Effectiveness of Self-management Support in Maintenance Haemodialysis Patients with Hypertension: A Pilot Cluster Randomized Controlled Trial.

BACKGROUND: Uncontrolled hypertension is an independent risk factor for cardiovascular disease and is the leading cause of mortality in haemodialysis patients. The aim of this study was to examine the effectiveness of self-management support SMS) for blood pressure (BP) control and health behaviors.

METHODS: We conducted a cluster randomized controlled trial (RCT) in which 90 adult haemodialysis patients were assigned to either an SMS or common intervention (CI) group. The SMS group received an intervention consisting of self-management education and motivational interviewing. The CI group received standard care and routine health education. The primary outcome was the BP monitored before each haemodialysis. Secondary outcomes included salt intake (measured using a balance formula), home BP monitoring (HBPM)(assessed using two self-administered questions), and medication adherence (measured using the 4-item Morisky Medication Adherence Scale). Data were collected at baseline and at 1, 3 and 6 months post-intervention.

RESULTS: The SMS group showed continuous reductions in systolic BP from baseline:-9.2, -8.7, and -8.4 mmHg at 1, 3 and 6 months after the intervention, respectively (P<0.01). Compared with the CI group, the SMS group had a greater decrease in systolic BP at 1 month:-5.9 mmHg (P=0.0388), but no significant difference was found at 3 or 6 months(P>0.05). SMS patients showed an improvement in health behaviors relative to baseline (less salt intake, more consistent HBPM, and greater medication adherence) (P<0.05).

CONCLUSIONS: SMS obtained short-term success in improving salt restriction, regular performance of HBPM and medication adherence, which led to better BP control.