OBJECTIVES:To evaluate the importance of providing guidelines to patients via active telephone calls for blood pressure control and for preventing the discontinuation of treatment among hypertensive patients.INTRODUCTION:Many reasons exist for non-adherence to medical regimens, and one of the strategies employed to improve treatment compliance is the use of active telephone calls.METHODS:Hypertensive patients (n = 354) who could receive telephone calls to remind them of their medical appointments and receive instruction about hypertension were distributed into two groups: a) “uncomplicated” – hypertensive patients with no other concurrent diseases and b) “complicated” - severe hypertensive patients (mean diastolic ≥110 mmHg with or without medication) or patients with comorbidities. All patients, except those excluded (n = 44), were open-block randomized to follow two treatment regimens (“traditional” or “current”) and to receive or not receive telephone calls (“phone calls” and “no phone calls” groups, respectively).RESULTS:Significantly fewer patients in the “phone calls” group discontinued treatment compared to those in the “no phone calls” group (4 vs. 30; p<0.0094). There was no difference in the percentage of patients with controlled blood pressure in the “phone calls” group and “no phone calls” group or in the “traditional” and “current” groups. The percentage of patients with controlled blood pressure (<140/90 mmHg) was increased at the end of the treatment (74%), reaching 80% in the “uncomplicated” group and 67% in the “complicated” group (p<0.000001).CONCLUSION:Guidance to patients via active telephone calls is an efficient strategy for preventing the discontinuation of antihypertensive treatment.

Pierin AMG, Ignez EC, Jacob Filho W, Barbato AJG, Mion Jr. D. Blood pressure measurements taken by patients are similar to home and ambulatory blood pressure measurements. Clinics. 2008;63(1):43-50. OBJECTIVE:To compare blood pressure measurements taken at home by physicians, nurses, and patients with office blood pressure measurement , ambulatory blood pressure monitoring and home blood pressure measurement. METHODS: A total of 44 patients seen by a home care program were studied. Protocol 1 a) blood pressure was measured by the patient, a physician and a nurse during a regular home visit (Home1); b) home blood pressure measurement was measured for 4 days (HBPM1); c) office blood pressure measurement was measured by a physician, a nurse, and the patient; and by 24-hour ambulatory blood pressure monitoring. Protocol 2 blood pressure was measured by the patient, a physician, and a nurse during a special home visit in the presence of a physician and a nurse only (Home2); and b) home blood pressure measurement was taken for the second time (HBPM2). Echocardiography, guided by a two-dimensional echocardiograph, was performed. RESULTS: Protocol 1: a) office blood pressure measurement and Home1 were significantly higher than ambulatory blood pressure monitoring, except for systolic and diastolic office blood pressure measurement taken by the patient or a family member, systolic blood pressure taken by a nurse, and diastolic blood pressure taken by a physician. b) ambulatory blood pressure monitoring and HBPM1 were similar. Protocol 2: a) HBPM2 and Home2 were similar. b) Home2 was significantly lower than Home1, except for diastolic blood pressure taken by a nurse or the patient. There were significant relationships between: a) diastolic blood pressure measured by the patient and the thickness of the interventricular septum, posterior wall, and left ventricular mass; and b) ambulatory and HBPM2 diastolic and systolic blood pressure taken by a physician (home2) and left ventricular mass. Therefore, the data indicate that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic values relative to "office measurement." CONCLUSION: This study showed that the measurement most similar to home blood pressure measurement and ambulatory blood pressure monitoring was blood pressure measured by the patient, and that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic value relative to "office measurements". KEYWORDS:Home blood pressure. Ambulatory blood pressure. Office blood pressure measurement. Hypertension. White coat effect.

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