• Patricia Martínez-Ibáñez, Irene Marco-Moreno, Salvador Peiró, Lucia Martínez-Ibáñez, Ignacio Barreira-Franch, Laura Bellot-Pujalte, Eugenia Avelino-Hidalgo, Marina Escrig-Veses, María Bóveda-García, Mercedes Calleja-Del-Ser, Andreu Ferrero-Gregori, Adina A Iftimi, Isabel Hurtado, Aníbal García-Sempere, Clara L Rodríguez-Bernal, Margarita Giménez-Loreiro, Gabriel Sanfélix-Gimeno, José Sanfélix-Genovés, and ADAMPA research group.
• INCLIVA Health Research Institute, Valencia, Spain.
• J Gen Intern Med. 2023 Jan 1; 38 (1): 818981-89.

BackgroundPatient empowerment through pharmacological self-management is a common strategy in some chronic diseases such as diabetes, but it is rarely used for controlling blood pressure.ObjectiveThis study aimed to assess self-monitoring plus self-titration of antihypertensive medication versus usual care for reducing systolic blood pressure (SBP) at 12 months in poorly controlled hypertensive patients.DesignThe ADAMPA study was a pragmatic, controlled, randomized, non-masked clinical trial with two parallel arms in Valencia, Spain.ParticipantsHypertensive patients older than 40 years, with SBP over 145 mmHg and/or diastolic blood pressure (DBP) over 90 mmHg, were recruited from July 2017 to June 2018.InterventionParticipants were randomized 1:1 to usual care versus an individualized, pre-arranged plan based on self-monitoring plus self-titration.Main MeasureThe primary outcome was the adjusted mean difference (AMD) in SBP between groups at 12 months.Key ResultsPrimary outcome data were available for 312 patients (intervention n=156, control n=156) of the 366 who were initially recruited. The AMD in SBP at 12 months (main analysis) was -2.9 mmHg (95% CI, -5.9 to 0.1, p=0.061), while the AMD in DBP was -1.9 mmHg (95% CI, -3.7 to 0.0, p=0.052). The results of the subgroup analysis were consistent with these for the main outcome measures. More patients in the intervention group achieved good blood pressure control (<140/90 mmHg) at 12 months than in the control group (55.8% vs 42.3%, difference 13.5%, 95% CI, 2.5 to 24.5%, p=0.017). At 12 months, no differences were observed in behavior, quality of life, use of health services, or adverse events.ConclusionSelf-monitoring plus self-titration of antihypertensive medication based on an individualized pre-arranged plan used in primary care may be a promising strategy for reducing blood pressure at 12 months compared to usual care, without increasing healthcare utilization or adverse events.Trial RegistrationEudraCT, number 2016-003986-25 (registered 17 March 2017) and clinicaltrials.gov , NCT03242785.© 2022. The Author(s).

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