What is the clinical evidence from this study?

Study design: Observational. Population: Hypertension (n=11059). Intervention: Home blood pressure monitoring (HBPM). Primary outcome: Active participation in home blood pressure monitoring (associated with age per decade) (AOR 1.29, 95% CI 1.23-1.36).

October 19, 2021Open Access

Factors influencing participation and long-term commitment to self-monitoring of blood pressure in a large remote clinical trial: The treatment in morning versus evening (TIME) study

Key Result

Older age was positively associated with active participation in home blood pressure monitoring (AOR 1.29 per decade), whereas smoking (AOR 0.63) and higher BMI (AOR 0.91) were negatively associated.

Study Design

Type

Observational (n=11,059)

Blinding

Open-label

Multicenter

Yes

Structured PICO

What factors influence active participation and long-term commitment to home blood pressure monitoring in adults with hypertension?

Population

11,059 adults aged 18 or over receiving treatment for hypertension with one or more antihypertensive drugs who agreed to submit home blood pressure measurements in the TIME study. Mean age 67.8, 61.5% male, UK-based.

Intervention

Home blood pressure monitoring (HBPM) participation and long-term commitment

Outcome

Active participation (submitting at least one 4-7 day set of BP measurements) and long-term commitment (submitting at least six 4-7 day sets of BP measurements post-consent, equivalent to 1 year)

Older age and lower socioeconomic deprivation are associated with better adherence to home blood pressure monitoring, whereas higher BMI and smoking are associated with lower participation, highlighting the need for targeted support in higher-risk groups.

Main Result

Effect estimate: AOR 1.29 (95% CI 1.23-1.36)

Limitations

Voluntary study participants may exhibit greater responsibility in chronic disease management, limiting generalizability to the broader population.
Reliance on participant-reported data without routine validation.
Very small numbers of participants from Northern Ireland limits country-specific generalizability.

Abstract

Abstract This study investigates factors associated with active participation, and long-term commitment, to home blood pressure monitoring (HBPM) in the TIME study, a remote clinical trial assessing the effectiveness of morning vs. evening dosing of antihypertensive medications on cardiovascular outcomes in adults with hypertension. Participants reporting HBPM ownership were invited to submit blood pressure (BP) measurements three-monthly. Factors associated with active participation (submitting at least one set of BP measurements), and longer-term commitment (at least six sets of BP measurements), were analysed using multivariable logistic regression. 11,059 participants agreed to provide BP measurements, of whom 7646 submitted. Active participation was associated with age (adjusted odds ratio (AOR) per decade, 1.29; 95% CI 1.23–1.36), positive family history of hypertension (AOR 1.11; 95% CI 1.01–1.21), number of antihypertensive medications (AOR, 1.10; 95% CI 1.04–1.16), and lower deprivation (AOR per decile, 1.03; 95% CI 1.01–1.05). People with higher body mass index (BMI) and smokers were less likely to participate (AOR, 0.91 (per increase of 5.0 kg/m 2 ) and 0.63 respectively; all p < 0.001). 3,655 participants (47.8%) submitted measurements beyond one year. Non-modifiable risk factors – age (AOR per decade, 1.29; 95% CI 1.21–1.37) and positive family history of hypertension (AOR, 1.15; 95% CI 1.03–1.27) – were positively associated with longer-term commitment. Higher BMI (AOR per 5.0 kg/m 2 , 0.89; 95% CI 0.85–0.93), smoking (AOR 0.60, 95% CI 0.44–0.82) and higher baseline systolic blood pressure (AOR per mmHg, 0.99; 95% CI 0.98–0.99) were negatively associated. This study provides insight into factors that influence HBPM use.

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