The Impact of Therapeutic Education in the Practice of Blood Pressure Self-measurement at the Institute of Cardiology of Abidjan

Introduction: Self-measurement of blood pressure is a recent technique, already studied and validated, but it is still underused in the management of hypertension. Therapeutic education of the patient aims at helping patients acquire or maintain the skills they need to best manage their lives with a chronic disease.

Aim: The objective of the study was to evaluate the value of therapeutic education in the practice of blood pressure self-measurement in patients followed at the Institute of Cardiology of Abidjan in order to integrate this technique into the management of hypertensive patients in Côte d'Ivoire.

Materials and Methods: This study was conducted for 15 months at the Institute of Cardiology of Abidjan. The study included patients aged at least 18 years old who were diagnosed with hypertension for at least 6 months and followed up in outpatient clinics. The data were collected on an individual survey form with several items based on information from the medical records and questioning of the patients. The analyzed parameters were: socio-demographic features, other cardiovascular risk factors, clinical and paraclinical data, antihypertensive treatment, and information on self-measurement.

Qualitative variables were presented as numbers and percentages and compared by Pearson's Chi-Square Test. Quantitative variables were described as means ± standard deviation and compared by the Reduced Error Test for large samples and by the Student's t-test for small samples (n<30). The results were statistically significant when p<0.05.

Results: The study population consisted of 300 patients with a male predominance (sex ratio of 1.46). The mean age of the patients was 59.5±12.7 years old. 65.3% of patients were uninsured. Other cardiovascular risk factors were dyslipidemia (35%) and overweight (30.3%). Patients with hypertension had complications in 39.3% of cases. Heart failure was the most common complication (14.7%).

Patients presented 38.3% and 26.3% left ventricular hypertrophy on the electrocardiogram and rhythm disorders, respectively. Echocardiographic data revealed 56.3% of left atrial dilatation. The geometry of the left ventricle was abnormal in 50.7% of cases. Among the patients, 68.3% said that they knew about the self-measurement of blood pressure. 36.3% of the subjects, who were interviewed, had already performed a blood pressure self-measurement. 40.3% were trained in blood pressure self-monitoring.

71.9% of physicians provided blood pressure self-measurement training to patients. Medical staff talked to the patient about self-monitoring in 52.1% and encouraged the patient to perform it in 37.2% of cases. Among those who had received training in blood pressure self-measurement, 31.4% said they were familiar with the 3-step rule and in whom 39.5% gave a correct explanation. Only 25.7% of patients had self-measurement devices at the time of the survey, and the majority of blood pressure monitors or devices were upper arm ones (65.5%).

The patients acquired blood pressure monitors by medical prescription in 41.6% of cases. Patients holding electronic blood pressure monitors or tensiometers used them regularly in 55.8% of cases.

Among them, 71.4% performed self-measurement at least once during their follow-up and 63.6% had insurance. 74.6% of complications occurred in patients who did not perform self-measurement. Therapeutic education improved considerably the practice of self-monitoring of blood pressure.

Conclusion: The various results show that few patients had self-measurement tensiometers. The insured patients own these devices. The practice of self-measurement of blood pressure was low. However, when properly practiced, it reduced the occurrence of cardiovascular complications. The practice of therapeutic education has positive effects on patients' self-measurement of blood pressure.