Self-management of hypertension was more effective in
lowering systolic BP during 1 year than usual care, representing what
researchers said is an important addition in hypertension control.
This randomized controlled trial was undertaken in 24
general practices in the U.K. Patients aged 35 to 85 years were enrolled if
they had BP >140/90 mm Hg and were willing to self-manage their
hypertension. Self-management consisted of
self-monitoring BP and self-titration of antihypertensive
drugs combined with telemonitoring of home BP measurements.
Of the participants included in the primary analysis
(n=480), 234 were placed in the self-management group and 246 were placed in
the control (usual care) group. Mean systolic BP in the self-management group
decreased 12.9 mm Hg (95% CI, 10.4–15.5) from baseline to 6 months vs. 9.2
mm Hg in the control group. Systolic BP decreased by 17.6 mm Hg in the
self-management group from baseline to 12 months vs. 12.2 mm Hg in the control
group (P=.0004). The occurrence of adverse events did not significantly
differ between groups, with the exception of an increased leg swelling in the
self-management group.
“Self-management of hypertension resulted in
significant and worthwhile reductions in BP that were maintained at 6 months
and 12 months compared with usual care,” the researchers concluded.
“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.” – by Brian Ellis
This is an interesting study, which shows that motivated
patients can safely telemonitor their own BP from home and effectively adjust
treatment using a simple algorithm, with improved control of their hypertension
compared to conventional management by a family doctor. Of note, fewer than one
patient in 10 invited to join the trial ended up being randomized, and the
follow-up of 1 year was too short to show a difference in hard outcomes such as
HF or stroke. The absolute level of improved BP was small but significant. The
influence of telemonitoring independent of training in home BP measurement was
not tested.
Dedicated and empowered patients are likely to be more
adherent to treatment for chronic diseases, including hypertension. The results
of this study are encouraging, but whether or not the methods employed in this
study can be successfully applied to reducing complications of hypertension in
the general population remains to be determined.
– Samuel L. Wann
Cardiology Today
Section Editor
