Abstract
BackgroundDespite the increased use of blood pressure (BP) monitoring devices at home, the hypertension of more than 50% of European patients remains uncontrolled. Nevertheless, the self-management of BP, through the combination of home monitoring of BP with self-titration, could be anaccessible and effective tool for improving hypertension control in the primary care setting. The ADAMPA study is a trial with participants randomised to BP self-management (BPSM) with self-titration of antihypertensive medication or to usual care, in a population of patients with poorly controlled hypertension.AimTo explore the views and attitudes of primary care doctors participating in the ADAMPA trial regarding BPSM with self-titration.Design & settingA focus group study took place with primary care doctors participating in the ADAMPA trial, which was carried out in one health district of the Valencia Health System in Spain.MethodNine primary care doctors participating in the ADAMPA trial were included in the focus group. Three researchers (two using manual methods and one using NVivo software) independently conducted a content analysis, reading the transcripts, identifying, classifying, and coding the contents, and developing a conceptual scheme based on these topics.ResultsParticipating doctors clearly support home BP monitoring (HBPM), the setting of individual BP targets, and incorporating patient readings into decision-making. They consider it an investment to educate patients for medication self-adjustment and estimate that an important proportion of their patients are potential candidates for hypertension self-management with medication self-titration. However, they show important divergences regarding the role of nursing in BP control.ConclusionPrimary care doctors participating in the ADAMPA trial feel comfortable with BPSM with self-titration, and would consider extending its use (or the use of some components, such as BP target setting) to other patients with hypertension outside the trial.
Highlights
While safe and effective antihypertensive pharmacological treatments have been available for decades, hypertension continues to be one of the largest contributors to the global burden of disease.[1]
Primary care doctors participating in the ADAMPA trial feel comfortable with BP self-m anagement (BPSM) with self-titration, and would consider extending its use to other patients with hypertension outside the trial
BPSM interventions whereby patients titrate their own medication according to a pre-a rranged plan offers promising evidence of effectiveness, this is only supported by a few clinical trials, all of which were carried out in the specific environment of the UK NHS
Summary
While safe and effective antihypertensive pharmacological treatments have been available for decades, hypertension continues to be one of the largest contributors to the global burden of disease.[1]. Despite the increased use of blood pressure (BP) monitoring devices at home, the hypertension of more than 50% of European patients remains uncontrolled. The self- management of BP, through the combination of home monitoring of BP with self-titration, could be anaccessible and effective tool for improving hypertension control in the primary care setting. The ADAMPA study is a trial with participants randomised to BP self-m anagement (BPSM) with self- titration of antihypertensive medication or to usual care, in a population of patients with poorly controlled hypertension
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