DIRECTLY OBSERVED THERAPY BEFORE AMBULATORY BLOOD PRESSURE MEASUREMENT – EFFECT ON BLOOD PRESSURE, SAFETY AND PATIENT PERCEPTION

Abstract

Objective: Non-adherence to medication is a key challenge in the treatment of hypertensive patients. Directly Observed Therapy before ambulatory blood pressure measurement (DOT-HTN) is relatively new in hypertension research and knowledge about its use and patients[Combining Acute Accent] perception of such control is warranted. We aimed to investigate DOT-HTN in relation to blood pressure control, safety and patients[Combining Acute Accent] perception. Design and method: Twenty patients with uncontrolled hypertension (daytime systolic ambulatory blood pressure measurement (ABPM) over or equal to 135 mm Hg) were randomized to intervention with DOT-HTN and a visual analogue scale (VAS) measuring if they found DOT-HTN problematic (10 cm = very problematic), or to standard ABPM. They were followed for up to 4 weeks.Results: There were no differences in baseline characteristics nor in change in daytime systolic ABPM between the groups (p = 0.67). Two patients were suggested to be non-adherent after DOT-HTN with reductions in daytime systolic ABPM of 18 and 19 mm Hg. No post DOT-HTN adverse reactions were reported. VAS assessment indicated that the patients had negligible problems being controlled (VAS median 0.30 cm (0.0–2.6)), however, comments and observed behaviour highly questioned the reliability of the patient-reported VAS in 38 % of patients. Conclusions: Two of eight patients decreased in ambulatory blood pressure after DOT-HTN suggesting non-adherence to antihypertensive medication. Descriptive findings suggested reluctance towards control with DOT-HTN not captured by the VAS assessment. No DOT-related medical adverse-effects were reported by the participating patients.