| Title: |
Home Blood Pressure Self-monitoring plus Self-titration of Antihypertensive Medication for Poorly Controlled Hypertension in Primary Care: the ADAMPA Randomized Clinical Trial. |
| Authors: |
Martínez-Ibáñez, Patricia, Marco-Moreno, Irene, Peiró, Salvador, Martínez-Ibáñez, Lucia, Barreira-Franch, Ignacio, Bellot-Pujalte, Laura, Avelino-Hidalgo, Eugenia, Escrig-Veses, Marina, Bóveda-García, María, Calleja-del-Ser, Mercedes, Ferrero-Gregori, Andreu, Iftimi, Adina A., Hurtado, Isabel, García-Sempere, Aníbal, Rodríguez-Bernal, Clara L, Giménez-Loreiro, Margarita, Sanfélix-Gimeno, Gabriel, Sanfélix-Genovés, José, the ADAMPA research group, Abad Carrasco, J |
| Source: |
JGIM: Journal of General Internal Medicine; Jan2023, Vol. 38 Issue 1, p81-89, 9p, 2 Diagrams, 3 Charts |
| Subject Terms: |
AMBULATORY blood pressure monitoring, BLOOD pressure, ANTIHYPERTENSIVE agents, DIASTOLIC blood pressure, SYSTOLIC blood pressure, CLINICAL trials monitoring, PATIENT participation |
| Geographic Terms: |
VALENCIA (Spain) |
| Abstract: |
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. [ABSTRACT FROM AUTHOR] |
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| Database: |
Complementary Index |
