Self-monitoring of hypertension in primary practice

Despite substantial advances in lifestyle and pharmaceutical interventions, only half of people on treatment for hypertension have their blood pressure controlled to current recommended levels. Patient selfmanagement with self-titration (ie, adjustment) of antihypertensive drugs has previously only been tested on a small scale, therefore this study assessed whether self-management by people with poorly controlled hypertension resulted in better blood pressure control compared with usual care.

The study was undertaken in 24 general practices in the UK. All patients were aged between 35 and 85 years and had blood pressure greater than 140/90 mm Hg. Participants were randomly assigned to either self-management – consisting of home blood pressure measurements and self-titration of hypertensive drugs, combined with telemonitoring of home blood pressure measurementsdor to usual care. The primary end point was change in mean systolic blood pressure between baseline and each follow-up point (6 months and 12 months).

Four hundred and eighty patients were included in the primary analysis, 234 were assigned to self-management and 246 patients acted as controls. Mean systolic blood pressure fell by 12.9 mm Hg at 6 months in the self-management group, compared with 9.2 mm Hg in the control group. From baseline to 12 months, systolic blood pressure decreased by 17.6 mm Hg in the self-management group and by 12.2 mm Hg in the control group (p¼0.0004). The frequency of most side-effects did not differ between the groups, however leg swelling was slightly more common in self-managed patients (32% vs 22%, p¼0.022).

Conclusions
This study demonstrates that self-management of hypertension, in combination with telemonitoring of blood pressure measurements, is an effective method of controlling hypertension in primary care.

• McManus RJ, Mant J, Bray EP, et al. Telemonitoring and self-management in the control of
hypertension (TASMINH2): a randomised controlled trial. Lancet 2010;376:163e72.

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