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

2022; Springer Science+Business Media; Volume: 38; Issue: 1 Linguagem: Inglês

10.1007/s11606-022-07791-z

1525-1497

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, Joaquín Abad Carrasco, MV Agudo Escagüés, Eugenia Avelino-Hidalgo, Ignacio Barreira-Franch, RM Bartual Penella, Laura Bellot-Pujalte, María Bóveda-García, M Calleja Del Ser, R Carrión Villanueva, A Costa Alcaraz, Isabel Cristófol López, Marina Escrig-Veses, Andreu Ferrero‐Gregori, Aníbal García‐Sempere, Margarita Giménez-Loreiro, Rosario González Candelas, Ricardo González Espadas, L González Luján, V Gosalbes, E Guinot Martínez, Isabel Hurtado, AA Iftimi, EL López Torres, Irene Marco-Moreno, Patricia Martínez-Ibáñez, L Martinez Ibañez, Silvia Molla LLosa, Víctor Moreno Comins, Miriam Moreno Prat, José Javier Navarro Pérez, Salvador Peiró, MJ Puchades Company, Alberto García, Paloma Ramos Ruiz, P Roca Navarro, Clara L. Rodríguez‐Bernal, Rosa Saiz Rodriguez, JL Salanova Chilet, José Sanfélix‐Genovés, Gabriel Sanfélix‐Gimeno, Ana Tchang Sanchez, Francisca Torres Asensi, Ruth Uribes Fillol, Cristina Valle García, Macarena Villar Ruiz,

Cardiac Health and Mental Health

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.