Good Outcomes with Blood Pressure Self-Management Program

For primary care patients with hypertension and cardiovascular risk factors, a blood pressure self-monitoring intervention—including self-titration of medications—yields greater reductions in systolic blood pressure at 1 year, concludes a randomized trial in the Journal of the American Medical Association.

The Targets and Self-Management for the Control of Blood Pressure in Stroke and at Risk Groups (TASMIN-SR) trial included 552 patients with hypertension, baseline blood pressure 130/80 mm Hg or higher, and a history of stroke, coronary heart disease, diabetes, or chronic kidney disease. The patients were drawn from 59 primary care practices in the United Kingdom. One group received a self-management intervention, in which they self-monitored blood pressure and adjusted their medications according to an individualized self-titration algorithm. The blood pressure targets in the self-management group were office measurements of 130/80 mm Hg and home measurements of 120/75 mm Hg.

The control patients received usual care, with office-based blood pressure measurements and medication changes. Information on changes in blood pressure at 12 months’ follow-up were available in 450 patients.

Blood pressure decreased from 143.1/80.5 mm Hg to 128.2/73.8 mm Hg in the self-management group versus 143.6/79.5 mm Hg to 137.8/76.3 mm Hg in the control group. After correction for baseline values, the study intervention was associated with a reduction of 9.2/3.4 mm Hg in blood pressure. With multiple imputation for missing values, the difference was 8.8/3.1 mm Hg.

The intervention yielded comparable reductions in blood pressure across patient subgroups, and adverse events were similar between the intervention and control groups. Patients in the self-management group had greater increases in antihypertensive drug prescriptions, particularly for calcium channel blockers and thiazides.

A previous trial showed good reductions in systolic blood pressure with self-monitoring and self-titration, but that study included few patients with cardiovascular disease or other high-risk conditions. The TASMIN-SR trial shows a significant 1-year reduction in systolic blood pressure with the self-management approach in hypertensive patients at high risk of cardiovascular events. Blood pressure self-monitoring with self-titration “is feasible and achievable in a high-risk population without special equipment and by following a modest amount of training and additional family physician input,” the researchers write [McManus RJ, et al. Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial. JAMA 2014; 312:799–808].