Long-Term Effect of Home Blood Pressure Self-Monitoring Plus Medication Self-Titration for Patients With Hypertension
Authors: Martínez-Ibáñez Patricia , Marco-Moreno Irene , García-Sempere Aníbal , Peiró Salvador , Martínez-Ibáñez Lucia , Barreira-Franch Ignacio , Bellot-Pujalte Laura , Avelino-Hidalgo Eugenia , Escrig-Veses Marina , Bóveda-García María , Calleja-del-Ser Mercedes , Robles-Cabaniñas Celia , Hurtado Isabel , Rodríguez-Bernal Clara L. , Giménez-Loreiro Margarita , Sanfélix-Gimeno Gabriel , Sanfélix-Genovés José ,   ADAMPA Research Group, Abad Carrasco Joaquín , Agudo Escagüés Maria Virginia , Navarro-Perez Jorge , Bartual Penella Rosa Maria , Carrión Villanueva Rosa , Costa Alcaraz Ana , Cristófol López Isabel , González Candelas Rosario , González Espadas Ricardo , González Luján Luis , Gosalbes Victoria , Guinot Martínez Enrique , López Torres Emilio Luis , Molla LLosa Silvia , Moreno Comins Víctor , Moreno Prat Miriam , Puchades Company Mª José , Ramos García Ángela , Ramos Ruiz Paloma , Roca Navarro Pilar , Saiz Rodriguez Rosa , Salanova Chilet Julia Lorena , Tchang Sanchez Ana , Torres Asensi Francisca , Uribes Fillol Ruth , Valle García Cristina , Villar Ruiz Macarena , Alcocer Escribano Marta , Almudever Campo Laura , Cruz Bautista Lorena , Fuertes Fernandez Mª Begoña , García Olivencia Victor , Molla Orts Carmen , Muñoz Sanchíz María José , Osuna Sabariego Francisca , Ramón Carretero Emilia , Roca Roda Pilar , Rodriguez García Esther , Serrada Iranzo Maria Rosa , Sierra García Eva , Iftimi Adina A , Ferrero-Gregori Andreu 
Published: May 2024

ImportancePatient empowerment through pharmacologic self-management is a common strategy for some chronic diseases such as diabetes, but it is rarely used for controlling blood pressure (BP). Several trials have shown its potential for reducing BP in the short term, but evidence in the longer term is scarce.ObjectiveTo evaluate the longer-term effectiveness of BP self-monitoring plus self-titration of antihypertensive medication vs usual care for patients with poorly controlled hypertension, with passive follow-up and primary-care nursing involvement.Design, Setting, and ParticipantsThe ADAMPA (Impact of Self-Monitoring of Blood Pressure and Self-Titration of Medication in the Control of Hypertension) study was a randomized, unblinded clinical trial with 2 parallel arms conducted in Valencia, Spain. Included participants were patients 40 years or older, with systolic BP (SBP) over 145 mm Hg and/or diastolic BP (DBP) over 90 mm Hg, recruited from July 21, 2017, to June 30, 2018 (study completion, August 25, 2020). Statistical analysis was conducted on an intention-to-treat basis from August 2022 to February 2024.InterventionsParticipants were randomized 1:1 to usual care vs an individualized, prearranged plan based on BP self-monitoring plus medication self-titration.Main Outcomes and MeasuresThe main outome was the adjusted mean difference (AMD) in SBP between groups at 24 months of follow-up. Secondary outcomes were the AMD in DBP between groups at 24 months of follow-up, proportion of patients reaching the BP target (SBP &amp;lt;140 mm Hg and DBP &amp;lt;90 mm Hg), change in behaviors, quality of life, health service use, and adverse events.ResultsAmong 312 patients included in main trial, data on BP measurements at 24 months were available for 219 patients (111 in the intervention group and 108 in the control group). The mean (SD) age was 64.3 (10.1) years, and 120 patients (54.8%) were female; the mean (SD) SBP was 155.6 (13.1) mm Hg, and the mean (SD) diastolic BP was 90.8 (7.7) mm Hg. The median follow-up was 23.8 months (IQR, 19.8-24.5 months). The AMD in SBP at the end of follow-up was −3.4 mm Hg (95% CI, −4.7 to −2.1 mm Hg; P &amp;lt; .001), and the AMD in DBP was −2.5 mm Hg (95% CI, −3.5 to −1.6 mm Hg; P &amp;lt; .001). Subgroup analysis for the main outcome showed consistent results. Sensitivity analyses confirmed the robustness of the main findings. No differences were observed between groups in behaviors, quality of life, use of health services, or adverse events.Conclusions and RelevanceIn this secondary analysis of a randomized clinical trial, BP self-monitoring plus self-titration of antihypertensive medication based on an individualized prearranged plan used in primary care reduced BP in the longer term with passive follow-up compared with usual care, without increasing health care use or adverse events. These results suggest that simple, inexpensive, and easy-to-implement self-management interventions have the potential to improve the long-term control of hypertension in routine clinical practice.Trial RegistrationClinicalTrials.gov Identifier: NCT03242785