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

• Published in: Medicine (Baltimore) 2020-04, Vol.99 (17), p.e19769-e19769
• Main Authors: Unda Villafuerte, Fabián, Llobera Cànaves, Joan, Lorente Montalvo, Patricia, Moreno Sancho, María Lucía, Oliver Oliver, Bartolomé, Bassante Flores, Patricia, Estela Mantolan, Andreu, Pou Bordoy, Joan, Rodríguez Ruiz, Tomás, Requena Hernández, Ana, Leiva, Alfonso, Torrent Quetglas, Matíes, Coll Benejam, José María, D’Agosto Forteza, Pilar, Rigo Carratalà, Fernando
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antihypertensive Agents - standards; Antihypertensive Agents - therapeutic use; Blood Pressure - drug effects; Blood Pressure Determination - methods; Blood Pressure Determination - standards; Caloric Restriction - methods; Cluster Analysis; Diet, Sodium-Restricted - methods; Exercise - physiology; Female; Humans; Hypertension - drug therapy; Hypertension - psychology; Life Style; Male; Middle Aged; Risk Factors; Self-Management - methods; Self-Management - psychology; Study Protocol Clinical Trial; Treatment Adherence and Compliance - psychology; Treatment Outcome
• ISSN: 0025-7974; 1536-5964; 1536-5964
• DOI: 10.1097/MD.0000000000019769

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. 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 (