Directly observed therapy prior to ambulatory blood pressure measurement (DOT-HTN) in uncontrolled hypertensive patients - Effect on blood pressure, safety and patient perception

Abstract

Aims: Non-adherence to medication is a key challenge in treatment of hypertensive patients. Directly Observed Therapy prior to ambulatory blood pressure measurement (DOT-HTN) is relatively new in hypertension research and knowledge about its use and patients’ perception of such control is warranted.

We aimed to investigate DOT-HTN in relation to blood pressure control, procedural safety and patients’ perception.

Methods and results: Twenty patients with uncontrolled hypertension (daytime systolic ambulatory blood pressure measurement (ABPM) ≥135 mm Hg) were randomized to intervention with DOT-HTN and a visual analogue scale (VAS) assessment if they found DOT-HTN problematic (10 cm = very problematic), or to standard ABPM. They were followed for 2–4 weeks.

There were no differences in baseline characteristics. Despite no difference in daytime systolic ABPM (p = 0.67) two patients were suggested to be non-adherent after DOT-HTN with reductions in daytime systolic ABPM of 18 and 22 mm Hg, respectively. No post DOT-HTN adverse reactions were reported. VAS assessment indicated that the patients had no problem being controlled (VAS median 0.30 cm (0.0–2.6)), however interesting comments and observed behaviour questioned the reliability of the patient-reported VAS in 38% of patients.

Conclusions: Two of eight patients seemed to be non-adherent after DOT-HTN. Descriptive findings suggested reluctance towards control with DOT-HTN not captured by the VAS assessment. No DOT-related medical adverse-effects were reported.

Keywords:

• Uncontrolled hypertension
• non-adherence
• antihypertensive therapy
• patient perspective
• perception
• control
• directly observed therapy
• DOT-HTN

Acknowledgement

The authors gratefully acknowledge the assistance of Pernille Fabritius Dybwad and Tone Rambjørg Heimstad of the Department of Nephrology, Oslo University Hospital, Ullevaal, and they thank Professor Sverre Erik Kjeldsen of the Department of Cardiology, Oslo University Hospital, Ullevaal, for commenting on this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.