Check and Support -Enhancing the Treatment of Hypertension in Outpatient Care, a Multicenter Study

NCT ID: NCT02377960

Last Updated: 2018-07-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

119 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-01-27

Study Completion Date

2018-03-06

Brief Summary

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The purpose of this pragmatic multi-centre, cluster randomized controlled trial is to test the effectiveness of tailored SMS-text message support combined with an information-motivation-behavioral skills (IMB) model-based initiation of medication in helping outpatient care patients with hypertension to achieve blood pressure target and to enhance medication adherence.

Detailed Description

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Background

Usual blood pressure is strongly related to vascular and overall mortality and high blood pressure is globally the leading risk factor for cardiovascular and related diseases. It is also well established that pharmacologic blood pressure reduction prevents cardiovascular events and deaths in persons with hypertension.

Today's physicians have plenty of knowledge and multiple effective and safety tools to treat hypertension but still majority of patients with antihypertensive medication do not achieve the blood pressure target. Poor medication adherence has been widely accepted to be the most important factor in failing to control hypertension and even 50% of hypertensive patients quit the antihypertensive medication during the first year of medication.

Numerous interventions to enhance medication adherence have been developed but even though, an intervention effective, simple and low cost enough to be carried out wide-scale in non-research settings is still to be found.

Objectives

To test whether a tailored SMS-text message support combined with an IMB model-based initiation of medication will increase the proportion of patients achieving the systolic blood pressure target at 12-month follow-up compared to usual care.

Additional objectives include investigating whether the intervention have effect on

* Medication adherence
* Systolic and diastolic blood pressure level
* Hypertension-related use of health care services
* Blood glucose, blood cholesterol, microalbuminuria, creatinine, ECG, body mass index, waist circumference exercising habits, smoking and alcohol use
* Perceived quality of life at base line and at 12-month follow-up
* Setting (physicians) and knowing (participants) an adequate BP target

And, besides

Detecting the participants who especially benefit from intervention

* Analyzing the quality and quantity of self-monitored BP and
* Assessing whether the IMB model-based structured initiation of medication can be used for screening of non-compliant patients and directing resources more accurately to them
* Collecting and analyzing participants' and physicians' feedback for future development of intervention

Study design

Pragmatic randomized controlled multicenter trial. The eight study centers are grouped to comparable pairs and randomized to function as intervention and control sites (2-cluster design).

Conditions

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Hypertension Blood Pressure Patient Compliance Patient Adherence Medication Adherence

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Usual care (Reference group)

Treatment is leaded by treating physician according to national guide lines with no study-specific medication or clinical appointment protocol.

Group Type ACTIVE_COMPARATOR

Usual care

Intervention Type BEHAVIORAL

Usual care

An IMB model-based initiation of medication

In addition to usual care, participants allocated to intervention group will receive

An IMB model-based initiation of medication i.e. a nine-point check list to be fulfilled by physician and patient together when ordering the antihypertensive medication for the first time

Group Type EXPERIMENTAL

IMB model-based initiation of antihypertensive medication

Intervention Type BEHAVIORAL

1.An IMB model-based initiation of medication i.e. a nine-point check list to be fulfilled by physician and patient together when ordering the antihypertensive medication for the first time

Tailored SMS-text message support

Intervention Type BEHAVIORAL

2.Tailored SMS-text message support for the first 12 months of medication. At the beginning (2 weeks), text messages are send on daily basis and focused on medications-reminders and coping with potential side-effects of medication. After that, text messages will be sent less often and the focus will change to keeping up with medication and reminding of importance of performing adequate home BP self-monitoring, achieving the BP target and attending clinical appointments.

Tailored SMS-text message support

Tailored SMS-text message support for the first 12 months of medication. At the beginning (2 weeks), text messages are send on daily basis and focused on medications-reminders and coping with potential side-effects of medication.

After that, text messages will be sent less often and the focus will change to keeping up with medication and reminding of importance of performing adequate home BP self-monitoring, achieving the BP target and attending clinical appointments.

Group Type EXPERIMENTAL

IMB model-based initiation of antihypertensive medication

Intervention Type BEHAVIORAL

1.An IMB model-based initiation of medication i.e. a nine-point check list to be fulfilled by physician and patient together when ordering the antihypertensive medication for the first time

Tailored SMS-text message support

Intervention Type BEHAVIORAL

2.Tailored SMS-text message support for the first 12 months of medication. At the beginning (2 weeks), text messages are send on daily basis and focused on medications-reminders and coping with potential side-effects of medication. After that, text messages will be sent less often and the focus will change to keeping up with medication and reminding of importance of performing adequate home BP self-monitoring, achieving the BP target and attending clinical appointments.

Interventions

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IMB model-based initiation of antihypertensive medication

1.An IMB model-based initiation of medication i.e. a nine-point check list to be fulfilled by physician and patient together when ordering the antihypertensive medication for the first time

Intervention Type BEHAVIORAL

Tailored SMS-text message support

2.Tailored SMS-text message support for the first 12 months of medication. At the beginning (2 weeks), text messages are send on daily basis and focused on medications-reminders and coping with potential side-effects of medication. After that, text messages will be sent less often and the focus will change to keeping up with medication and reminding of importance of performing adequate home BP self-monitoring, achieving the BP target and attending clinical appointments.

Intervention Type BEHAVIORAL

Usual care

Usual care

Intervention Type BEHAVIORAL

Other Intervention Names

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Check list for initiation of antihypertensive medication Text message support Standard care

Eligibility Criteria

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Inclusion Criteria

* A clinical diagnosis of hypertension
* About to start medication for hypertension for the first time
* Aged 30-75 years
* Must own a mobile phone
* Must be able to read text messages
* Must be able to master own medication
* Must be able to perform home BP measurements
* Must agree in using electric drug prescription (standard in Finnish health care)

Exclusion Criteria

* Having or is suspected to have depression or psychosis
* Serious disease, which is evaluated to have an impact on life expectancy
* Atrial flutter or atrial fibrillation
* Previous history of antihypertensive medication
* Pregnancy
* Not willing to give informed consent and take part in the study
* Systolic BP more than 200 mmHg
* Diastolic BP more than 120 mmHg
* Sudden onset or worsening of hypertension
* Clinical signs of kidney disease: proteinuria (du-prot \> 500 mg), glomerulus filtration rate (eGFR) less than 45 ml/min or hypokalemia
Minimum Eligible Age

30 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Health Centre of Jyväskylä Cooperation Area

UNKNOWN

Sponsor Role collaborator

Central Finland Hospital District

OTHER

Sponsor Role collaborator

Occupational Health Care Työterveys Aalto

UNKNOWN

Sponsor Role collaborator

Mehiläinen Jyväskylä Occupational health services

UNKNOWN

Sponsor Role collaborator

Northern Savo Hospital District

OTHER

Sponsor Role collaborator

Kuopio University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Pekka Mäntyselkä, MD,Prof.

Role: STUDY_CHAIR

University of Eastern Finland

Aapo Tahkola, LM,PHD st.

Role: PRINCIPAL_INVESTIGATOR

Health Centre of Jyväskylä Cooperation Area

Locations

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Health Centre of Jyväskylä Cooperation Area

Jyväskylä, , Finland

Site Status

Mehiläinen Jyväskylä Occupational Health Services

Jyväskylä, , Finland

Site Status

Central Finland Hospital District (Perusterveydenhuollon liikelaitos Seututerveyskeskus)

Jyväskylä, , Finland

Site Status

Oma Lääkärisi Tikkakoski

Jyväskylä, , Finland

Site Status

Oma Lääkärisi Korpilahti

Jyväskylä, , Finland

Site Status

Sote kuntayhtymä/Perusturvaliikelaitos Saarikka

Saarijärvi, , Finland

Site Status

Countries

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Finland

References

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Tahkola A, Korhonen P, Kautiainen H, Niiranen T, Mantyselka P. The impact of antihypertensive treatment initiation on health-related quality of life and cardiovascular risk factor levels: a prospective, interventional study. BMC Cardiovasc Disord. 2021 Sep 16;21(1):444. doi: 10.1186/s12872-021-02252-7.

Reference Type DERIVED
PMID: 34530733 (View on PubMed)

Palmer MJ, Machiyama K, Woodd S, Gubijev A, Barnard S, Russell S, Perel P, Free C. Mobile phone-based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults. Cochrane Database Syst Rev. 2021 Mar 26;3(3):CD012675. doi: 10.1002/14651858.CD012675.pub3.

Reference Type DERIVED
PMID: 33769555 (View on PubMed)

Tahkola A, Korhonen P, Kautiainen H, Niiranen T, Mantyselka P. Feasibility of a checklist in treating hypertension in primary care - base line results from a cluster-randomised controlled trial (check and support). BMC Cardiovasc Disord. 2018 Dec 19;18(1):240. doi: 10.1186/s12872-018-0963-5.

Reference Type DERIVED
PMID: 30567497 (View on PubMed)

Other Identifiers

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KUH500SH01

Identifier Type: -

Identifier Source: org_study_id

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