Patients who monitor their blood pressure at home tend to have better results


Patients who monitor their blood pressure at home tend to have better results

According to a new trial, patients with high blood pressure (hypertension) who are trained to check their blood pressure at home, according to some pre-determined rules, tend to experience a more significant fall in blood pressure, when compared to patients receiving conventional treatment. You can read about this in the latest issue of The Lancet.

The authors say that although previous studies have examined telemonitoring and self-adjustment of medication for hypertension independently, TASMINH2 (the name of the latest trial) is the first one to test both of them together, and also the first to examine self-adjustment on a large scale.

Patients received two training sessions on how to use their automated sphygmomanometer - a type of blood pressure monitor - as well as training on how to transmit their reading to the research team via an automated modem, which was connected to the sphygmomanometer and plugged into a normal telephone socket.

Patients measured their blood pressure twice each morning - five minutes apart. They were told to act upon just the second reading. They had to use a traffic-light type system, with green and amber being below or above target, but still within safety limts, and red being outside safety limits.

A month was confirmed to be above target, given that on four or more days the readings were above target during that month. After a review visit by the patients in the intervention group and their family doctor, a drug-adjustment schedule that included two increases or changes in medication was arranged. Blood tests monitoring angiotensin converting enzyme (ACE) inhibitors was an option too. The doctor did not receive specific direction for medication change by the research team other than guidelines by the UK National Institute for Health and Clinical Excellence (NICE).

After patients had two months of readings above target consecutively, they were told to change their medication in accordance with the drug-adjustment schedule by asking for a new prescription without seeing their doctor. When the two sets of changes had been implemented, the patients requested their doctor for a new drug-adjustment schedule given that blood pressure was above target. Summaries of the patients blood pressure readings were sent monthly to their family doctor. Patients that had access to the internet were able to check their own readings online.

The patients in the control group were then reviewed by their GP (family doctor). The clinicians had no set instructions about the visit other than to review blood pressure medication. Care was then at the discretion of the family doctor.

NICE guidelines for hypertension and diabetes were used as a base for target home readings of blood pressure, attuned down by 10/5 mm Hg by recommendations of the British Hypertension Society given that home readings are usually lower than readings taken by a doctor. The home targets were set at 130/85mm Hg for patients without diabetes, and 130/75 mm Hg for the patients with diabetes.

There were a total of 527 patients in this randomised controlled trial, of which 263 were assigned to self-management, and 264 assigned to the control group. The primary analysis included 480 of the total patients (91% of total ; 234 self management patients and 246 control).

  • Mean systolic blood pressure decreased by 12•9 mm Hg from baseline to 6 months in the self-management group
  • Mean systolic blood pressure decreased by 9•2 mm Hg (6•7 - 11•8) in the control group (a difference between groups of 3•7 mm Hg)
  • After 12 months, systolic blood pressure had decreased by 17•6 mm Hg in the self-management group
  • After 12 months, systolic blood pressure had decreased by 12•2 mm Hg in the control group (a difference between groups of 5•4 mm Hg)
  • Frequency of most side-effects did not differ between groups, apart from leg swelling (self-management 32% of patients and control 22%)
The authors wrote:

"Self-management of hypertension resulted in significant and worthwhile reductions in blood pressure that were maintained at 6 months and 12 months compared with usual care. These findings seem to be the result of an increase in the number of antihypertensive drugs prescribed according to a simple titration plan. Thus, self-management represents an important new addition to the control of hypertension in primary care."

They also added:

"Self-management will not be suitable for all patients*. However, even if only 20% of individuals with hypertension self-managed their disorder, this proportion would still represent around 4% of the UK population - ie, more than 2 million individuals."

Dr Gbenga Ogedegbe, Center for Healthful Behavior Change, New York University School of Medicine, USA, said in an accompanying Comment:

"Although findings of the TASMINH2 trial suggest that self-titration of antihypertensive drugs has come of age in terms of its feasibility, safety, and efficacy, its widespread dissemination into primary care practices might be premature until these findings are replicated by other investigators, especially in low-income, low-literate patients who receive care in low-resource, non-academic settings. While we await the findings from two studies that are currently investigating these issues, the future of telemonitoring plus self-titration as a practice-based strategy for management of patients with uncontrolled hypertension is not far off on the horizon."

"Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial"

Richard J McManus, Jonathan Mant, Emma P Bray, Roger Holder, Miren I Jones, Sheila Greenfield, Billingsley Kaambwa, Miriam Banting, Stirling Bryan, Paul Little, Bryan Williams, FD Richard Hobbs

The Lancet, Early Online Publication, 8 July 2010

doi:10.1016/S0140-6736(10)60964-6

How Blood Pressure Works Animation - Understanding Blood Pressure Measurement Monitor Readings Video (Video Medical And Professional 2020).

Section Issues On Medicine: Cardiology