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

Importance Patient 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. Objective To 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 Participants The 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. Interventions Participants were randomized 1:1 to usual care vs an individualized, prearranged plan based on BP self-monitoring plus medication self-titration. Main Outcomes and Measures The 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;amp;lt;140 mm Hg and DBP &amp;amp;lt;90 mm Hg), change in behaviors, quality of life, health service use, and adverse events. Results Among 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;amp;lt; .001), and the AMD in DBP was −2.5 mm Hg (95% CI, −3.5 to −1.6 mm Hg; P &amp;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 Relevance In 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 Registration ClinicalTrials.gov Identifier: NCT03242785