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Unda Villafuerte F, Llobera Cànaves J, Estela Mantolan A, Bassante Flores P, Rigo Carratalà F, Requena Hernández A, Oliver Oliver B, Pou Bordoy J, Moreno Sancho ML, Leiva A, Lorente Montalvo P. Effectiveness of medication self-management, self-monitoring and a lifestyle intervention on hypertension in poorly controlled patients: The MEDICHY randomized trial. Front Cardiovasc Med 2024; 11:1355037. [PMID: 38836068 PMCID: PMC11148777 DOI: 10.3389/fcvm.2024.1355037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/07/2024] [Indexed: 06/06/2024] Open
Abstract
Background Uncontrolled hypertension is a common problem worldwide, despite the availability of many effective antihypertensive drugs and lifestyle interventions. We assessed the efficacy of a multi-component intervention in individuals with uncontrolled hypertension in a primary care setting. Methods This study was a randomized, multicenter, parallel, two-arm, single-blind controlled trial performed in primary healthcare centers in Mallorca (Spain). All participants were 35 to 75-years-old and had poorly controlled hypertension. Patients were randomly assigned in a 1:1 ratio to a control group (usual care) or an intervention group (self-monitoring of blood pressure, self-titration of hypertensive medications, dietary interventions, and physical activity interventions). The primary outcome was decrease in the mean SBP at 6 months relative to baseline. Results A total of 153 participants were randomized to an intervention group (77) or a control group (76). After 6 months, the intervention group had a significantly lower systolic blood pressure (135.1 mmHg [±14.8] vs. 142.7 mmHg [±15.0], adjusted mean difference: 8.7 mmHg [95% CI: 3.4, 13.9], p < 0.001) and a significantly lower diastolic blood pressure (83.5 mmHg [±8.8] vs. 87.00 mmHg [±9.0], adjusted mean difference: 5.4 [95% CI: 2.9, 7.8], p < 0.0001). The intervention group also had significantly more patients who achieved successful blood pressure control (<140/90 mmHg; 54.4% vs. 32.9%, p = 0.011). Discussion Self-monitoring of blood pressure in combination with self-management of hypertensive medications, diet, and physical activity in a primary care setting leads to significantly lower blood pressure in patients with poorly controlled hypertension.Clinical Trial Registration: ClinicalTrials.gov, identifier ISRCTN14433778.
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Affiliation(s)
- Fabián Unda Villafuerte
- Sóller-Serra Nord Healthcare Center, Sóller, Spain
- Red de Investigación Cooperativa de Atención Primaria y Promoción de La Salud (RICAPPS)-Carlos III Health Institute (ISCIII), Madrid, Spain
- Balearic Islands Health Research Institute (IdISBa), Palma, Spain
| | - Joan Llobera Cànaves
- Red de Investigación Cooperativa de Atención Primaria y Promoción de La Salud (RICAPPS)-Carlos III Health Institute (ISCIII), Madrid, Spain
- Balearic Islands Health Research Institute (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Health Services (IB-Salut), Escola Graduada n3, Palma, Spain
| | - Andreu Estela Mantolan
- Balearic Islands Health Research Institute (IdISBa), Palma, Spain
- Dalt San Joan Healthcare Center, Mahó, Fornells, Maó, Spain
| | | | - Fernando Rigo Carratalà
- Red de Investigación Cooperativa de Atención Primaria y Promoción de La Salud (RICAPPS)-Carlos III Health Institute (ISCIII), Madrid, Spain
- Balearic Islands Health Research Institute (IdISBa), Palma, Spain
- San Agustín Healthcare Center, Palma, Spain
| | | | | | | | - María Lucía Moreno Sancho
- Enfermería Familiar y Comunitaria, Programa Pacient Actiu de les Illes Balears, Gerencia de Atención Primaria de Mallorca, Escola Graduada n3, Palma, Spain
| | - Alfonso Leiva
- Red de Investigación Cooperativa de Atención Primaria y Promoción de La Salud (RICAPPS)-Carlos III Health Institute (ISCIII), Madrid, Spain
- Balearic Islands Health Research Institute (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Health Services (IB-Salut), Escola Graduada n3, Palma, Spain
| | - Patricia Lorente Montalvo
- Red de Investigación Cooperativa de Atención Primaria y Promoción de La Salud (RICAPPS)-Carlos III Health Institute (ISCIII), Madrid, Spain
- Balearic Islands Health Research Institute (IdISBa), Palma, Spain
- Balearic Public Health Service (Ib-Salut), Palma, Spain
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Ndip Agbor V, Temgoua MN, Noubiap JJN. Scaling up the use of home blood pressure monitoring in the management of hypertension in low-income countries: A step towards curbing the burden of hypertension. J Clin Hypertens (Greenwich) 2017; 19:786-789. [PMID: 28371238 DOI: 10.1111/jch.12999] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Mazou N. Temgoua
- Department of Internal Medicine and Specialties; Faculty of Medicine and Biomedical Sciences; University of Yaoundé 1; Yaoundé Cameroon
| | - Jean Jacques N. Noubiap
- Department of Medicine; Groote Schuur Hospital and University of Cape Town; Cape Town South Africa
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Krakoff LR. Ambulatory blood pressure improves prediction of cardiovascular risk: implications for better antihypertensive management. Curr Atheroscler Rep 2013; 15:317. [PMID: 23423525 DOI: 10.1007/s11883-013-0317-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Accurate measurement of arterial pressure is necessary for diagnosis of hypertension and for assessment of its therapy. The development and growing application of ambulatory blood pressure monitoring (ABPM) furthers these goals. Use of ABPM has defined white coat hypertension (WCH) and masked hypertension (MH), important prognostic diagnoses. ABPM categorizes blood pressure in several ways that increase accuracy for diagnosis and prediction of cardiovascular risk. Measurements of blood pressure throughout the day, at night during sleep, during the morning surge, and, in some instances selected intervals can be especially valuable for both research and clinical management. ABPM is being explored for its value in measuring pulse pressure and a derived index of arterial stiffness. ABPM has also shown to be valuable for defining the effects of antihypertensive drugs therapy. Results of such studies are crucial for advancing antihypertensive management. This review will summarize the important and emerging role of ABPM in defining risk for cardiovascular disease.
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Affiliation(s)
- Lawrence R Krakoff
- Mount Sinai Medical Center/Medical School, One Gustave L Levy Place, Box 1030, New York, NY 10029, USA.
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Xu T, Zhang Y, Tan X. Estimate of nocturnal blood pressure and detection of non-dippers based on clinical or ambulatory monitoring in the inpatient setting. BMC Cardiovasc Disord 2013; 13:37. [PMID: 23692688 PMCID: PMC3665662 DOI: 10.1186/1471-2261-13-37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 05/17/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ambulatory blood pressure monitoring is regarded as the gold standard for monitoring nocturnal blood pressure (NBP) and is usually performed out of office. Currently, a novel method for monitoring NBP is indispensible in the inpatient setting. The widely used manual BP monitoring procedure has the potential to monitor NBP in the hospital setting. The feasibility and accuracy of manual sphygmomanometer to monitor NBP has not been explored widely. METHODS A cross-sectional study was conducted at the cardiology department of a university-affiliated hospital to study patients with mild-to-moderate essential hypertension. One hundred and fifty-five patients were recruited to compare BP derived from a manual device and ambulatory BP monitoring (ABPM). The manual BP measurement was performed six times at 22:00, 02:00, 06:00, 10:00, 14:00 and 18:00 h. The measurements at 22:00, 02:00 and 06:00 h were defined as night-time and the others as daytime. ABPM was programmed to measure at 30-min intervals between measurements. RESULTS All-day, daytime and night-time BP did not differ significantly from 24-h ambulatory systolic BP [all-day mean difference -0.52±4.67 mmHg, 95% confidence interval (CI) -1.26 to 0.22, P=0.168; daytime mean difference 0.24±5.45 mmHg, 95% CI -0.62 to 1.11, P=0.580; night-time mean difference 0.30±7.22 mmHg, 95% CI -0.84 to 1.45, P=0.601) rather than diastolic BP. There was a strong correlation between clinical and ambulatory BP for both systolic and diastolic BP. On the basis of ABPM, 101 (65%) patients were classified as non-dippers, compared with 106 (68%) by manual sphygmomanometer (P<0.001). CONCLUSIONS Traditional manual sphygmomanometer provides similar daytime and night-time systolic BP measurements in hospital. Moreover, the detection of non-dippers by manual methods is in good agreement with 24-h ABPM. Further studies are required to confirm the clinical relevance of these findings by comparing the association of NBP in the hospital ward assessed by manual monitoring with preclinical organ damage and cardiovascular and cerebrovascular outcomes.
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Affiliation(s)
- Tan Xu
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Yongqing Zhang
- Department of Cardiology, Peoples’ Hospital of SanYan, SanYan, Hainan 572000, China
| | - Xuerui Tan
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, China
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