Chmiel Corinne, Senn Oliver, Rosemann Thomas, Del Prete Valerio, Steurer-Stey Claudia
Institute of General Practice and Health Services Research, University of Zurich, Zürich, Switzerland.
Patient Prefer Adherence. 2014 Oct 16;8:1383-92. doi: 10.2147/PPA.S68213. eCollection 2014.
Inadequate blood pressure (BP) control is a frequent challenge in general practice. The objective of this study was to determine whether a color-coded BP booklet using a traffic light scheme (red, >180 mmHg systolic BP and/or >110 mmHg diastolic BP; yellow, >140-180 mmHg systolic BP or >90-110 mmHg diastolic BP; green, ≤140 mmHg systolic BP and ≤90 mmHg diastolic BP) improves BP control and adherence with home BP measurement.
In this two-group, randomized controlled trial, general practitioners recruited adult patients with a BP >140 mmHg systolic and/or >90 mmHg diastolic. Patients in the control group received a standard BP booklet and the intervention group used a color-coded booklet for daily home BP measurement. The main outcomes were changes in BP, BP control (treatment goal <140/90 mmHg), and adherence with home BP measurement after 6 months.
One hundred and twenty-one of 137 included patients qualified for analysis. After 6 months, a significant decrease in systolic and diastolic BP was achieved in both groups, with no significant difference between the groups (16.1/7.9 mmHg in the intervention group versus 13.1/8.6 mmHg in the control group, P=0.3/0.7). BP control (treatment target <140/90 mmHg) was achieved significantly more often in the intervention group (43% versus 25%; P=0.037; number needed to treat of 5). Adherence with home BP measurement overall was high, with a trend in favor of the intervention group (98.6% versus 96.2%; P=0.1).
Color-coded BP self-monitoring significantly improved BP control (number needed to treat of 5, meaning that every fifth patient utilizing color-coded self-monitoring achieved better BP control after 6 months), but no significant between-group difference was observed in BP change. A markedly higher percentage of patients achieved BP values in the normal range. This simple, inexpensive approach of color-coded BP self-monitoring is user-friendly and applicable in primary care, and should be implemented in the care of patients with arterial hypertension.
血压控制不佳是全科医疗中常见的挑战。本研究的目的是确定使用交通信号灯方案（红色，收缩压>180 mmHg和/或舒张压>110 mmHg；黄色，收缩压>140 - 180 mmHg或舒张压>90 - 110 mmHg；绿色，收缩压≤140 mmHg且舒张压≤90 mmHg）的彩色编码血压手册是否能改善血压控制并提高家庭血压测量的依从性。
在这项两组随机对照试验中，全科医生招募了收缩压>140 mmHg和/或舒张压>90 mmHg 的成年患者。对照组患者收到一本标准血压手册，干预组使用彩色编码手册进行日常家庭血压测量。主要结局指标为6个月后血压的变化、血压控制情况（治疗目标 <140/90 mmHg）以及家庭血压测量的依从性。
137例纳入患者中有121例符合分析条件。6个月后，两组收缩压和舒张压均显著下降，组间无显著差异（干预组为16.1/7.9 mmHg，对照组为13.1/8.6 mmHg，P = 0.3/0.7）。干预组实现血压控制（治疗目标 <140/90 mmHg）的比例显著更高（43% 对 25%；P = 0.037；需治疗人数为5）。总体而言，家庭血压测量的依从性较高，干预组有更高的趋势（98.6% 对 96.2%；P = 0.1）。
彩色编码血压自我监测显著改善了血压控制（需治疗人数为5，意味着每五名使用彩色编码自我监测的患者在6个月后血压控制更好），但在血压变化方面未观察到组间显著差异。达到正常血压值的患者比例明显更高。这种简单、廉价的彩色编码血压自我监测方法对用户友好，适用于初级保健，应在动脉高血压患者的护理中实施。
