Home Blood Pressure Self-monitoring plus Self-titration of Antihypertensive Medication for Poorly Controlled Hypertension in Primary Care: the ADAMPA Randomized Clinical Trial.

Autor:	Martínez-Ibáñez P; INCLIVA Health Research Institute, Valencia, Spain.; Health Services Research Unit, FISABIO, Catalunya Av. 21, 46020, Valencia, Spain.; Research Network On Chronicity, Primary Care, and Health Promotion (RICAPPS), Valencia, Spain., Marco-Moreno I; INCLIVA Health Research Institute, Valencia, Spain.; Health Services Research Unit, FISABIO, Catalunya Av. 21, 46020, Valencia, Spain.; Research Network On Chronicity, Primary Care, and Health Promotion (RICAPPS), Valencia, Spain., Peiró S; Health Services Research Unit, FISABIO, Catalunya Av. 21, 46020, Valencia, Spain.; Department of Statistics and Operations Research, Universidad de Valencia, Valencia, Spain.; Research Network On Chronicity, Primary Care, and Health Promotion (RICAPPS), Valencia, Spain., Martínez-Ibáñez L; INCLIVA Health Research Institute, Valencia, Spain., Barreira-Franch I; INCLIVA Health Research Institute, Valencia, Spain., Bellot-Pujalte L; INCLIVA Health Research Institute, Valencia, Spain., Avelino-Hidalgo E; INCLIVA Health Research Institute, Valencia, Spain., Escrig-Veses M; INCLIVA Health Research Institute, Valencia, Spain., Bóveda-García M; INCLIVA Health Research Institute, Valencia, Spain., Calleja-Del-Ser M; INCLIVA Health Research Institute, Valencia, Spain., Ferrero-Gregori A; INCLIVA Health Research Institute, Valencia, Spain.; Health Services Research Unit, FISABIO, Catalunya Av. 21, 46020, Valencia, Spain., Iftimi AA; INCLIVA Health Research Institute, Valencia, Spain.; Health Services Research Unit, FISABIO, Catalunya Av. 21, 46020, Valencia, Spain.; Department of Statistics and Operations Research, Universidad de Valencia, Valencia, Spain., Hurtado I; Health Services Research Unit, FISABIO, Catalunya Av. 21, 46020, Valencia, Spain.; Network for Health Services Research in Chronic Diseases (REDISSEC), Valencia, Spain.; Research Network On Chronicity, Primary Care, and Health Promotion (RICAPPS), Valencia, Spain., García-Sempere A; Health Services Research Unit, FISABIO, Catalunya Av. 21, 46020, Valencia, Spain.; Network for Health Services Research in Chronic Diseases (REDISSEC), Valencia, Spain.; Research Network On Chronicity, Primary Care, and Health Promotion (RICAPPS), Valencia, Spain., Rodríguez-Bernal CL; Health Services Research Unit, FISABIO, Catalunya Av. 21, 46020, Valencia, Spain.; Network for Health Services Research in Chronic Diseases (REDISSEC), Valencia, Spain.; Research Network On Chronicity, Primary Care, and Health Promotion (RICAPPS), Valencia, Spain., Giménez-Loreiro M; INCLIVA Health Research Institute, Valencia, Spain., Sanfélix-Gimeno G; Health Services Research Unit, FISABIO, Catalunya Av. 21, 46020, Valencia, Spain. sanfelix_gab@gva.es.; Network for Health Services Research in Chronic Diseases (REDISSEC), Valencia, Spain. sanfelix_gab@gva.es.; Research Network On Chronicity, Primary Care, and Health Promotion (RICAPPS), Valencia, Spain. sanfelix_gab@gva.es., Sanfélix-Genovés J; INCLIVA Health Research Institute, Valencia, Spain.; Health Services Research Unit, FISABIO, Catalunya Av. 21, 46020, Valencia, Spain.; Network for Health Services Research in Chronic Diseases (REDISSEC), Valencia, Spain.
Jazyk:	angličtina
Zdroj:	Journal of general internal medicine [J Gen Intern Med] 2023 Jan; Vol. 38 (1), pp. 81-89. Date of Electronic Publication: 2022 Oct 11.
DOI:	10.1007/s11606-022-07791-z
Abstrakt:	Background: Patient empowerment through pharmacological self-management is a common strategy in some chronic diseases such as diabetes, but it is rarely used for controlling blood pressure. Objective: This study aimed to assess self-monitoring plus self-titration of antihypertensive medication versus usual care for reducing systolic blood pressure (SBP) at 12 months in poorly controlled hypertensive patients. Design: The ADAMPA study was a pragmatic, controlled, randomized, non-masked clinical trial with two parallel arms in Valencia, Spain. Participants: Hypertensive patients older than 40 years, with SBP over 145 mmHg and/or diastolic blood pressure (DBP) over 90 mmHg, were recruited from July 2017 to June 2018. Intervention: Participants were randomized 1:1 to usual care versus an individualized, pre-arranged plan based on self-monitoring plus self-titration. Main Measure: The primary outcome was the adjusted mean difference (AMD) in SBP between groups at 12 months. Key Results: Primary outcome data were available for 312 patients (intervention n=156, control n=156) of the 366 who were initially recruited. The AMD in SBP at 12 months (main analysis) was -2.9 mmHg (95% CI, -5.9 to 0.1, p=0.061), while the AMD in DBP was -1.9 mmHg (95% CI, -3.7 to 0.0, p=0.052). The results of the subgroup analysis were consistent with these for the main outcome measures. More patients in the intervention group achieved good blood pressure control (<140/90 mmHg) at 12 months than in the control group (55.8% vs 42.3%, difference 13.5%, 95% CI, 2.5 to 24.5%, p=0.017). At 12 months, no differences were observed in behavior, quality of life, use of health services, or adverse events. Conclusion: Self-monitoring plus self-titration of antihypertensive medication based on an individualized pre-arranged plan used in primary care may be a promising strategy for reducing blood pressure at 12 months compared to usual care, without increasing healthcare utilization or adverse events. Trial Registration: EudraCT, number 2016-003986-25 (registered 17 March 2017) and clinicaltrials.gov , NCT03242785. (© 2022. The Author(s).)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu Full text from SpringerLink