Monitoramento residencial da pressão arterial em pacientes com hipertensão não controlada: ensaio clínico randomizado

Abstract

This study aimed to test Home Blood Pressure Monitoring (HBPM) in reducing blood pressure (BP) values among individuals with uncontrolled hypertension. It was a randomized clinical trial (RCT) conducted with 70 adult individuals with uncontrolled hypertension randomly allocated into two groups: 31 in the Intervention Group (IG) and 39 in the Control Group (CG), followed up between December 2022 and September 2023, in Fortaleza-CE, Brazil. Data collection occurred in 5 stages: 1) recruitment; 2) inclusion in the study and baseline data collection, including information on sociodemographic issues, anthropometric and clinical profile, and adherence to medication treatment; 3) randomization; 4) intervention; and 5) reassessment of adherence to medication treatment. All participants were followed up by the research team in three return visits to the unit. The intervention consisted of IG participants performing HBPM, who were loaned an automatic BP monitor to perform measurements at home for 5 consecutive days each month. The CG participants did not perform HBPM but were also followed up by the research team at return visits. In these return visits, for both groups, the researchers carried out new BP measurements using the oscillometric method. The third return visit was complemented by the reassessment of treatment adherence data. The Human Research Ethics Committee of the Federal University of Ceará approved the project under opinion n. 5,769,427, which was also registered on the Brazilian Clinical Trial Registry Platform. In the intergroup analysis, participants in the IG presented an average reduction of 16.71 mmHg in SBP values, from 154.61 to 137.90 mmHg, while the CG had a reduction of 10.87 mmHg, from 152.67 to 141.80 mmHg. For DBP, the IG demonstrated a reduction of 12.47 mmHg, from 87.03 to 74.57 mmHg, and the CG had a reduction of 9.73 mmHg, from 88.67 to 78.94 mmHg. At the end of the study, the prevalence of high adherence to medication treatment was higher in the IG (53.85%) than in the CG (33.33%), with a statistical difference. It is concluded that the use of HBPM enables a greater reduction in SBP and DBP values, when compared with regular follow-up at the unit, besides improving adherence to medication treatment. Therefore, it can be used as an intervention to achieve and maintain blood pressure targets, contributing to reduce healthcare costs as it impacts the general improvement of patients’ cardiovascular health.