HYPERTENSION MANAGEMENT IN CANADIAN INDIGENOUS COMMUNITIES AND LOWER AND MIDDLE INCOME COUNTRIES, RESULTS OF THE CANADIAN ARM OF THE DREAMGLOBAL STUDY

Abstract

The DreamGlobal study incorporates innovations in digital medicine technology with text messaging and the use of cell phones, as well as task shifting of blood pressure measurement to the Community and transmission of the measures to the patient's health care provider. In this pragmatic RCT study participants received culturally competent text message to improve their engagement in hypertension management over a one year period. Blood pressure was measured with an automated device linked by BlueTooth to a smartphone and central server. Blood pressure was measured by trained non-medical health workers every three months. The readings in the first two months were compared to the readings in the last two months of the study. Participants had uncontrolled hypertension and lived on one of six participating First Nations reserves in Ontario, Québec, or New Brunswick. Participants received Hypertension Canada Clinical Practice Guidelines based SMS text messages twice weekly, randomized to receive either passive (health behaviours change only) or active (including also treatment information). Health literacy about the SMS messages was assessed at study end. Over 120 subjects were part of the blood pressure lowering cohort. Baseline blood pressure was 143/85 mmHg and fell to 136/81 mmHg over the course of the study. There was a greater blood pressure fall in the active than in the passive SMS groups (7.5/4.7 mmHg vs 6.5/2.7 mmHg p < 0.01 for DBP). Health literacy scores for the active SMS group were higher than in the passive SMS group. Achieving guidelines based management of non-communicable chronic diseases is more challenging in remote, resource poor environments. SMS messages can help to improve health literacy and are shown to be associated with improved blood pressure lowering in people with uncontrolled hypertension. Task shifting of blood pressure measurement including non-medical health workers supported by a secure system to bring the results to the health record and to the patient, supported by informative SMS messages leads to lower blood pressure. Canadian Institutes of Health Research (CIHR)