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

Autor: Patricia, Martínez-Ibáñez, Irene, Marco-Moreno, Salvador, Peiró, Lucia, Martínez-Ibáñez, Ignacio, Barreira-Franch, Laura, Bellot-Pujalte, Eugenia, Avelino-Hidalgo, Marina, Escrig-Veses, María, Bóveda-García, Mercedes, Calleja-Del-Ser, Andreu, Ferrero-Gregori, Adina A, Iftimi, Isabel, Hurtado, Aníbal, García-Sempere, Clara L, Rodríguez-Bernal, Margarita, Giménez-Loreiro, Gabriel, Sanfélix-Gimeno, José, Sanfélix-Genovés, M, Villar Ruiz
Rok vydání: 2022
Předmět:
Zdroj: Journal of General Internal Medicine. 38:81-89
ISSN: 1525-1497
0884-8734
DOI: 10.1007/s11606-022-07791-z
Popis: 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 (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.
Databáze: OpenAIRE
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