Check and Support -Enhancing the Treatment of Hypertension in Outpatient Care, a Multicenter Study

The proportion of patients (%) achieving systolic office blood pressure (BP) target (<140 mmHg) and home BP target (<135 mmHg) are both analyzed separately using mixed effects model.

Both office BP and home BP are measured with a validated blood pressure monitoring device (Microlife Watch BP Home A or Microlife Watch BP Home N) after appropriate rest from the left arm with an appropriately sized semi-rigid conical cuff. Office BP is the mean of three measurements separated by 15 seconds. Home BP is measured correspondingly three times in the morning and in the evening on 7 consecutive days at 12 months. Home BP is the mean of all available measurements.

Medication adherence is assessed by pharmacy refill data and by self-report strategy (Morisky Medication Adherence Scale, MMAS-8). Tresholds for good adherence are correspondingly (i) Medication possession ratio (MPR) 80 % or more and (ii) MMAS-8 with a score of 6 or more. Both are analyzed separately using generalized mixed effects model.

Besides, medication adherence is analyzed as follows:

• Persistence: time (days) from the newly initiated medication order to (i) last dispensation before failing to refill within 180 days or (ii) end of follow-up period
• Early non-persistence: newly initiated medication order dispensed within 30 days of the initial order with no refills within 180 days
• Primary non-adherence: newly initiated medication order not dispensed within 30 days of the initial order

Both office BP and home BP are measured with a validated blood pressure monitoring device (Microlife Watch BP Home A or Microlife Watch BP Home N) after appropriate rest from the left arm with an appropriately sized semi-rigid conical cuff. Office BP is the mean of three measurements separated by 15 seconds. Home BP is measured correspondingly three times in the morning and evening on 7 consecutive days at 12 months. Home BP is the mean of all available measurements.

Change in office BP and home BP are both analyzed separately using generalized mixed effects model. Change in systolic and diastolic blood pressure are as well both analyzed separately using generalized mixed effects model.

Hypertension-related use of health care services (outpatient care and hospital admissions) is assessed by examining participants' electronic health records and with a questionnaire regarding the use of health services other than study centers. Proportion of scheduled clinic appointments attended is also analyzed.

Perceived quality of life is assessed by EQ-5D-5L questionnaire

Knowing the target is assessed by questionnaire at baseline and at 12 months. The results are divided into three groups: (i) knows the adequate target (ii) knows the target but it is not adequate (iii) do not know the target.

The target is considered adequate if it differs less than 5/3 mmHg from the Finnish national guide lines for treating hypertension (Office BP target <140/90 mmHg except diabetics <140/80 mmHg. Home BP target <135/85 mmHg except diabetics <135/75 mmHg)

Setting the target is assessed by examining the electric health record at 12 months The results are divided into three groups: (i) written target is set and adequate (ii) written target is set but not adequate and (iii) written target is not set.

The target is considered adequate if it differs less than 5/3 mmHg from the national guide lines for treating hypertension (Office BP target <140/90 mmHg except diabetics <140/80 mmHg. Home BP target <135/85 mmHg except diabetics <135/75 mmHg)

The quality and quantity of self-monitored blood pressure measurements made prior to follow-up period is assessed first at base line. All participants are then equipped with a validated blood pressure monitoring device (Microlife Watch BP Home A or Microlife Watch BP Home N) with a memory space up to 250 measurements. The quality and quantity of self-monitored blood pressure measurements during the follow-up is assessed by examining the memory of every single device at and,the written follow-up form filled up by each participant at 12 months.

The target is considered adequate if it differs less than 5/3 mmHg from the national guide lines for treating hypertension (Office BP target <140/90 mmHg except diabetics <140/80 mmHg. Home BP target <135/85 mmHg except diabetics <135/75 mmHg)

ECG is taken at baseline (timeframe 6 months before - 1 month after initiation of medication) and at 12 months.

Blood glucose level is tested at baseline (timeframe 6 months before - 1 month after initiation of medication) and at 12 months.

Blood cholesterol level is tested at baseline (timeframe 6 months before - 1 month after initiation of medication) and at 12 months.

The presence of microalbuminuria is tested at baseline (timeframe 6 months before - 1 month after initiation of medication) and at 12 months.

Creatinine level is tested at baseline (timeframe 6 months before - 1 month after initiation of medication) and at 12 months.

Participant's height and weight are measured by nurse/treating physician and BMI calculated at baseline and at 12 month.

Participant's waist circumference is measured by nurse/treating physician at baseline and at 12 month.

Every participant meets a query measuring participants' exercising habits (Kasari -index) at baseline and at 12 months.

Every participant meets a query measuring participants' smoking (Heaviness of smoking -index) at baseline and at 12 months.

Every participant meets a query measuring participants' alcohol use (Audit-c) at baseline and at 12 months.

IMB model-based initiation of medication (check list for the initiation) includes a 10-grade numeric rating scale asking the participant to evaluate the necessity of antihypertensive medication at individual level. Our hypothesis is that the evaluated necessity of antihypertensive medication is related to medication adherence and achieving blood pressure target.