Factors influencing home blood pressure monitor ownership in a large clinical trial

Abstract

Home blood pressure monitor (HBPM) ownership prevalence and the factors that influence it are unclear. This study aimed to investigate factors associated with HBPM ownership among participants in the Treatment in Morning versus Evening (TIME) hypertension study. This study is a sub-analysis of the TIME study, a randomised trial investigating the effect of day-time versus night-time dosing of antihypertensive medication on cardiovascular outcomes in adults with hypertension. As part of the TIME study online registration process, participants were asked to indicate whether they owned an HBPM. A multivariable logistic regression model was constructed to determine factors associated with HBPM ownership. Of 21,104 randomised participants, 11,434 (54.2%) reported owning an HBPM. The mean age of all participants at enrolment was 67.7 ± 9.3 years, 12,134 (57.5%) were male, and 8892 (42.1%) reported a current or previous history of smoking. Factors associated with an increased likelihood of reporting HBPM owned include being male (OR:1.47; 95% CI 1.39–1.56) or residing in a less deprived socioeconomic region (IMD Decile 6–10) (OR:1.31; 95% CI 1.23–1.40). Participants with a history of diabetes mellitus (OR:0.74; 95% CI:0.64–0.86) or current smokers, compared to non-smokers, (OR:0.71; 95% CI:0.62–0.82) were less likely to report owning an HBPM. This study has identified important patient factors influencing HBPM ownership. Further qualitative research would be valuable to identify and explore potential patient-level barriers to engagement with self-monitoring of blood pressure.

Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial

“…Data have previously been published on the types of home blood pressure monitors owned, the factors associated with ownership, and the factors associated with long-term commitment to submitting home blood pressure measurements to the TIME study. 24 , 25 , 26 Older participants, those with a positive family history of hypertension, those taking a higher number of antihypertensive medications, and those with less social deprivation were more likely to participate in providing home blood pressure measurements, whereas those with a higher BMI and who were smokers were less likely to provide home blood pressure measurements. Therefore, the home blood pressure data are not necessarily fully representative of the randomised population in the TIME study.…”

“…Participants were asked at baseline if they owned a home blood pressure monitor and this subset of participants were asked whether they would be willing to provide home blood pressure measurements. 24 , 25 , 26 Those willing to do this were invited to provide sets of home blood pressure measurements in the morning and evening at 3-monthly intervals via an online portal throughout the study.…”

Home Blood Pressure Monitoring (HBPM): The way forward for Sri Lanka; a review article

“…Though, there are few consensuses reached regarding BP measurement technique by different associations such as American College of Cardiology (ACC), American Heart Association (AHA) and European Society of Cardiology (ESC), they have not been put forth into the practice, because multiple readings are time consuming and there's a lack of awareness regarding measurement accuracy. (8)(9)(10) There are a few ways in which a BP measurement could be obtained. Making a BP recording at an office or screening setting is considered as office blood pressure measurement (OBPM) (2,10).…”

“…Presence of multiple cardiovascular risk factors in addition to hypertension increases the risk for adverse cardiac outcomes (16,35). Thus, monitoring of blood pressure is important in post COVID patients with hypertension and multiple comorbidities (8).…”

Update on trials examining effects of night-time blood pressure lowering drug treatment on prevention of cardiovascular disease

“…At the same time, the TIME trial was piloted in 2011 and 2014 to validate the feasibility of an online study with online recruitment, consent and follow-up. Similar to BPMedtime, the TIME trial adjusted the sample size from 10,269 to more than 20,000 participants in order to "achieve the necessary number of events needed" and actually 21,104 participants were enrolled and randomised after five years of recruitment in 2016 [17,22,23]. No calculation for the updated sample size, no information on the expected event rate, and no data on the actual event rates were observed since the trial start date has been reported.…”