Hypertension is the most important cardiovascular risk factor (CVRF) worldwide. Hypertension is a major modifiable CVRF that affects 14 to 15 million people in France [1] . The prevalence of this condition is 31% and increases with the aging of the population in France [2] [3] . In a study carried out by Kramoh et al. [4] in Côte d’Ivoire in 2017, the prevalence of hypertension was 20.4%. According to data from the Observatory of Medical Practice in 2009, it represented 13.1% of consultations by the general practitioner [5] . Although the clinical care of hypertension is regularly improved by new therapies, its management is closely linked to the patient as an individual who needs to learn to live with his disease. This is why the patient must be actively involved in the follow-up of his disease. Therefore, patient adherence to treatment is an important point to improve in the management of hypertension. This fundamentally requires an improvement in knowledge [6] . Self-measurement of blood pressure (SMBP) is a recent technique that has already been studied and validated; however, it is still not widely used. It is well-known as part of the clinical management of hypertension and of the recommendations of scientific societies [7] [8] . All agree to promote ambulatory measurement and, particularly, SMBG because the reproducibility of blood pressure (BP) measurement is better in SMBG (and in ABPM) than in the doctor’s office [9] [10] . Therapeutic patient education (TPE) aims to help patients acquire or maintain the skills they need to best manage their lives with a chronic disease [11] . This study was conducted to evaluate the impact of therapeutic education in the practice of blood pressure self-measurement in patients followed at the Institute of Cardiology of Abidjan for integration of blood pressure self-measurement into the care of hypertensive patients in Côte d’Ivoire.

The descriptive prospective study was conducted between February 1, 2019, and May 1, 2020, at the Institute of Cardiology of Abidjan Heart in the Ivory Coast. The study included hypertensive patients aged at least 18 years old having hypertension for at least 6 months and receiving outpatient consultations for their follow-up. Patients had to be in sinus rhythm on electrocardiogram. Thus, considering the prevalence of hypertension at 20.4% [4] , taking a confidence level of 95% and a margin of error of 5%, the minimum sample size calculated by SPSS software should be 250 patients increased to 300 patients for this study. Patients who had only one consultation and for whom the diagnosis of hypertension was suspected but could not be confirmed by a second consultation and/or additional investigations and patients with permanent atrial fibrillation on the electrocardiogram were not included. Data was collected on a simple survey form consisting of several items based on information from the patients’ medical records and their questioning. The studied parameters were socio-demographic parameters, other cardiovascular risk factors, clinical and paraclinical features, antihypertensive treatment, and information on self-measurement. As part of this study, 300 patients were selected. They received “OMRON” brand blood pressure monitors and about four educational sessions on the benefits of self-measurement of blood pressure. The patients were divided into five groups supervised by one of three people, including a doctor. Each patient should do research on blood pressure and monitor blood pressure and record it in a diary. Data analysis and processing were performed using SPSS software version 22. Categorical variables, presented as numbers and percentages, were compared with Pearson’s Chi-Square Test. Quantitative variables, presented as means ± standard deviation, were compared with the Reduced Error Test for large samples and the Student’s t-test for small samples (n < 30). The results were considered significant when p < 0.05.

For ethical considerations, the patients gave their informed consent. The results were analyzed in accordance with the laws on the protection of patients’ data and with the ethical principles regarding the Declaration of Helsinki. This work was approved by the ethics committee of the Abidjan Institute of Cardiology.

The general objective of this study was to evaluate the interest in therapeutic

education in the practice of blood pressure self-measurement and the compliance of antihypertensive treatment at the Institute of Cardiology of Abidjan. The study showed that 68.3% of patients said they knew about SMBG before the therapeutic training. However, only 36.3% had already done it. In the majority of cases, training on TMA is given by physicians (71.9%). The patient was self-taught in 14.9% of cases. The medical staff talked to the patients about SMBG in 52.1% of cases and encouraged them to perform it in 37.2% of cases. 25.7% of the patients had self-measurement devices at the time of the survey and the majority of them were upper arm monitors (65%). Blood pressure monitors were prescribed to patients in 41.6% of cases. Complications occurred most often in patients who had not benefited from SMBG (74.6%). After the therapeutic training, 91% of the patients performed SMBG compared with only 36.3% before the training. Although in-office BP measurement remains the cornerstone of the diagnosis of hypertension, out-of-office BP measurements, when used appropriately, are also effective in accelerating diagnosis and blood pressure control [12] . During the interviews conducted as part of the survey, 68% of patients reported having knowledge about SMBP, of which 36.3% were aware of the practice of SMBP, observed in Table 9 . Only 25.7% of this study population had an electronic blood pressure monitor, 71% of whom performed SMBP. These proportions were lower than those observed in the United States [13] , France [14] and in Guadeloupe [15] , where more than 40% and 43% of hypertensive patients respectively had self-measurement devices. Most of the time, training on self-measurement was provided by the physician (71.9%). Paramedical personnel were involved in only 5% of cases. The involvement of paramedical staff could help increase the practice of self-measurement, especially in rural and semi-rural areas where the proportion of physicians is low. The pharmacist can play an important role at this stage by providing only validated devices, advising the patient on the correct use of the device, and proposing a periodic check of the device [16] . Annual Belgian statistics show that the majority of self-measurement monitors sold in pharmacies are validated tools [17] . Most of the patients who had an electronic blood pressure monitor had health insurance (68.64%). The SMBG is mainly used by patients with jobs. This could be explained by the fact that professional patients were able to afford electronic blood pressure monitors due to the cost of the devices. In 2009 in France, 36% of treated hypertensive patients owned a blood pressure monitor compared with 12% of those who did not receive antihypertensive treatment in 2009 in France [18] . These findings are comparable to that of Great Britain, where 10% of the general population uses a self-tensiometer [19] .

The different results found in this work showed that few patients had self-measurement devices. Those who had them were mainly covered by health insurance. Self-measurement of blood pressure was not widely practiced, although several patients reported having some knowledge of it; however, when it was practiced correctly, it reduced the occurrence of cardiovascular complications. The limits on its extension result from the cost of the devices in a country where health insurance coverage is low and self-tensiometers are not reimbursed by health insurance. The practice of therapeutic education has had a positive effect on both the realization of self-measurement of blood pressure by patients and the promotion of therapeutic observance. Given the benefits of therapeutic education, practitioners should take more interest in it and integrate it into a large program of hypertension management. The promotion of SMBP practice should be appropriate in a health environment dominated today by coronavirus disease.