Blood pressure

In France, only 25% of hypertensive adults are diagnosed and controlled. The French National Authority for Health (Haute Autorité de Santé, HAS) recommends home blood pressure monitoring (HBPM) for the diagnosis and management of patients with elevated blood pressure, in line with international hypertension guidelines. HAS advises the “rule of 3”: three measurements in the morning and three in the evening for at least three consecutive days. Although HBPM is widely adopted by general practitioners and patients with home devices, few patients (140 mmHg performing HBPM at home from March to September 2025. The primary outcome was adherence to HAS recommendations and reporting of HBPM results before and after a brief oral and written educational intervention combined with formal prescription. The primary outcome was expressed as a percentage and analyzed using McNemar’s test.Twenty-three patients were included (mean age 71±10 years; 12 women). Mean office systolic blood pressure was 155±14 mmHg. At baseline, 12 patients (52%) performed three consecutive measurements, 19 (83%) in the morning, 14 (61%) in the evening, and 12 (52%) over at least three consecutive days. Overall, only 8 patients (35%) fully complied with HAS recommendations. Two weeks after the intervention, 20 patients (87%) performed three measurements in the morning and evening for at least three days and reported their measurements to their physician (p<0.001).-This real-life primary care study shows that brief education combined with prescription of HBPM significantly improves patient adherence to guidelines and reporting of results. Strengths include its pragmatic design and clinical applicability. Limitations include the small sample size, single-center design, and short follow-up. Further analyses are ongoing to assess whether patient adherence to HBPM recommendations is sustained over time.

Hypertension is a major modifiable risk factor for cardiovascular disease, yet blood pressure (BP) control remains suboptimal, particularly in socially disadvantaged communities. Recent guidelines promote initiating single-pill combination (SPC) therapy to improve medication adherence and BP control, but clinical adoption in primary care remains limited.To evaluate the SOLO care improvement project, which promoted SPC initiation among general practitioners in Amsterdam-Zuidoost, a socially disadvantaged, multi-ethnic community in The Netherlands with a high hypertension burden.In a cluster quasi-randomized design, adult hypertensive patients from nine general practices within the same health facility were allocated to an intervention (IC; n=5) or a usual care cluster (UC; n=4). Intervention practices received information and guidance on SPC therapy. Outcomes included SPC uptake, changes in mean systolic and diastolic BP (SBP and DBP, respectively), target BP achievement and incident cardiovascular events. Analyses used intention-to-treat adjusted regression and Cox models, with an as-treated analysis among patients initiated on SPC therapy.We included 438 patients (mean age 64.5±12.2 years) with a median follow-up of 367 days [interquartile range 213-467]. SPC therapy was more often initiated in the IC (n=50/199; 25.1%) than in the UC (n=24/239; 9.6%, p<0.001). In the IC, average SBP and DBP reductions were -15.7 mmHg (95%CI -18.4; -13.0) and -6.9 mmHg (95%CI -8.4; -5.3), respectively. In the UC, corresponding reductions were -10.4 mmHg (95%CI -12.9; -7.8) and -4.6 mmHg (95%CI -6.1-; 3.2). Compared to UC, SBP and DBP decreased significantly more in the IC (delta -5.3 mmHg (95%CI -9.0-; -1.6) and delta -2.3 mmHg (95%CI -4.4-; -0.2), respectively). Patients in the IC achieved more often their target BP: OR 1.4 (95%CI 1.0; 2.1). In the as-treated analysis among SPC patients, SBP and DBP decreased by 22.4 mmHg (95%CI -27.8; -17.1) and 10.5 mmHg (95%CI -13.5; -7.5), respectively. Cardiovascular events occurred in six patients during follow-up, with no association with cluster allocation or SPC initiation.The SOLO project was associated with a higher uptake of SPC therapy and improved blood pressure control.These findings support that local SPC implementation projects could lead to more effective hypertension management in primary care.