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Randomized Controlled Trial
. 2012 Feb;44(2):89-96.
doi: 10.1016/j.aprim.2010.09.022. Epub 2011 Oct 20.

[Prevention of therapeutic inertia in the treatment of arterial hypertension by using a program of home blood pressure monitoring]

[Article in Spanish]
Emilio Márquez Contreras  1 , José Luis Martín de Pablos, Jacinto Espinosa García, José Joaquín Casado Martínez, Eugenio Sanchez López, José Escribano; Grupo de Trabajo sobre Cumplimiento de la Asociación de la Sociedad española de Hipertensión Arterial y Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA)
Affiliations
Randomized Controlled Trial

[Prevention of therapeutic inertia in the treatment of arterial hypertension by using a program of home blood pressure monitoring]

[Article in Spanish]
Emilio Márquez Contreras et al. Aten Primaria. 2012 Feb.

Abstract
in English, Spanish

Objective: To evaluate the efficacy of a program of home blood pressure monitoring (HBPM) on therapeutic Inertia (TI) in mild-to-moderate hypertension (AHT).

Design: Controlled, randomised clinical trial.

Setting: Forty six clinics in 35 primary care centres. Spain.

Participants: A total of 232 patients with uncontrolled hypertension were included.

Intervention: Two groups with 116 patients were formed: 1) Control group (CG): standard health intervention; 2) Intervention group (IG): patients who were included in the HBPM program.

Main measurements: TI was calculated by the ratio: Number of patients whose pharmacological treatment was not changed in each visit/Number of patients with an average BP 140mmHg and/or 90mmHg in the general population or 130 and/or 90 mmHg in diabetics. The mean BPs and the percentage of controlled patients were calculated. The mean number of people that required an intervention in order to avoid TI was calculated (NI).

Results: A total of 209 patients completed the study, with TI in 35.64% (95% CI=29.85%-41.43%) of the sample, and in 71.63% (95% CI=63.9-79.36%) of the uncontrolled hypertensive patients. The TI was 22.42% (95% CI=24.2-37%) in the IG and 50% (95% CI=37.75-62.25) in the CG (p<.05) in visit 2, and 25.23% (95% CI=14.84-35.62) and 46.07% (95% CI=33.85-58.29) in the final visit for IG and CG, respectively (P<.05). The NI was 4.3.

Conclusions: TI was very significant among the uncontrolled hypertensive patients. The studied interventions are effective for improving TI.

Objetivo: Evaluar si un programa de automedida domiciliaria de presión arterial (AMPA) es eficaz para obtener una menor inercia terapéutica (IT) en el tratamiento de la HTA.

Diseño: Estudio clínico controlado, aleatorizado y multicéntrico.

Emplazamiento: 35 centros de salud de España.

Participantes: Se incluyeron 232 hipertensos.

Intervención: Se formaron 2 grupos con 116 individuos: 1, grupo de control (GC): recibieron la intervención habitual; 2, grupo de intervención: se inscribieron en un programa de AMPA.

Mediciones principales: La IT se midió mediante el cociente: (Número de pacientes sin modificación del tratamiento farmacológico en cada visita / Número de pacientes con cifras medias de PA ≥ 140 mmHg y/o ≥ 90 mmHg en población general o ≥ 130 y/o 80 mmHg en diabéticos) y multiplicado por 100. Se calculó la IT por visitas, las PA medias y grado de control de la HTA.

Resultados: Concluyeron 209 individuos (edad media 69,28 ± 11,6 años) (p = NS por grupos) (GI 107 individuos y GC 102).

La IT fue 35,64% de las visitas de la muestra (IC = 29,85-41,43%) y en el 71,63% (IC = 63,9-79,36%) en hipertensos no controlados.

La IT fue del 22,42% (IC = 24,2-37%) en el GI y 50% (IC = 37,75-62,25) en el GC (p < 0,05) en visita 2, y del 25,23% (IC = 14,84-35,62) y 46,07% (IC = 33,85-58,29) en visita final para GI y GC respectivamente (p < 0,05).

Conclusiones: La IT ha sido muy relevante. El programa de AMPA es eficaz para obtener una menor IT.

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Figures

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Esquema general del estudio: Ensayo clínico controlado, abierto y aleatorio en el que se estudia la eficacia de un programa de automedida domiciliaria de la PA en la disminución de la inercia terapéutica profesional, en el tratamiento de la HTA.
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References

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