Patterns of Adherence to Home Blood Pressure Monitoring Among Men and Women in the Electronic Framingham Heart Study

Background Worldwide, there are differences in hypertension control by sex. The use of home blood pressure monitoring (HBPM) is associated with lower average blood pressures and higher medication adherence. However, little is known about adherence trajectories and sex differences in HBPM. This study characterizes adherence to HBPM among those with and without hypertension.

Electronic Framingham Heart Study participants were instructed to perform HBPM weekly for 1 year. Adherence was defined as having ≥1 measurement per week averaged over 4-week segments. Primary exposures of hypertension status and sex were self-reported. Group-based trajectory modeling was used to identify adherence trajectories. Logistic regression was applied to investigate factors associated with membership in each trajectory group in the sex-stratified and whole cohorts.

Among 990 participants (58% women, age 53±9 years, 26% hypertension), three groups with distinct HBPM adherence patterns were identified: “early discontinuation”, “gradual decrease”, and “high adherence”. Participants with hypertension were more likely to maintain “high adherence” compared to those without (OR 1.55; 95% CI 1.08-2.23), with similar findings seen among women with hypertension (OR 2.24; 95% CI 1.35-3.72) but not men. In women, these findings remained significant when adjusting for anxiety, depression, and blood pressure, but were attenuated by adjusting for age and income.

This study highlights HBPM adherence trajectories and shows that women with hypertension were more likely to be in the high adherence group, though these associations were attenuated after adjusting for demographic factors and co-morbidities. Future studies should explore strategies to enhance adherence in populations at risk of early discontinuation. Competing Interest Statement The authors have declared no competing interest. Funding Statement The Framingham Heart Study is supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health and Boston University School of Medicine, under NIH award 75N92019D00031. The eFHS research study was supported by grant R01HL141434 and Robert Wood Johnson Award. Dr. Kovell is supported by the National Heart, Lung, and Blood Institute through K23HL163450. DDM is supported by R01HL155343, R01HL141434, R33HL158541, U54HL143541 and U54HL143541-05S1, and UG3NS135168. AS is supported by U54HL143541 and U54HL143541-05S1, U01HL146382, and UG3NS135168; EJB is supported by R01HL092577; American Heart Association AF AHA_18SFRN34110082; R01HL141434. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: University of Massachusetts Chan Medical School I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability The data used in this manuscript can be made available pending approval of the Framingham Heart Study investigators/steering committee.