In France, only 25% of hypertensive adults are diagnosed and controlled. The French National Authority for Health (Haute Autorité de Santé, HAS) recommends home blood pressure monitoring (HBPM) for the diagnosis and management of patients with elevated blood pressure, in line with international hypertension guidelines. HAS advises the “rule of 3”: three measurements in the morning and three in the evening for at least three consecutive days. Although HBPM is widely adopted by general practitioners and patients with home devices, few patients (140 mmHg performing HBPM at home from March to September 2025. The primary outcome was adherence to HAS recommendations and reporting of HBPM results before and after a brief oral and written educational intervention combined with formal prescription. The primary outcome was expressed as a percentage and analyzed using McNemar’s test.Twenty-three patients were included (mean age 71±10 years; 12 women). Mean office systolic blood pressure was 155±14 mmHg. At baseline, 12 patients (52%) performed three consecutive measurements, 19 (83%) in the morning, 14 (61%) in the evening, and 12 (52%) over at least three consecutive days. Overall, only 8 patients (35%) fully complied with HAS recommendations. Two weeks after the intervention, 20 patients (87%) performed three measurements in the morning and evening for at least three days and reported their measurements to their physician (p<0.001).-This real-life primary care study shows that brief education combined with prescription of HBPM significantly improves patient adherence to guidelines and reporting of results. Strengths include its pragmatic design and clinical applicability. Limitations include the small sample size, single-center design, and short follow-up. Further analyses are ongoing to assess whether patient adherence to HBPM recommendations is sustained over time.

Hypertension is a major modifiable risk factor for cardiovascular disease, yet blood pressure (BP) control remains suboptimal, particularly in socially disadvantaged communities. Recent guidelines promote initiating single-pill combination (SPC) therapy to improve medication adherence and BP control, but clinical adoption in primary care remains limited.To evaluate the SOLO care improvement project, which promoted SPC initiation among general practitioners in Amsterdam-Zuidoost, a socially disadvantaged, multi-ethnic community in The Netherlands with a high hypertension burden.In a cluster quasi-randomized design, adult hypertensive patients from nine general practices within the same health facility were allocated to an intervention (IC; n=5) or a usual care cluster (UC; n=4). Intervention practices received information and guidance on SPC therapy. Outcomes included SPC uptake, changes in mean systolic and diastolic BP (SBP and DBP, respectively), target BP achievement and incident cardiovascular events. Analyses used intention-to-treat adjusted regression and Cox models, with an as-treated analysis among patients initiated on SPC therapy.We included 438 patients (mean age 64.5±12.2 years) with a median follow-up of 367 days [interquartile range 213-467]. SPC therapy was more often initiated in the IC (n=50/199; 25.1%) than in the UC (n=24/239; 9.6%, p<0.001). In the IC, average SBP and DBP reductions were -15.7 mmHg (95%CI -18.4; -13.0) and -6.9 mmHg (95%CI -8.4; -5.3), respectively. In the UC, corresponding reductions were -10.4 mmHg (95%CI -12.9; -7.8) and -4.6 mmHg (95%CI -6.1-; 3.2). Compared to UC, SBP and DBP decreased significantly more in the IC (delta -5.3 mmHg (95%CI -9.0-; -1.6) and delta -2.3 mmHg (95%CI -4.4-; -0.2), respectively). Patients in the IC achieved more often their target BP: OR 1.4 (95%CI 1.0; 2.1). In the as-treated analysis among SPC patients, SBP and DBP decreased by 22.4 mmHg (95%CI -27.8; -17.1) and 10.5 mmHg (95%CI -13.5; -7.5), respectively. Cardiovascular events occurred in six patients during follow-up, with no association with cluster allocation or SPC initiation.The SOLO project was associated with a higher uptake of SPC therapy and improved blood pressure control.These findings support that local SPC implementation projects could lead to more effective hypertension management in primary care.

Hypertension is the leading modifiable risk factor for cardiovascular disease worldwide and highly prevalent among people with diabetes. Effective detection and control of raised blood pressure (BP) are essential components of diabetes care. Despite this, global data on hypertension awareness, treatment and control in people with diabetes remain limited, and international patterns relevant for primary care equity are poorly described.To compare hypertension prevalence, awareness, treatment and control between people with and without diabetes screened in the May Measurement Month (MMM) campaigns, and to assess whether these associations differ by age, sex and world region.We analysed harmonised data from five MMM campaigns (2017–2022). Adults ≥18 years with two valid BP readings and information on diabetes status were included. Hypertension was defined as BP ≥140/90 mmHg or current antihypertensive treatment. Logistic regression was used to estimate odds ratios (ORs) for diabetes vs no diabetes, stratified by sex and age.To assess regional variation, we estimated diabetes–hypertension associations separately for each region.Of 3.8 million participants, 302,060 (7.9%) reported diabetes. Across all sex–age strata, individuals with diabetes had higher odds of hypertension (overall OR 4.0), and higher awareness (OR 4.5), treatment (OR 4.3) and overall BP control (OR 2.1) than those without diabetes. Associations were strongest in younger adults and attenuated with age. Control among treated individuals differed only modestly between groups (57% diabetes vs 56% non-diabetes). Strong regional variation was observed: East and South Asia showed the strongest associations between diabetes and higher awareness, treatment and overall BP control, while these associations were weaker in Europe and the Americas.People with diabetes are more often detected and treated for hypertension, likely due to more frequent primary care contact, yet BP control remains suboptimal. The gap between treatment and control highlights missed opportunities for treatment intensification, adherence support and integrated care.Globally, individuals with diabetes are more likely to be aware of and treated for hypertension but still fail to achieve adequate BP control. Strengthening primary care systems by integrating hypertension and diabetes management, improving adherence support and adapting regional BP targets may reduce inequities and improve cardiovascular outcomes.

High blood pressure (BP) is an often treatable cause of cardiovascular disease. We developed an intervention, featuring a cardiovascular expert team and a toolbox, to support healthcare professionals (HCPs) in hypertension management and enhance patient self-management.This study evaluates the adoption and feasibility of this intervention.A mixed-methods study in general practices in the Netherlands. HCPs could consult a cardiovascular expert team and use a self-management toolbox for their patients as preferred. We interviewed HCPs guided by the Consolidated Framework of Implementation Research (CFIR), and HCPs completed the Determinants of Implementation Behaviour Questionnaire (DIBQ). Using CFIR-ERIC matching tool, we matched implementation strategies to identified barriers. Adults with elevated BP, who were prescribed at least two blood pressure lowering medications were eligible to participate. Patient and disease characteristics were extracted from the electronical medical record.Of 591 eligible patients at thirteen general practices, 176 participated. The cardiovascular expert team was well-received, with 33 unique consultations, although nurse practitioners (NPs) might need the expertise of the expert team more frequently than general practitioners (GP) (adoption). The toolbox was perceived as challenging to use (feasibility). We subsequently identified three key strategies to improve implementation. Mean systolic and diastolic BP were 158/87 mmHg at baseline and 148/85 mmHg after 12 months, although this change cannot be conclusively linked to the intervention.Overall, the study emphasized the importance of structured implementation strategies to optimize hypertension care interventions. Primary and secondary care working together in the form of a cardiovascular expert team, teleconsultation and self-management tools are valuable ways to improve hypertension management. To ensure adoption and feasibility, future implementation efforts should focus on engaging NP’s as key users of the cardiovascular expert team and applying strategies such as formal implementation plan and the identification of champions.Structured implementation strategies may be helpful in hypertension management. The cardiovascular expert team was considered valuable, but might be better targeted to NPs rather than GPs.

Ambulatory blood pressure (BP) measurements are recommended for the diagnosis and follow-up of hypertensive patients. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is the most cost-effective strategy. It provides accurate BP measurements and variations over the nycthemeral cycle. Several BP profiles have been described: white-coat, daytime, 24-hour and nocturnal hypertension. Adverse work conditions have been associated with an increased risk of hypertension. Few data are available on work conditions and BP profiles.We aimed to analyze the characteristics and circadian BP profiles of French primary care patients with elevated office BP, according to their perception of work conditions.This observational, cross‐sectional, multicenter study prospectively enrolled the patients of 23 general practitioners in XXX region, France. We included the first patient of the day with office BP ≥ 140/90 mm Hg, whatever the reason for consultation and treatment. All included patients underwent ABPM. Hypertension profiles were defined according to current guidelines. Medical, sociodemographic and deprivation data were collected. Active patients were analyzed and work conditions were assessed thanks to a declarative self-questionnaire. Patients with easy and demanding work conditions were compared. The determinants of demanding work conditions were identified using logistic regression models in men and women.From July 2015 to August 2020, 627 patients were included with 178 workers. Work conditions were described as rather demanding/demanding for 55 (61.1%) men and 49 (55.7%) women. In multivariate analyses, demanding work conditions were associated with nighttime systolic hypertension (OR=3.15; 95%CI 1.043-9.50) and low/moderate cardiovascular score risk (OR=0.19; 95%CI 0.06-0.65) among men. Among women, young age (OR=0.91; 95%CI 0.86-0.97) and isolated nocturnal hypertension (OR=5.48; 95%CI 1.24-24.2) were associated with demanding work conditions.This 5-year multicenter study provides original and relevant data for daily practice. The declarative endpoint is subjective but pragmatic. Questioning patients about their work conditions, through a simple way, is relevant for a global and comprehensive approach. ABPM seems preferable to self-measurement among patients reporting demanding work conditions to determine nighttime BP and assess cardiovascular risk.Patients with demanding work conditions may have specific BP profiles with a higher cardiovascular risk. Effective cardiovascular primary prevention strategies may target this population.