Skip to main content
Top
Published in: BMC Primary Care 1/2018

Open Access 01-12-2018 | Study protocol

Rationale and design of a pragmatic clinical trial to assess the impact of self-monitoring blood pressure at home and self-titration of antihypertensive medication in poorly controlled hypertension: the ADAMPA study protocol

Authors: José Sanfélix-Genovés, Clara L. Rodríguez-Bernal, Irene Marco-Moreno, Patricia Martinez-Ibañez, Lucía Martinez-Ibañez, María Bóveda-García, Ignacio Barreira-Franch, Mercedes Calleja-Del Ser, Greta Borrás-Moreno, Eugenia Avelino-Hidalgo, Marina Escrig-Veses, Margherita Lauriano, Margarita Giménez-Loreiro, Laura Bellot-Pujalte, Aníbal García-Sempere, Salvador Peiró, Gabriel Sanfélix-Gimeno, ADAMPA group

Published in: BMC Primary Care | Issue 1/2018

Login to get access

Abstract

Background

Lack of control of hypertension is one of the most prevalent problems encountered by general practitioners (GPs). Self-measured blood pressure monitoring at home (SMBP) and self-titration of medication could be a good strategy to improve hypertension management, however, evidence is limited and not conclusive. We aimed to assess the effectiveness, in the primary care setting, of an intervention that includes educational components, SMBP and self-titration of antihypertensive medication to decrease systolic blood pressure compared to usual care, in a population with poorly controlled hypertension, during a 12-month period.

Methods

Pragmatic, controlled, randomized, unblinded clinical trial with two parallel groups assigned in a ratio of 1:1 to self-management (which includes educational components, SBMP and self-titration of antihypertensive medication based on a patient’s GP’s pre-established adjustment plan) or to usual care (with educational components too).

Discussion

If the data from this trial show positive results, the study may contribute to a change of strategy in the treatment of hypertension, focusing on the patient as the main actor to achieve blood pressure control. Furthermore, this approach might contribute to the financial sustainability of the National Health Service.

Trial registration

This trial has been registered in the database with reference number EudraCT: 2016-003986-25. Registered 05 May 2017, https://​www.​clinicaltrialsre​gister.​eu/​ctr-search/​search?​query=​2016-003986-25
Literature
1.
go back to reference Murphy T, Naghavi M, Neal B, Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2224–60.CrossRef Murphy T, Naghavi M, Neal B, Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2224–60.CrossRef
2.
go back to reference Catalá-López F, Sanfélix-Gimeno G, García-Torres C, Ridao M, Peiró S. Control of arterial hypertension in Spain: a systematic review and meta-analysis of 76 epidemiological studies on 341 632 participants. J Hypertens. 2012;30(1):168–76.CrossRef Catalá-López F, Sanfélix-Gimeno G, García-Torres C, Ridao M, Peiró S. Control of arterial hypertension in Spain: a systematic review and meta-analysis of 76 epidemiological studies on 341 632 participants. J Hypertens. 2012;30(1):168–76.CrossRef
3.
go back to reference Catalá-López F, Ridao M, Sanfélix-Gimeno G, Peiró S. Trends of uncontrolled blood pressure in Spain: an updated meta-regression analysis. J Hypertens. 2013;31(3):630–1.CrossRef Catalá-López F, Ridao M, Sanfélix-Gimeno G, Peiró S. Trends of uncontrolled blood pressure in Spain: an updated meta-regression analysis. J Hypertens. 2013;31(3):630–1.CrossRef
4.
go back to reference Joffres M, Falaschetti E, Gillespie C, Robitaille C, Loustalot F, Poulter N, et al. Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischemic heart disease mortality: a cross-sectional study. BMJ Open. 2013;3(8):e003423.CrossRef Joffres M, Falaschetti E, Gillespie C, Robitaille C, Loustalot F, Poulter N, et al. Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischemic heart disease mortality: a cross-sectional study. BMJ Open. 2013;3(8):e003423.CrossRef
5.
go back to reference Redon J, Olsen MH, Cooper RS, Zurriaga O, Martinez-Beneito MA, Laurent S, et al. Stroke mortality and trends from 1990 to 2006 in 39 countries from Europe and Central Asia: implications for control of high blood pressure. Eur Heart J. 2011;32(11):1424–31.CrossRef Redon J, Olsen MH, Cooper RS, Zurriaga O, Martinez-Beneito MA, Laurent S, et al. Stroke mortality and trends from 1990 to 2006 in 39 countries from Europe and Central Asia: implications for control of high blood pressure. Eur Heart J. 2011;32(11):1424–31.CrossRef
6.
go back to reference Zhao Y, Yan H, Marshall RJ, Dang S, Yang R, Li Q, et al. Trends in population blood pressure and prevalence, awareness, treatment, and control of hypertension among middle-aged and older adults in a rural area of Northwest China from 1982 to 2010. PLoSOne. 2013;8(4):e61779.CrossRef Zhao Y, Yan H, Marshall RJ, Dang S, Yang R, Li Q, et al. Trends in population blood pressure and prevalence, awareness, treatment, and control of hypertension among middle-aged and older adults in a rural area of Northwest China from 1982 to 2010. PLoSOne. 2013;8(4):e61779.CrossRef
7.
go back to reference Guo F, He D, Zhang W, Walton RG. Trends in prevalence, awareness, management, and control of HypertensionAmong United States adults, 1999 to 2010. J Am Coll Cardiol. 2012;60(7):599–606.CrossRef Guo F, He D, Zhang W, Walton RG. Trends in prevalence, awareness, management, and control of HypertensionAmong United States adults, 1999 to 2010. J Am Coll Cardiol. 2012;60(7):599–606.CrossRef
8.
go back to reference Banegas JR, Graciani A, de la Cruz-Troca JJ, León-Muñoz LM, Guallar-Castillón P, Coca A, et al. Achievement of cardiometabolic goals in aware hypertensive patients in Spain: a nationwide population-based study. Hypertension 2012;60(4):898–905.CrossRef Banegas JR, Graciani A, de la Cruz-Troca JJ, León-Muñoz LM, Guallar-Castillón P, Coca A, et al. Achievement of cardiometabolic goals in aware hypertensive patients in Spain: a nationwide population-based study. Hypertension 2012;60(4):898–905.CrossRef
9.
go back to reference Borghi C, Tubach F, De Backer G, Dallongeville J, Guallar E, Medina J, et al. Lack of control of hypertension in primary cardiovascular disease prevention in Europe: results from the EURIKA study. Int J Cardiol. 2016;218:83–8.CrossRef Borghi C, Tubach F, De Backer G, Dallongeville J, Guallar E, Medina J, et al. Lack of control of hypertension in primary cardiovascular disease prevention in Europe: results from the EURIKA study. Int J Cardiol. 2016;218:83–8.CrossRef
10.
go back to reference Cifu AS, Davis AM. Prevention, detection, evaluation, and Management of High Blood Pressure in adults. JAMA. 2017;318(21):2132–4.CrossRef Cifu AS, Davis AM. Prevention, detection, evaluation, and Management of High Blood Pressure in adults. JAMA. 2017;318(21):2132–4.CrossRef
11.
go back to reference McManus RJ, Wood S, Bray EP, Glasziou P, Hayen A, Heneghan C, et al. Self-monitoring in hypertension: a web-based survey of primary care physicians. J Hum Hypertens. 2014;28(2):123–7.CrossRef McManus RJ, Wood S, Bray EP, Glasziou P, Hayen A, Heneghan C, et al. Self-monitoring in hypertension: a web-based survey of primary care physicians. J Hum Hypertens. 2014;28(2):123–7.CrossRef
12.
go back to reference Logan AG, Dunai A, McIsaac WJ, Irvine MJ, Tisler A. Attitudes of primary care physicians and their patients about home blood pressure monitoring in Ontario. J Hypertens. 2008;26(3):446–52.CrossRef Logan AG, Dunai A, McIsaac WJ, Irvine MJ, Tisler A. Attitudes of primary care physicians and their patients about home blood pressure monitoring in Ontario. J Hypertens. 2008;26(3):446–52.CrossRef
13.
go back to reference Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev. 2010;3. CD005182. Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev. 2010;3. CD005182.
14.
go back to reference Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Ann Intern Med. 2013;159(3):185–94.CrossRef Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Ann Intern Med. 2013;159(3):185–94.CrossRef
15.
go back to reference McManus RJ, Mant J, Bray EP, Holder R, Jones MI, Greenfield S, et al. Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomized controlled trial. Lancet. 2010;376(9736):163–72.CrossRef McManus RJ, Mant J, Bray EP, Holder R, Jones MI, Greenfield S, et al. Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomized controlled trial. Lancet. 2010;376(9736):163–72.CrossRef
16.
go back to reference McManus RJ, Mant J, Haque MS, Bray EP, Bryan S, Greenfield SM, et al. Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial. JAMA. 2014;312(8):799–808.CrossRef McManus RJ, Mant J, Haque MS, Bray EP, Bryan S, Greenfield SM, et al. Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial. JAMA. 2014;312(8):799–808.CrossRef
17.
go back to reference Margolius D, Bodenheimer T, Bennett H, Wong J, Ngo V, Padilla G, et al. Health coaching to improve hypertension treatment in a low-income, minority population. Ann Fam Med. 2012;10:199–205.CrossRef Margolius D, Bodenheimer T, Bennett H, Wong J, Ngo V, Padilla G, et al. Health coaching to improve hypertension treatment in a low-income, minority population. Ann Fam Med. 2012;10:199–205.CrossRef
18.
go back to reference James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth joint National Committee (JNC 8). JAMA. 2014;311(5):507.CrossRef James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth joint National Committee (JNC 8). JAMA. 2014;311(5):507.CrossRef
19.
go back to reference Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti BM, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) J Hypertension. 2013;31:1281–357. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti BM, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) J Hypertension. 2013;31:1281–357.
20.
go back to reference Navar-Boggan AM, Pencina MJ, Williams K, Sniderman AD, Peterson ED. Proportion of US adults potentially affected by the 2014 hypertension guideline. JAMA. 2014;311(14):1424–9.CrossRef Navar-Boggan AM, Pencina MJ, Williams K, Sniderman AD, Peterson ED. Proportion of US adults potentially affected by the 2014 hypertension guideline. JAMA. 2014;311(14):1424–9.CrossRef
21.
go back to reference The ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575–85.CrossRef The ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575–85.CrossRef
22.
go back to reference The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103–16.CrossRef The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103–16.CrossRef
23.
go back to reference Lonn EM, Bosch J, López-Jaramillo P, Zhu J, Liu L, Pais P, et al. (HOPE-3 investigators). Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med. 2016;374(21):2009–20.CrossRef Lonn EM, Bosch J, López-Jaramillo P, Zhu J, Liu L, Pais P, et al. (HOPE-3 investigators). Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med. 2016;374(21):2009–20.CrossRef
24.
go back to reference Scott NW, McPherson GC, Ramsay CR, Campbell MK. The method of minimization for allocation to clinical trials. a review Control Clin Trials 2002 Dec;23(6):662-74. Review. PubMed PMID: 12505244.CrossRef Scott NW, McPherson GC, Ramsay CR, Campbell MK. The method of minimization for allocation to clinical trials. a review Control Clin Trials 2002 Dec;23(6):662-74. Review. PubMed PMID: 12505244.CrossRef
25.
go back to reference Delbecq A, Van De Ven A. A group process model for problem identification and program planning. J Appl Behav Sci. 1971;7(4):466–92.CrossRef Delbecq A, Van De Ven A. A group process model for problem identification and program planning. J Appl Behav Sci. 1971;7(4):466–92.CrossRef
Metadata
Title
Rationale and design of a pragmatic clinical trial to assess the impact of self-monitoring blood pressure at home and self-titration of antihypertensive medication in poorly controlled hypertension: the ADAMPA study protocol
Authors
José Sanfélix-Genovés
Clara L. Rodríguez-Bernal
Irene Marco-Moreno
Patricia Martinez-Ibañez
Lucía Martinez-Ibañez
María Bóveda-García
Ignacio Barreira-Franch
Mercedes Calleja-Del Ser
Greta Borrás-Moreno
Eugenia Avelino-Hidalgo
Marina Escrig-Veses
Margherita Lauriano
Margarita Giménez-Loreiro
Laura Bellot-Pujalte
Aníbal García-Sempere
Salvador Peiró
Gabriel Sanfélix-Gimeno
ADAMPA group
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2018
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-018-0846-y

Other articles of this Issue 1/2018

BMC Primary Care 1/2018 Go to the issue