Self-management of hypertension effective measure to lower BP

McManus R. Lancet. 2010;doi:10.1016/S0140-6736(10)60964-6.

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

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