Authors: (including presenting author): :
Li MNC (1), Wong SN (1), Chan SL(1), Ho WS(1), Lau KY(1)
Affiliation: :
Community Care Services, Queen Mary Hospital
Keyword 1: :
Blood pressure control
Keyword 2: :
community home-dwelling elderly
Keyword 3: :
Self-monitoring blood pressure
Keyword 4: :
community care service
Introduction: :
Hypertension is a major global health problem, particularly among older adults, and can lead to serious complications if not adequately controlled. Effective management depends on pharmacological treatment, lifestyle modification, and sustained adherence. Self-monitoring of blood pressure (SMBP) is increasingly recognized as a useful strategy to improve blood pressure control. This project aimed to evaluate the effectiveness of an SMBP program in enhancing adherence to pharmacological and non-pharmacological treatment among community-dwelling older adults with primary hypertension followed by the Hong Kong West Cluster (HKWC) Community Nursing Service (CNS) team
Objectives: :
The project had four objectives: (1) to enhance patients’ knowledge and self-empowerment in hypertension management; (2) to ensure correct performance of SMBP; (3) to achieve better blood pressure (BP) control, defined as BP below 140/90 mmHg or a 20–30% reduction from baseline; and (4) to improve adherence to anti-hypertensive medications.
Methodology: :
Community-dwelling adults aged 65 years or above with a diagnosis of hypertension on pharmacological treatment were recruited if they could perform home BP monitoring independently or with caregiver support. A total of 22 participants (mean age 83.5 years, 68% female) were enrolled from two Community Nursing Service (CNS) Centres; all had hypertension, and many had comorbid diabetes and hyperlipidaemia. The intervention comprised an SMBP program incorporating structured education (PowerPoint and BP record book) and ongoing follow-up via nurse home visits and tele-visits. Data were collected using the Hill-Bone Medication Adherence Scale (HB-MAS)- a Nine-item questionnaire with widespread
application across numerous long-term diseases and condition
for self-evaluation of medication adherence, an Empowerment score, and pre- and post-intervention mean systolic (SBP) and diastolic blood pressure (DBP). Paired samples t-tests were applied for statistical analysis
Result & Outcome: :
The program led to notable improvements. Mean SBP decreased from 145.41 mmHg to 126.00 mmHg, a mean reduction of 19.41 mmHg (p < 0.001), while mean DBP decreased from 70.27 mmHg to 66.45 mmHg, although this change was not statistically significant (p = 0.078). Although post-intervention BP was below the 140/90 mmHg target, the percentage reductions (13.35% for SBP and 5.44% for DBP) did not reach the planned 20–30% reduction. Medication adherence improved significantly according to HB-MAS scores. At the end of the study period, 18 (82%) of 22 participants achieving 100% adherence to antihypertensive drugs during the intervention. The mean Empowerment score increased from 12.68 to 17.47 (p < 0.001), indicating greater self-efficacy in BP self-management, and all participants were able to perform SMBP correctly and consistently record their readings after the program. The SMBP program enhanced participants’ hypertension knowledge, self-empowerment, and correct SMBP technique, and it improved overall BP control and medication adherence in community-dwelling older adults. These findings support integrating SMBP into community-based hypertension management to strengthen self-management and clinical outcomes in the elderly population.
