Self‐blood pressure monitoring is associated with improved awareness, adherence, and attainment of target blood pressure goals: Prospective observational study of 7751 patients

Abstract

A large-scale, cross-sectional study incorporating data from various countries around the world, including both low-and high-income subjects, showed that the prevalence of hypertension (HTN) was 40.8% in 142 042 participants, but only 46.5% were aware of the diagnosis criteria, and 32.5% had controlled blood pressure (BP), despite the high rate (87.5%) of pharmaceutical treatment. 1 Low BP control could be attributed to poor medication adherence and patients' ignorance on the importance of HTN, as well as therapeutic inertia by physicians. To overcome this, many approaches have been attempted including self-blood pressure monitoring (SBPM). However, this has demonstrated mixed results on HTN control. 2-5 Some meta-analyses including small-sized studies have also shown inconsistent results. 2,5 These conflicting data may partly be attributed to the diversity of socio-economic levels and racial differences of the participants and combined other interventions on top of SBPM as well as small sample size.We performed this nationwide large-scale prospective observational study involving general hospitals and local clinics to examine AbstractWe investigated whether self-blood pressure monitoring (SBPM) can improve the control rate of blood pressure (BP), adherence of antihypertensive medications, and the awareness of the importance of BP control in hypertensive patients. A total of 7751 patients who visited the outpatient clinics of private and university hospitals in Korea were given automatic electronic BP monitors and were recommended to measure their BP daily at home for 3 months. Changes in office BP, attainment of target BP, adherence to taking antihypertensive drugs, and awareness of BP were compared before and after SBPM. Patients and physicians were surveyed on their perception of BP and SBPM. Mean BP significantly decreased from 142/88 to 129/80 mm Hg (P < .001), and attainment of the target BP increased from 32% to 59% (P < .001) after SBPM. Drug non-adherence, which was defined as patient's not taking medication days per week, decreased significantly from 0.86 days to 0.53 days (P < .001).The rate of awareness of the BP goal increased from 57% to 81% (P < .001). Patients estimated that their mean BP was 125/81 mm Hg, but their actual mean BP was 142/88 mm Hg. Awareness about the importance of SBPM increased from 90% to 98%. The rate of SBPM ≥ once per week further increased, from 34% to 96%. In conclusion, SBPM is associated with reduced BP, better BP control rate, greater drug adherence, and improved perception of BP by the patients.

Self‐blood pressure monitoring as a tool to increase hypertension awareness, adherence to antihypertensive therapy, and blood pressure control

“…In the current issue of Journal of Clinical Hypertension , Jo and coll reported the results of an observational prospective study, assessing the impact of a 3‐month self‐BP monitoring program on BP control, compliance to treatment, and awareness of hypertension. The study population consisted of a large cohort of 7751 hypertensive patients attending outpatient clinics of private and university hospital in Korea …”

“…The authors found that after the 3‐month period of SBPM, BP significantly decreased, the number of patients with controlled BP increased, and adherence to drug therapy and patients’ perception of BP improved …”

“…Even if more than 50 previous investigations and some meta‐analyses (Table ) explored a similar issue, the study of Jo et al is the one of the largest and the unique studies evaluating also the effect of SBPM on perception and attitude on BP of patients and physicians …”

“…From a prognostic point of view, the most important finding of this paper is represented by the improvement of BP control rate after 3‐month period of SBPM. This result may be largely driven by the raised adherence to antihypertensive therapy which in turn may be explained, at least in part, by the improved awareness of the importance of BP control in both patients and physicians …”

“…The results of this interesting study need to be interpreted with caution, because of some limitations. Beside the intrinsic weakness due to its observational nature, the inability to account for some potentially important confounding factors, such as drug antihypertensive therapy, intensification of treatment and lifestyle factors, the nonrandomized inclusion of the participants, the absence of information about the true home BP measurement of the patients, the nonobjective estimation of the adherence to antihypertensive prescriptions, based on the frequency of drug skipping reported by the patients, and the short duration of the study are other drawbacks of this paper …”