Effectiveness of medication self-management, self-monitoring and a lifestyle intervention on hypertension in poorly controlled patients: The MEDICHY randomized trial.

Background: Uncontrolled hypertension is a common problem worldwide, despite the availability of many effective antihypertensive drugs and lifestyle interventions. We assessed the efficacy of a multi-component intervention in individuals with uncontrolled hypertension in a primary care setting. Methods: This study was a randomized, multicenter, parallel, two-arm, single-blind controlled trial performed in primary healthcare centers in Mallorca (Spain). All participants were 35 to 75-years-old and had poorly controlled hypertension. Patients were randomly assigned in a 1:1 ratio to a control group (usual care) or an intervention group (self-monitoring of blood pressure, self-titration of hypertensive medications, dietary interventions, and physical activity interventions). The primary outcome was decrease in the mean SBP at 6 months relative to baseline. Results: A total of 153 participants were randomized to an intervention group (77) or a control group (76). After 6 months, the intervention group had a significantly lower systolic blood pressure (135.1 mmHg [±14.8] vs. 142.7 mmHg [±15.0], adjusted mean difference: 8.7 mmHg [95% CI: 3.4, 13.9], p < 0.001) and a significantly lower diastolic blood pressure (83.5 mmHg [±8.8] vs. 87.00 mmHg [±9.0], adjusted mean difference: 5.4 [95% CI: 2.9, 7.8], p < 0.0001). The intervention group also had significantly more patients who achieved successful blood pressure control (<140/90 mmHg; 54.4% vs. 32.9%, p = 0.011). Discussion: Self-monitoring of blood pressure in combination with self-management of hypertensive medications, diet, and physical activity in a primary care setting leads to significantly lower blood pressure in patients with poorly controlled hypertension.Clinical Trial Registration: ClinicalTrials.gov, identifier ISRCTN14433778.

Effectiveness of a multifactorial intervention, consisting of self-management of antihypertensive medication, self-measurement of blood pressure, hypocaloric and low sodium diet, and physical exercise, in patients with uncontrolled hypertension taking 2 or more antihypertensive drugs: The MEDICHY study.

INTRODUCTION: High blood pressure is the leading modifiable risk factor for cardiovascular disease, and is associated with high morbidity and mortality and with significant health care costs for individuals and society. However, fewer than half of the patients with hypertension receiving pharmacological treatment have adequate blood pressure control. The main reasons for this are therapeutic inertia, lack of adherence to treatment, and unhealthy lifestyle (i.e., excess dietary fat and salt, sedentary lifestyle, and overweight). Cardiovascular risk and mortality are greater in hypertensive patients who are receiving treatment but have suboptimal control of blood pressure. METHODS/DESIGN: This is a multicentre, parallel, 2-arm, single-blind (outcome assessor), controled, cluster-randomized clinical trial. General practitioners and nurses will be randomly allocated to the intervention group (self-management of antihypertensive medication, self-measurement of blood pressure, hypocaloric and low sodium diet, and physical exercise) or the control group (regular clinical practice). A total of 424 patients in primary care centers who use 2 or more antihypertensive drugs and blood pressure of at least 130/80 during 24-hambulatory blood pressure monitoring will be recruited. The primary outcome is systolic blood pressure at 12 months. The secondary outcomes are blood pressure control (<140/90 mm Hg); quality of life (EuroQol 5D); direct health care costs; adherence to use of antihypertensive medication; and cardiovascular risk (REGICOR and SCORE scales). DISCUSSION: This trial will be conducted in the primary care setting and will evaluate the impact of a multifactorial intervention consisting of self-management of blood pressure, antihypertensive medications, and lifestyle modifications (hypocaloric and low sodium diet and physical exercise).

[Prevalence of cardiovascular risk factors in the Balearic Islands (CORSAIB Study)]. / Prevalencia de factores de riesgo cardiovascular en las Islas Baleares (estudio CORSAIB).

INTRODUCTION AND OBJECTIVES: Indices of cardiovascular morbidity and mortality in the Balearic Islands in Spain are poor. We decided to investigate the prevalence of the main cardiovascular risk factors (CRFs) and of different cardiovascular diseases in inhabitants of these islands aged 35-74 years. SUBJETS AND METHOD: A population-based descriptive cross-sectional study was used. The Balearic Islands were divided into 14 sectors, each with three or four participating general practitioners (GPs). A random selection of 40 patients registered with each GP was made. Patients were contacted in the surgery or by mail or telephone. Each GP administered a questionnaire on the patients' family and personal history of cardiovascular disease and CRFs such as levels of smoking and physical activity, carried out anthropometric and blood pressure measurements, and requested blood glucose, cholesterol, and cholesterol fraction measurements. RESULTS: The study included 1685 individuals. Some 27% smoked (men 36.9%, women 18.7%), 47.8% had high blood pressure (men 52.3%, women 43.4%), 24.2% had hypercholesterolemia (men 24.4%, women 24.1%), 11.7% had diabetes mellitus (men 15.3%, women 8.4%), 27% were obese (men 24.8%, women 29%), 40.1% were overweight (men 48.3%, women 33.4%), and 43.1% of men and 45.6% of women were sedentary. Two or more CRFs were observed in 58.4%, and 9.8% had a diagnosed cardiovascular disease. The Framingham method gave a higher estimate of cardiovascular risk in all age groups than the REGICOR method. CONCLUSIONS: The prevalence of the main CRFs in the Balearic Islands is high, implying a high risk profile. Dietary and lifestyle interventions, and preventive measures are recommended.

Prevalencia de factores de riesgo cardiovascular en las Islas Baleares (estudio CORSAIB) / Prevalence of cardiovascular risk factors in the Balearic Islands (CORSAIB study)

Introducción y objetivos. Baleares presenta indicadores desfavorables de morbimortalidad cardiovascular. Por ello se planteó estimar la prevalencia de los principales factores de riesgo cardiovascular (FRC) y de la enfermedad cardiovascular diagnosticada entre la población de 35 a 74 años de las islas.Sujetos y método. Se realizó un diseño descriptivo transversal de base poblacional. Se dividió la comunidad en 14 sectores y participaron 3 o 4 médicos de familia por sector (50 en total). Se seleccionó aleatoriamente a 40 personas entre las adscritas a cada médico, que se captaron en la consulta, por carta y por teléfono. Cada médico administró un cuestionario de antecedentes personales y familiares de enfermedades del aparato cardiovascular y de FRC, hábito tabáquico, ejercicio físico, exploración física de medidas antropométricas y presión arterial, y solicitó una determinación de las concentraciones de glucemia, colesterol y sus fracciones. Resultados. Se incluyó a 1.685 personas. Las prevalencias estimadas fueron: tabaquismo del 27% (el 36,9% en varones y el 18,7% en mujeres); hipertensión del 47,8% (el 52,3% en varones y el 43,4% en mujeres); hipercolesterolemia del 24,2% (el 24,4% en varones y el 24,1% en mujeres); diabetes del 11,7% (el 15,3% en varones y el 8,4% en mujeres); obesidad del 27% (el 24,8% en varones y el 29% en mujeres), sobrepeso del 40,1% (el 48,3 en varones y el 33,4% en mujeres), y sedentarismo (el 43,1% en varones y el 45,6% en mujeres). El 58,4% tenía 2 o más FRC. El 9,8% tenía una enfermedad cardiovascular diagnosticada. El riesgo cardiovascular individual fue superior al calcularlo con la ecuación de Framingham que con la de REGICOR en todos los grupos de edad. Conclusiones. Los principales FRC tienen una alta prevalencia en Baleares, lo que supone un elevado perfil de riesgo. Es recomendable la intervención en los hábitos dietéticos y los estilos de vida, así como la adopción de medidas de prevención

Introduction and objectives. Indices of cardiovascular morbidity and mortality in the Balearic Islands in Spain are poor. We decided to investigate the prevalence of the main cardiovascular risk factors (CRFs) and of different cardiovascular diseases in inhabitants of these islands aged 35-74 years. Subjets and method. A population-based descriptive cross-sectional study was used. The Balearic Islands were divided into 14 sectors, each with three or four participating general practitioners (GPs). A random selection of 40 patients registered with each GP was made. Patients were contacted in the surgery or by mail or telephone. Each GP administered a questionnaire on the patients' family and personal history of cardiovascular disease and CRFs such as levels of smoking and physical activity, carried out anthropometric and blood pressure measurements, and requested blood glucose, cholesterol, and cholesterol fraction measurements. Results. The study included 1685 individuals. Some 27% smoked (men 36.9%, women 18.7%), 47.8% had high blood pressure (men 52.3%, women 43.4%), 24.2% had hypercholesterolemia (men 24.4%, women 24.1%), 11.7% had diabetes mellitus (men 15.3%, women 8.4%), 27% were obese (men 24.8%, women 29%), 40.1% were overweight (men 48.3%, women 33.4%), and 43.1% of men and 45.6% of women were sedentary. Two or more CRFs were observed in 58.4%, and 9.8% had a diagnosed cardiovascular disease. The Framingham method gave a higher estimate of cardiovascular risk in all age groups than the REGICOR method. Conclusions. The prevalence of the main CRFs in the Balearic Islands is high, implying a high risk profile. Dietary and lifestyle interventions, and preventive measures are recommended