Key result
BP self-monitoring plus education reduces systolic BP by ~6 mmHg versus standard care.
Why the study?
Self-monitoring of blood pressure has been shown to optimize hypertension management in high-income settings, but evidence from low-to-middle income countries is limited.
Does self-monitoring of blood pressure and health education reduce systolic blood pressure in hypertensive patients in a middle-income country?
RCT (n=80)
Open-label
1:1
Yes
Does self-monitoring of blood pressure and health education reduce systolic blood pressure in hypertensive patients in a middle-income country?
A pilot trial in Lebanon demonstrates that self-monitoring of blood pressure combined with education is feasible, acceptable, and associated with significant short-term reductions in systolic blood pressure.
Supports self-monitoring plus education for hypertension in middle-income countries; extends prior high-income RCT evidence to new settings.
Background Self-monitoring of blood pressure has been shown to optimize the management of blood pressure in high-income settings, but there is less evidence from low-to-middle income countries. We designed a proof-of-concept pilot trial to assess the feasibility and acceptability of an intervention built around self-monitoring of blood pressure and health education, and to measure its association with reduced blood pressure among hypertensives. The study was conducted in Lebanon, a country where the management of hypertension presents challenges similar to those faced in countries of the Arab region and other middle-income countries. Methods We conducted a parallel two-arm pilot trial with a mixed-method approach to investigate the effect of the intervention on patient experience. Hypertensive patients (n = 80) were recruited at two primary and one tertiary health centers in Beirut, and were randomly allocated (1:1) to either an intervention group where patients received blood pressure devices, diaries and educational sessions, or a control group where patients received standard of care as practiced in their health centers. The main outcomes were feasibility (recruitment, retention and adherence), acceptability, and changes in systolic blood pressure. Quantitative and qualitative data were obtained at baseline and 6 weeks later. Results The recruitment rates for the study was 52% and retention was 95%. Most participants in the self-monitoring group (33/38) reported that the device was convenient and easy to use. Complete case analysis showed that blood pressure monitoring was associated with a greater reduction in systolic (-6.3 mmHg, 95%CI [-12.4; − 0.17]) and diastolic (-1.9 mmHg, 95%CI [-6.34; 2.58]) blood pressure in the self-monitoring group (n = 36) as compared to the standard of care group (n = 36). Improved knowledge of hypertension was also observed in the self-monitoring group. There were no adverse events related to study participation. Conclusions Self-monitoring is acceptable and feasible and has the potential to improve hypertension management. Our results should be further tested in trials with adequate statistical power and longer follow-up periods to examine the effectiveness of the intervention on blood pressure levels. Trial Registration and funding: Retrospectively Registered on April 3, 2020. ISRCTN 16450193. Funded by the Harvard Medical School Center for Global Health Delivery.
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Akl et al. (2020) conducted an RCT in Hypertension (n=80). Self-monitoring of blood pressure and health education vs. Standard of care was evaluated on Change in systolic blood pressure at 6 weeks (MD -6.3 mmHg, 95% CI -12.4 to -0.17, p=0.04). Self-monitoring of blood pressure combined with health education significantly reduced systolic blood pressure by an adjusted mean difference of 6.3 mmHg compared to standard of care.
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