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A randomized controlled trial on home blood pressure monitoring and quality of care in stage 2 and 3 hypertension

Hypertension Research volume 44, pages 533–540 (2021)Cite this article

Abstract

In a 12-week, randomized, controlled trial, we investigated whether home blood pressure monitoring (HBPM) would improve treatment adherence and blood pressure control in stage 2 and 3 hypertension. Eligible patients (18–75 years of age and 160–199/100–119 mmHg of clinic systolic/diastolic blood pressure after a 1-week wash-out) were randomized in a 1:4 ratio to an experimental group (with HBPM) and a control group (without HBPM). All patients started antihypertensive treatment with the irbesartan 150 mg/hydrochlorothiazide 12.5 mg/day combination, with the possible addition of irbesartan 150 mg/day and uptitration to irbesartan 300 mg/hydrochlorothiazide 25 mg/day at 4 and 8 weeks of follow-up, respectively. The primary endpoint was the clinic blood pressure control (systolic/diastolic, nondiabetes <140/90 mmHg and diabetes <130/80 mmHg) rate at 12 weeks of follow-up. The randomized patients in the HBPM (n = 96) and control groups (n = 405) had similar characteristics at baseline and similar use of higher dosages of irbesartan/hydrochlorothiazide (300 mg/12.5–25 mg) at 4 (9.4% vs. 12.2%, P = 0.45) and 8 weeks of follow-up (27.1% vs. 35.5%, P = 0.13). During follow-up, both the cumulative treatment discontinuation rate (1.0% vs. 12.6%, P = 0.0008) and the less optimal treatment adherence rate (<90% of prescribed medication, 1.0% vs. 9.9%, P = 0.005) were significantly lower in the HBPM group than in the control group. The proportion of patients who achieved the goal of clinic blood pressure control at 12 weeks of follow-up was significantly higher in the HBPM group than in the control group (66.7% vs. 55.1%, P = 0.04). In conclusion, HBPM improved treatment adherence and blood pressure control in patients with hypertension, despite similar antihypertensive treatment intensities.

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Acknowledgements

The authors gratefully acknowledge the participation of the patients and the contribution of the investigators from 18 participating hospitals. For detailed information on the participating hospitals, please refer to [9].

Funding

The study was funded and sponsored by Sanofi China (Shanghai).

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Authors and Affiliations

  1. Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Di Zhang, Qi-Fang Huang, Yan Li & Ji-Guang Wang

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  1. Di Zhang
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  2. Qi-Fang Huang
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Correspondence to Ji-Guang Wang.

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J-GW reports receiving consulting and lecture fees from Sanofi China (Shanghai). The other authors declare that they have no conflict of interest.

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Zhang, D., Huang, QF., Li, Y. et al. A randomized controlled trial on home blood pressure monitoring and quality of care in stage 2 and 3 hypertension. Hypertens Res 44, 533–540 (2021). https://doi.org/10.1038/s41440-020-00602-0

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