. Patient attitudes toward mobile phone-based health monitoring: questionnaire study among kidney transplant recipients. J Med Internet Res. 2013;15(1):e6. doi:10.2196/jmir.2284.
38.
StellefsonMChaneyBBarryAE. Web 2.0 chronic disease self-management for older adults: a systematic review. J Med Internet Res. 2013;15(2):e35.
39.
WangJWangYWeiCYaoNAYuanAShanYYuanC. Smartphone interventions for long-term health management of chronic diseases: an integrative review. Telemed J E Health. 2014;20(6):570–583. doi:10.1089/tmj.2013.0243.
40.
BolandP. The emerging role of cell phone technology in ambulatory care. J Ambul Care Manage. 2007;30(2):126–133.
41.
SetoELeonardKJCafazzoJABarnsleyJMasinoCRossHJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res. 2012;14(1):e25. doi:10.2196/jmir.1912.
42.
KauerSDReidSCCrookeAH. Self-monitoring using mobile phones in the early stages of adolescent depression: randomized controlled trial. J Med Internet Res. 2012;14(3):e67.
43.
QuinnCCShardellMDTerrinML. Mobile diabetes intervention for glycemic control in 45- to 64-year-old persons with type 2 diabetes [published online ahead of print August 6, 2014]. J Appl Gerontol. 2014. doi:10.1177/0733464814542611.
44.
VuongAMHuberJCJrBolinJN. Factors affecting acceptability and usability of technological approaches to diabetes self-management: a case study. Diabetes Technol Ther. 2012;14(12):1178–1182. doi:10.1089/dia.2012.0139.
45.
SetoELeonardKJCafazzoJABarnsleyJMasinoCRossHJ. Mobile phone-based telemonitoring for heart failure management: a randomized controlled trial. J Med Internet Res. 2012;14(1):e31. doi:10.2196/jmir.1909.
