Given the important place of hypertension in daily clinical practice, any advance or contribution that sheds light on new aspects of diagnosis, evaluation, treatment or follow-up is received by professionals with keen interest. In this connection, self-measurement of blood pressure (SMBP) has been introduced in recent years as a useful tool for managing patients with hypertension. Among its widely reported advantages are its diagnostic value (avoiding the alert reaction), its usefulness in evaluating variability in blood pressure, its contribution to the evaluation of the antihypertensive effects of different drugs, and its good correlation with involvement of target organs. These features clearly outweigh the limitations of this method,1 which has been recommended in current international consensus documents on hypertension.
One of the biggest challenges now faced in actual clinical practice is obtaining patients' active participation in controlling their illnesses in general, and hypertension in particular. The patient's involvement in the health care process is needed to modify attitudes and behaviors related with fundamental aspects such as adherence to therapy. It should not be forgotten that noncompliance rates among patients with hypertension can be as high as 30%-40%,2 so without progress in this area, improved control of the process will be difficult to achieve.
In this context the Dioampa study attempts to show that in addition to the advantages of SMBP noted above, it has the potential to raise patients' awareness and level of motivation, thus presumably improving compliance with therapy and control of their hypertension. The authors' working hypothesis seems reasonable: if we are able to involve our patients in the evaluation and follow-up of their illness, as with SMBP, this would probably have a positive effect on their awareness of their disease and their motivation to take part in its treatment. This attitude, in turn, would lead to improved compliance with treatment, and would eventually lead to better control of their hypertension, as suggested by the positive outcomes of previous studies.3-5 However, the results were not as positive as hoped, and contrasted with those of earlier studies. Although there was an initial increase in the percentage of patients whose blood pressure was well controlled, this positive effect was diluted over the short term with no gains in the rate of adherence to therapy or in the control of blood pressure.
Many studies have been published on the problem of noncompliance with therapy in patients with hypertension.2 There is evidence that involving the patient in the health care process helps improve compliance, but it may be unrealistic to assume that a single intervention might provide the solution to a complex situation such as noncompliance with treatment. The etiology of this problem is multifactorial and represents a pattern of behavior that tends to recur with time. The best results among attempts to deal with this problem have been obtained with combined, long-term techniques; the effectiveness of a single technique used on a single occasion tends to be limited, and its benefits tend to fade with time.6,7
With regard to the other main objective analyzed in this study--the degree of control of blood pressure achieved--lack of adherence to therapy is undoubtedly one of the most important factors in the poor results seen on a national and international level. However, there are other factors that should also be considered in any evaluation of the problem, such as underdiagnosis or treatment that is insufficient to meet real needs.8,9 These factors also depend on attitudes and behaviors, but in this case it is the attitude and behavior of health professionals, not their patients, which are involved.
The article by Dalfó i Baqué et al may thus serve to place SMBP in perspective. It cannot be considered a miracle method that provides an instant cure-all for all the problems faced by our patients with hypertension. Nevertheless, we should not neglect SMBP because of its limitations, as its drawbacks are amply compensated by its well-documented usefulness.
