Effect of Posting on Social Media on Systolic Blood Pressure and Management of Hypertension: A Randomized Controlled Trial

Abstract

Background Online platforms are used to manage aspects of our lives including health outside clinical settings. Little is known about the effectiveness of using online platforms to manage hypertension. We assessed effects of tweeting/retweeting cardiovascular health content by individuals with poorly controlled hypertension on systolic blood pressure (SBP) and patient activation. Methods and Results We conducted this 2-arm randomized controlled trial. Eligibility included diagnosis of hypertension; SBP >140 mm Hg; and an existing Twitter account or willingness to create one to follow study Twitter account. Intervention arm was asked to tweet/retweet health content 2×/week using a specific hashtag for study duration (6 months). The main measures include primary outcome change in SBP; secondary outcome point change in Patient Activation Measure (PAM). We remotely recruited and enrolled 611 participants, mean age 52 (SD, 11.7). Mean baseline SBP for the intervention group was 155.8 and for control was 155.6. At 6 months, mean SBP for intervention group was 137.6 and for control was 135.7. Mean change in SBP from baseline to 6 months for the intervention group was -18.5 and for control was -19.8 (P=0.48). Mean PAM at baseline for the intervention group was 70.3 for control was 72.7. At 6 months, mean PAM scores were 71.1 (intervention) and 75.6 (control). Mean change in PAM score for the intervention group was 0.0 and for control was 3.3 (P=0.12). Conclusions Recruiting and engaging patients and collecting outcome measures remotely are feasible using Twitter. Encouraging patients with poorly controlled hypertension to tweet or retweet health content on Twitter did not improve SBP or PAM score at 6 months. Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02622256.

Keywords: Twitter; blood pressure; digital health; hypertension; online post; social media.

Conflict of interest statement

Dr Merchant reports research funding (NIH R01 122457). Dr Asch has received research funding from NIH; owns stock in Berkshire Hathaway; is a partner in and part owner of VAL Health; and has received compensation and/or travel support for speaking, writing, or consulting from the following organizations: AFYA, MTS Health Partnership, Children’s Hospital of Philadelphia, University of Virginia, Salzburg Global Seminars, GSK, JFK Health System, Cosmetic Boot Camp, Meeting Designs, Capital Consulting, Healthcare Financial Management Association, Joslin Diabetes Center, National Academy of Medicine, the Commonwealth Fund, Massachusetts Medical Society, Endocrine Society, Osteoarthritis Research Society International, Baystate Medical Center, Weill‐Cornell Medical College, Association of American Medical Colleges, TED MED, National Alliance of Health Care Purchaser Coalitions, Deloitte, Harvard University, American Association for Physician Leadership, Brandeis University, University of Rochester, Partner’s Health Care System, John Dolan Lectureship, Johns Hopkins University, and MITRE. The remaining authors have no disclosures to report.

Figures

Figure 1. Consolidated Standards of Reporting Trials diagram.

This figure illustrates the study Consolidated Standards of Reporting Trials diagram regarding participant inclusion, exclusion, and outcomes. *The 17 participants who withdrew from the study were in the intervention arm, White (n=16; 94%), and majority men (n=10; 59%).