Hypertension self-management program linked to lower BP at 12 months

For the TASMIN-SR trial, Richard J. McManus, FRCGP, and colleagues studied 552 patients aged 35 years and older with baseline systolic BP ≥130 mm Hg/diastolic BP ≥80 mm Hg who had a history of stroke, CHD, diabetes or chronic kidney disease.

Participants were randomly assigned to receive usual care or an intervention in which they were trained to self-monitor BP using a validated monitor (WatchBP Home, Microlife) and to self-titrate medication following a predetermined plan. The intervention group was instructed to contact their primary care physician upon receiving a very high or very low BP reading.

The primary outcome was the difference in systolic BP between the intervention and control groups at 12 months. Primary outcome data were available for 81% of participants at 12 months.

At baseline, mean BP was 143.1 mm Hg/80.5 mm Hg in the intervention group and 143.6 mm Hg/79.5 mm Hg in the control group.

Intervention had greater effect

At 12 months, mean BP decreased to 128.2 mm Hg/73.8 mm Hg in the intervention group, compared with 137.8 mm Hg/76.3 mm Hg in the control group, according to McManus, from the University of Oxford, and colleagues.

After correction for baseline BP, the mean difference between the groups was 9.2 mm Hg systolic BP (95% CI, 5.7-12.7) and 3.4 mm Hg diastolic BP (95% CI, 1.8-5).

After multiple imputation for missing results, the difference remained, according to the researchers. The mean difference was 8.8 mm Hg systolic BP (95% CI, 4.9-12.7) and 3.1 mm Hg diastolic BP (95% CI, 0.7-5.5).

The results were consistent across subgroups and there were no excessive adverse events in either group, the researchers wrote.

“This trial has shown for the first time, to our knowledge, that a group of high-risk individuals … are able to self-monitor and self-titrate antihypertensive treatment following a prespecified algorithm developed with their family physician and that in doing so, they achieved a clinically significant reduction in systolic and diastolic [BP] without an increase in adverse events,” they wrote. “This is a population with the most to gain in terms of reducing future [CV] events from optimized [BP] control.”

Important step

In a related editorial, Peter M. Nilsson, MD, PhD, of Skane University Hospital, Malmo, Sweden, and Fredrik H. Nystrom, MD, PhD, of Linkoping University, Linkoping, Sweden, called this study “an important step toward patient-centered treatment of hypertension,” despite limitations such as no detail on suitable timing of recordings or which medications to choose for self-titration.

While the study “does not settle all questions regarding self-titration based on self-measurement, it is an important step toward adaptation of treatment for patients who want to actively take part in their own risk-factor control,” they wrote. “Future trials studying the effects of self-titration on [CV] events are needed.”

Source: www.healio.com