Self-monitoring of blood pressure for improving adherence to antihypertensive medicines and blood pressure control: a randomized controlled trial.
BACKGROUND
Self-monitoring is reported to have limited efficacy for hypertension management in high-income countries. In this study, we aimed to evaluate the effect of self-monitoring on blood pressure (BP) control in an Iranian population.


METHODS
A randomized controlled trial was conducted on 196 mild to moderate hypertensive patients in an outpatient cardiovascular clinic. Patients in the intervention group received a wrist self-monitoring device and were educated to measure and document their BP daily during the study period (24 weeks). Patients in the control group received usual care. Three follow-up visits with the physician were scheduled for all patients (weeks 4, 12, and 24), and the investigator assessed adherence to medications after each visit (pill counting). The primary outcome (BP) was compared between groups using repeated-measure analysis of variance.


RESULTS
One hundred ninety patients completed the study. Systolic BP (144.4±7.4 vs 145.9±6.4mm Hg) and diastolic BP (85.5±6.9 vs. 85.1±7.7mm Hg) were similar between groups at baseline. The trend of BP was not significantly different between groups during the study period. Systolic and diastolic BP decreased significantly in both groups at the first follow-up visit (systolic BP: 132.6 vs. 133.4mm Hg; diastolic BP: 77.4 vs. 77.2mm Hg). In the intervention group, we observed a small continued decrease in diastolic BP up to week 24 BP (P = 0.01). Both groups showed adherence rates >95% during the study period.


CONCLUSIONS
Our study could not confirm that self-monitoring can improve BP control in patients with frequent medical visits.
Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran;
Masumeh
M
Hosseininasab
Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran;
Zahra
Z
Jahangard-Rafsanjani
Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran;
Abbas
A
Mohagheghi
Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran;
Amir
A
Sarayani
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Arash
A
Rashidian
Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran;
Mohammadreza
M
Javadi
Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran;
Alireza
A
Ahmadvand
Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran;
Molouk
M
Hadjibabaie
Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran; khgholami@tums.ac.ir.
Kheirollah
K
Gholami
D000368:Aged; D000553:Ambulatory Care; D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory / Q000295:instrumentation; D015924:Blood Pressure Monitors; D016009:Chi-Square Distribution; D004867:Equipment Design; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D007492:Iran; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009819:Office Visits; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents
adherence to medication; antihypertensive medication; blood pressure; compliance; hypertension; pill counting; self-monitoring.