Eficacia de un programa de automedida domiciliaria de la presión arterial como estrategia para disminuir la inercia terapéutica / Prevention of therapeutic inertia in the treatment of arterial hypertension by using a program of home blood pressure monitoring

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(AU)

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(AU)

[Prevention of therapeutic inertia in the treatment of arterial hypertension by using a program of home blood pressure monitoring]. / Eficacia de un programa de automedida domiciliaria de la presión arterial como estrategia para disminuir la inercia terapéutica.

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.

Intervención no farmacológica como estrategia para favorecer el control de la hipertensión arterial y mejorar el cumplimiento antihipertensivo / Non-pharmacological intervention as a strategy to improve antihypertensive treatment compliance

Objetivo: Comprobar la eficacia de una intervención mediante una revista educacional en el cumplimiento antihipertensivo de la hipertensión arterial (HTA) no controlada.DiseñoEstudio clínico controlado, aleatorizado y multicéntrico.EmplazamientoOchenta y siete Centros de Salud de España.ParticipantesSe incluyeron 450 pacientes hipertensos diagnosticados de HTA no controlada.IntervenciónSe formaron 2 grupos con 225 individuos: a) grupo de intervención (GI), los que recibieron una revista educacional domiciliaria bimensual y b) grupo de control (GC), que tuvieron práctica clínica habitual.ResultadosConcluyeron 393 individuos (edad: 62,4 años [desviación estándar de 11,6 años]), 196 pacientes del GI y 197 pacientes del GC. Ciento ochenta y cuatro eran varones (46,8%).ResultadosFueron cumplidores del total de las dosis tomadas el 83,2% en el GI (del 78 al 88,4%) y el 49,2% del GC (IC del 95%: del 42,2 al 56,2%) (p=0,0001) y fueron cumplidores diarios el 74% del GI (IC del 95%: del 67,9 al 80,1%) y el 42,6% del GC (IC del 95%: del 35,7 al 49,5%) (p=0,0001).ResultadosEl control de la HTA fue del 81,6% en el GI (IC del 95%: del 76,2 al 86,5%) y del 56,3% en el GC (IC del 95%: del 49,4 al 63,2%). El NNT con la intervención fue de 3,3 pacientes.ConclusionesEl incumplimiento del tratamiento fue muy alto. La revista educacional es una estrategia eficaz para disminuir el incumplimiento y mejorar el grado de control de la HTA(AU)

Objetive: To evaluate the efficacy of an intervention by means of an educational magazine on treatment compliance in uncontrolled arterial hypertension (AHT).DesignControlled, randomised clinical trial.Setting87 primary care centres. Spain.ParticipantsA total of 450 patients with uncontrolled hypertension were included.InterventionTwo groups of 225 patients were formed: 1) Control group (CG): standard health intervention; 2) Intervention Group (IG): received a twice monthly educational magazine at home.Main measurementsCompliance was measured using the Medication Event Monitoring System (MEMS-Aardex). Compliance rate (CR) was recorded. Compliers were defined as individuals with a treatment compliance of 80–110%. The percentage of compliers, the mean percentage of doses taken and the percentage of patients taking the medication at the correct times were estimated. The mean blood pressures (BPs) and the percentage of controlled patientswere calculated. The number needed to treat (NNT) was calculated.ResultsA total of 393 individuals were evaluable (Age: 62.4 years), 196 in the IG and 197 in the CG. There were 83.2% (95% CI 78–88.4) and 49.2% (95% CI 42.2–56.2) (P=0.0001) of overall compliers in the IG and CG, respectively and 74% (95% CI: 67.9–80.1) and 42.6% (95% CI=35.7–49.5) (P=0.0001) of correct times compliers. A total of 81.6% (95% CI=76.2–86.5%)) were controlled in the IG and 56.3% (95% CI=49.4–63.2) in the CG. The NNT was 3.3 patients.ConclusionsTherapeutic non-compliance was very high. The educational magazine is an effective strategy to improve the compliance and degree of control of the AHT(AU)

[Non-pharmacological intervention as a strategy to improve antihypertensive treatment compliance]. / Intervención no farmacológica como estrategia para favorecer el control de la hipertensión arterial y mejorar el cumplimiento antihipertensivo.

OBJECTIVE: To evaluate the efficacy of an intervention by means of an educational magazine on treatment compliance in uncontrolled arterial hypertension (AHT). DESIGN: Controlled, randomised clinical trial. SETTING: 87 primary care centres. Spain. PARTICIPANTS: A total of 450 patients with uncontrolled hypertension were included. INTERVENTION: Two groups of 225 patients were formed: 1) Control group (CG): standard health intervention; 2) Intervention Group (IG): received a twice monthly educational magazine at home. MAIN MEASUREMENTS: Compliance was measured using the Medication Event Monitoring System (MEMS-Aardex). Compliance rate (CR) was recorded. Compliers were defined as individuals with a treatment compliance of 80-110%. The percentage of compliers, the mean percentage of doses taken and the percentage of patients taking the medication at the correct times were estimated. The mean blood pressures (BPs) and the percentage of controlled patientswere calculated. The number needed to treat (NNT) was calculated. RESULTS: A total of 393 individuals were evaluable (Age: 62.4 years), 196 in the IG and 197 in the CG. There were 83.2% (95% CI 78-88.4) and 49.2% (95% CI 42.2-56.2) (P=0.0001) of overall compliers in the IG and CG, respectively and 74% (95% CI: 67.9-80.1) and 42.6% (95% CI=35.7-49.5) (P=0.0001) of correct times compliers. A total of 81.6% (95% CI=76.2-86.5%)) were controlled in the IG and 56.3% (95% CI=49.4-63.2) in the CG. The NNT was 3.3 patients. CONCLUSIONS: Therapeutic non-compliance was very high. The educational magazine is an effective strategy to improve the compliance and degree of control of the AHT.

[Control of therapeutic inertia in the treatment of arterial hypertension by using different strategies]. / El control de la inercia terapéutica en el tratamiento de la hipertensión arterial mediante diferentes estrategias.

OBJECTIVE: To evaluate the efficacy of different interventions on therapeutic Inertia (TI) in mild-to-moderate hypertension (AHT). DESIGN: Controlled, randomised clinical trial. SETTING: Two hundred clinics in 5 primary care centres. Spain. PARTICIPANTS: A total of 1104 patients with uncontrolled hypertension were included. INTERVENTION: Four groups with 276 patients were formed: 1) Control group (CG): standard health intervention; 2) Education intervention and a program of home blood pressure monitoring (HBPM) (EG); 3) Card control intervention and HBPM programme (CHG); 4) Education intervention, card control and HBPM programme (ECHG). MAIN MEASUREMENTS: TI was calculated by the rate: (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 921 patients completed the study, and 1842 visits were made, with TI in 36.8% (IC=5.8%) of the sample and in 82.58% (IC=8.2%) of the uncontrolled hypertensive patients. The TI was 60% (CI=4.2%), 38.4% (CI=4.4%) 30.2 (CI=4.3%) and 14.7 (CI=3.3%) (p=0.001) for CG, EG, CHG and ECHG, respectively. The percentage controlled at the end of study was 35.3% (CI=1.1%), 54.7% (CI=1.8%), 60.2% (CI=2.1%) and 65.1% (CI=2.2%) (p<0.01) for CG, EG, CHG and ECHG, respectively. The NI were 4.6, 3.3 and 2.2 for CG, EG, CHG and ECHG, respectively. CONCLUSIONS: TI was very significant among the uncontrolled hypertensive patients. The studied interventions are effective for improving TI.

El control de la inercia terapéutica en el tratamiento de la hipertensión arterial mediante diferentes estrategias / Control of therapeutic inertia in the treatment of arterial hypertension by using different strategies

ObjetivoComprobar la eficacia de diferentes intervenciones en la disminución de la inercia terapéutica (IT) en el tratamiento farmacológico de la hipertensión no controlada.Diseñoestudio clínico controlado, aleatorizado y multicéntrico.Emplazamiento205 centros de salud de España.ParticipantesSe incluyó a 1.104 hipertensos diagnosticados.IntervenciónSe formaron cuatro grupos con 276 individuos: un grupo de control (GC), que recibió la intervención habitual; un grupo de intervención educativa (GE) y programa de automedición domiciliaria de presión arterial (AMPA); un grupo que usó una tarjeta autoevaluadora del cumplimiento (GT) y programa de AMPA, y un grupo con intervención mixta: tarjeta, intervención educativa y programa AMPA (GET).Mediciones principalesLa IT se midió mediante el cociente: número de pacientes a los que no se ha modificado el tratamiento farmacológico en cada visita dividido por el número de pacientes con cifras medias de PA ≥140mmHg y/o ≥90mmHg en población general o ≥130 y/o 80mmHg en diabéticos, multiplicado por 100. Se calculó la IT por visitas totales y visita a los 3 y a los 6 meses. Se calcularon las PA medias y el grado de control de la hipertensión. Se calculó el número de individuos que es necesario tratar (NNT) para evitar 1 caso de IT.Resultadosconcluyeron 921 individuos. Se realizaron 1.842 visitas, con IT en el 36,8% (intervalo de confianza [IC], 5,8%) de la muestra y en el 82,58% (IC, 8,2%) de los hipertensos no controlados. La IT fue del 60% (IC, 4,2%), el 38,4% (IC, 4,4%), el 30,2% (IC, 4,3%) y el 14,7% (3,3%) (p=0,001) en el GC, el GE, el GT y el GET respectivamente, y los porcentajes de control al final fueron del 35,3% (IC, 1,1%), el 54,7% (IC, 1.8%), el 60,2% (IC, 2,1%) y el 65,1% (IC, 2,2%) (p<0,01) respectivamente. Los NNT fueron 4,6, 3,3 y 2,2 para los grupos GE, GT y GET respectivamente(AU)

Conclusionesla IT ha sido muy relevante entre los hipertensos no controlados. Las intervenciones estudiadas son eficaces para disminuir la IT(AU)

ObjectiveTo evaluate the efficacy of different interventions on therapeutic Inertia (TI) in mild-to-moderate hypertension (AHT).DesignControlled, randomised clinical trial.SettingTwo hundred clinics in 5 primary care centres. Spain.ParticipantsA total of 1104 patients with uncontrolled hypertension were included.InterventionFour groups with 276 patients were formed: 1) Control group (CG): standard health intervention; 2) Education intervention and a program of home blood pressure monitoring (HBPM) (EG); 3) Card control intervention and HBPM programme (CHG); 4) Education intervention, card control and HBPM programme (ECHG).Main measurementsTI was calculated by the rate: (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 90mmHg 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).ResultsA total of 921 patients completed the study, and 1842 visits were made, with TI in 36.8% (IC=5.8%) of the sample and in 82.58% (IC=8.2%) of the uncontrolled hypertensive patients. The TI was 60% (CI=4.2%), 38.4% (CI=4.4%) 30.2 (CI=4.3%) and 14.7 (CI=3.3%) (p=0.001) for CG, EG, CHG and ECHG, respectively. The percentage controlled at the end of study was 35.3% (CI=1.1%), 54.7% (CI=1.8%), 60.2% (CI=2.1%) and 65.1% (CI=2.2%) (p<0.01) for CG, EG, CHG and ECHG, respectively. The NI were 4.6, 3.3 and 2.2 for CG, EG, CHG and ECHG, respectively.ConclusionsTI was very significant among the uncontrolled hypertensive patients. The studied interventions are effective for improving TI(AU)

Level of blood pressure control in a hypertensive population when measurements are performed outside the clinical setting.

BACKGROUND: To determine whether the number of optimally controlled hypertensive patients is higher using self-measurement of blood pressure at home and ambulatory monitoring, compared to using conventional blood pressure measurements at the doctor's office. METHOD: An observational, cross-sectional, multicentre, descriptive study of a random sample of 237 primary health care patients, known to be hypertensive, from Badajoz (Spain). Blood pressure was measured at the doctor's office and by self-measurement at home. Those patients showing good control by self-measurement were subjected to 24-hour ambulatory monitoring. Optimal control was understood as blood pressure < 140/90 mm Hg when measured at the doctor's office, and < 135/85 mm Hg when self-measured at home and by daytime ambulatory monitoring. RESULTS: Mean systolic/diastolic measurements at the doctor's office and by self-measurement were 145.6/83.9 and 134.0/78.7 mm Hg, respectively (p < 0.000). In the population optimally controlled by self-measurement and who subsequently received ambulatory monitoring, the mean blood pressure was 121.8/73.4 and 125.6/76.2 mm Hg, respectively (p = 0.002; p < 0.000). When measured at the doctor's office blood pressure was controlled in about 29.5% (95% CI 23.7-35.3%) of patients, in 38% when self-measured (95% CI 31.4-44.2%; p < 0.000), and in 24.5% when it was confirmed through ambulatory monitoring (95% CI 15.4-33.6%). Sensitivity and positive predictive values of the office measurements for the detection of patients who were well-controlled by self-measurement were 50% and 64.3%, respectively, and 53.4% and 73.8% as regards ambulatory monitoring. CONCLUSIONS: A higher level of control is achieved with self-measurement at home not confirmed by ambulatory monitoring. Therefore, the white coat effect does not seem to influence the percentage of well-controlled patients detected at the doctor's office. Office blood pressure does not appear to be useful in distinguishing which individual patients are optimally controlled.

[Analysis of studies published on hypertension treatment non-compliance in Spain between 1984 and 2005]. / Análisis de los estudios publicados sobre el incumplimiento terapéutico en el tratamiento de la hipertensión arterial en España entre los años 1984 y 2005.

OBJECTIVE: To analyse therapy non-compliance in hypertension treatment in Spain, after a review of studies published between 1984 and 2005. DESIGN: Systematic review. DATA SOURCES: Data searches used Internet (Medline and Spanish index on doctoral these), a manual search of several Spanish journals, and bibliographic references to compliance from detected articles and through personal contact with experts. Descriptors used were: hypertension and patient compliance, compliance, adherence, patient drop-outs, treatment refusal, and their combinations. SELECTION OF STUDIES: Studies conducted in Spain and published between 1984 and 2005 were included, along with original articles, congress abstracts or doctoral theses, which used as a method of measurement pill count or counting of spaces in electronic monitoring systems, and which defined as non-compliers patients with a compliance percentage <80% and >110%. DATA EXTRACTION: The percentage of non-compliers was calculated, with 95% confidence intervals and weighted average of the percentage of non-compliers in each study. RESULTS: Twenty-six research studies published in Spain, excluding 2 analytical studies, were found. A total of 3553 patients with hypertension were included, of which 32.53% were non-compliers (n= 1156; 95 CI, 29.83-35.23) and 67.47% were compliers (n=2397; 95% CI, 65.67-69.27). The weighted average of non-compliance was at 32.78%. CONCLUSIONS: The percentage of therapy non-compliance in the treatment of hypertension in Spain has fallen in recent years, although it continues to be high.

Análisis de los estudios publicados sobre el incumplimiento terapéutico en el tratamiento de la hipertensión arterial en España entre los años 1984 y 2005 / Analysis of studies published on therapy non-compliance with hypertension treatment in Spain between 1984 and 2005

Objetivos. Analizar el incumplimiento farmacológico de la hipertensión arterial (HTA) en España, a partir de una revisión de estudios publicados entre 1984 y 2005. Diseño. Revisión sistemática. Fuentes de datos. Se realizó una búsqueda mediante internet (Medline e índice español de tesis doctorales), búsqueda manual de diferentes revistas españolas y referencias bibliográficas de artículos detectados sobre cumplimiento y contacto personalizado de expertos. Los descriptores fueron: hypertension and patient compliance, or compliance, or adherence, or patient dropouts or treatment refusal y sus combinaciones. Selección de estudios. Se incluyen estudios publicados entre 1984-2005, como artículos originales, resúmenes de congresos o tesis doctorales, realizados en España y que utilizaran como método de medida el recuento de comprimidos o el de aberturas de los monitores electrónicos (MEMS) y haber definido a los incumplidores, con un porcentaje de cumplimiento 110%. Extracción de datos. Se calcularon el porcentaje de incumplidores y sus intervalos de confianza (IC) del 95%, y la media ponderada del porcentaje de incumplidores de cada estudio. Resultados. Se ha obtenido un total de 26 estudios de investigación publicados en España, excluyéndose 2 del análisis. El número total de pacientes incluidos ha sido de 3.553 hipertensos, con un 32,53% de incumplidores (n = 1.156; IC del 95%, 29,83-35,23) y un 67,47% de cumplidores (n = 2.397; IC del 95%, 65,67-69,27). La media ponderada del porcentaje de incumplimiento fue del 32,78%. Conclusiones. El porcentaje de incumplimiento en el tratamiento farmacológico de la HTA en España ha descendido en los últimos años, aunque sigue siendo elevado

Objective. To analyse therapy non-compliance in hypertension treatment in Spain, after a review of studies published between 1984 and 2005. Design. Systematic review. Data Sources. Data searches used Internet (Medline and Spanish index on doctoral these), a manual search of several Spanish journals, and bibliographic references to compliance from detected articles and through personal contact with experts. Descriptors used were: hypertension and patient compliance, compliance, adherence, patient drop-outs, treatment refusal, and their combinations. Selection of studies. Studies conducted in Spain and published between 1984 and 2005 were included, along with original articles, congress abstracts or doctoral theses, which used as a method of measurement pill count or counting of spaces in electronic monitoring systems, and which defined as non-compliers patients with a compliance percentage 110%. Data extraction. The percentage of non-compliers was calculated, with 95% confidence intervals and weighted average of the percentage of non-compliers in each study. Results. Tweenty-six research studies published in Spain, excluding 2 analytical studies, were found. A total of 3553 patients with hypertension were included, of which 32.53% were non-compliers (n= 1156; 95 CI, 29.83-35.23) and 67.47% were compliers (n=2397; 95% CI, 65.67-69.27). The weighted average of non-compliance was at 32.78%. Conclusions. The percentage of therapy non-compliance in the treatment of hypertension in Spain has fallen in recent years, although it continues to be high