Effects of self-monitoring devices on blood pressure in older adults with hypertension and diabetes: a randomised controlled trial

Abstract

Background Hypertension and diabetes frequently coexist, which results in the difficulty of hypertension control in community-dwelling elderly adults who lack effective prevention and control strategies. The aim of this study is to determine whether a combined pedometer and home blood pressure monitoring (HBPM) programme could improve blood pressure (BP) among community-dwelling elderly adults with hypertension and diabetes. Methods The trial was a 2×2 factorial randomised clinical trial that recruited 180 community-dwelling elderly people (aged ≥60) with hypertension and diabetes in Tianjin, China. Participants were randomly assigned to control, pedometer, HBPM, and pedometer+HBPM groups. Intervention period was 12 months. The coprimary outcomes of the study were systolic and diastolic BP; the secondary outcomes included the proportion of patients with controlled hypertension. BP was measured twice in the right arm using a mercurial sphygmomanometer. The mean of these two measurements was taken as the BP value. Results At 12 months, compared with the control group, the adjusted differences in least squares mean (95% CI) in systolic and diastolic BP changes for pedometer, HBPM, and pedometer+HBPM groups were −4.2 (–8.4 to 0.1), –2.7 (–6.9 to 1.5) and −8.1 (–12.3 to –3.9) mm Hg (p<0.01); −3.2 (–5.2 to –1.1), −0.1(−2.1 to 1.9) and −3.6 (–5.6 to –1.5) mm Hg (p<0.001), respectively; the adjusted difference in percentage (95% CI) in the controlled hypertension (BP <140/90 mm Hg) for pedometer, HBPM and pedometer+HBPM groups were 7.5 (–12.2 to 27.1), 9.9 (–10.4 to 30.3) and 23.1 (5.0 to 41.1) (p=0.09). Conclusion Combination pedometer and HBPM interventions can significantly decrease BP levels in elderly adults with hypertension and diabetes. Trials Registration number UMIN000021613.