Self-monitoring plus self-titration of antihypertensive medication did not significantly reduce systolic blood pressure at 12 months compared to usual care (adjusted mean difference -2.9 mmHg).
RCT (n=366)
Open-label
1:1
Yes
Does home blood pressure self-monitoring plus self-titration of antihypertensive medication reduce systolic blood pressure at 12 months in poorly controlled hypertensive patients in primary care?
Self-monitoring and self-titration of antihypertensive medication did not significantly reduce systolic blood pressure at 12 months compared to usual care, though it improved the proportion of patients achieving optimal blood pressure control.
Effect estimate: AMD -2.9 mmHg (95% CI -5.9 to 0.1)
Absolute Event Rate: 136.1% vs 139.1%
p-value: p=0.061
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.
Martínez-Ibáñez et al. (Tue,) conducted a rct in Poorly controlled hypertension (n=366). Self-monitoring plus self-titration of antihypertensive medication vs. Usual care was evaluated on Adjusted mean difference in systolic blood pressure at 12 months (AMD -2.9 mmHg, 95% CI -5.9 to 0.1, p=0.061). Self-monitoring plus self-titration of antihypertensive medication did not significantly reduce systolic blood pressure at 12 months compared to usual care (adjusted mean difference -2.9 mmHg).