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JAMA. 2014 Aug 27;312(8):799-808. doi: 10.1001/jama.2014.10057.

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.

Author information

1
National Institute for Health Research (NIHR) School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
2
Primary Care Unit, Strangeways Research Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
3
Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Birmingham, Edgbaston, Birmingham, United Kingdom.
4
School of Psychology, University of Central Lancashire, Preston, Lancashire, United Kingdom.
5
Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada6School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
6
Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
7
School of Medicine, University of Southampton, Southampton, United Kingdom.
8
Institute of Cardiovascular Sciences, NIHR University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom.
9
West Midlands South: Atherstone Surgery
10
West Midlands South: Churchfields Surgery
11
West Midlands South: The Marches
12
West Midlands South: Trinity Court

Erratum in

  • JAMA. 2014 Nov 26;312(20):2169. Gooding, Trevor [Added]; Morrey, Ian [Added]; Fisher, Crispin [Added]; Buckley, David [Added].

Abstract

IMPORTANCE:

Self-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups.

OBJECTIVE:

To determine the effect of self-monitoring with self-titration of antihypertensive medication compared with usual care on systolic blood pressure among patients with cardiovascular disease, diabetes, or chronic kidney disease.

DESIGN, SETTING, AND PATIENTS:

A primary care, unblinded, randomized clinical trial involving 552 patients who were aged at least 35 years with a history of stroke, coronary heart disease, diabetes, or chronic kidney disease and with baseline blood pressure of at least 130/80 mm Hg being treated at 59 UK primary care practices was conducted between March 2011 and January 2013.

INTERVENTIONS:

Self-monitoring of blood pressure combined with an individualized self-titration algorithm. During the study period, the office visit blood pressure measurement target was 130/80 mm Hg and the home measurement target was 120/75 mm Hg. Control patients received usual care consisting of seeing their health care clinician for routine blood pressure measurement and adjustment of medication if necessary.

MAIN OUTCOMES AND MEASURES:

The primary outcome was the difference in systolic blood pressure between intervention and control groups at the 12-month office visit.

RESULTS:

Primary outcome data were available from 450 patients (81%). The mean baseline blood pressure was 143.1/80.5 mm Hg in the intervention group and 143.6/79.5 mm Hg in the control group. After 12 months, the mean blood pressure had decreased to 128.2/73.8 mm Hg in the intervention group and to 137.8/76.3 mm Hg in the control group, a difference of 9.2 mm Hg (95% CI, 5.7-12.7) in systolic and 3.4 mm Hg (95% CI, 1.8-5.0) in diastolic blood pressure following correction for baseline blood pressure. Multiple imputation for missing values gave similar results: the mean baseline was 143.5/80.2 mm Hg in the intervention group vs 144.2/79.9 mm Hg in the control group, and at 12 months, the mean was 128.6/73.6 mm Hg in the intervention group vs 138.2/76.4 mm Hg in the control group, with a difference of 8.8 mm Hg (95% CI, 4.9-12.7) for systolic and 3.1 mm Hg (95% CI, 0.7-5.5) for diastolic blood pressure between groups. These results were comparable in all subgroups, without excessive adverse events.

CONCLUSIONS AND RELEVANCE:

Among patients with hypertension at high risk of cardiovascular disease, self-monitoring with self-titration of antihypertensive medication compared with usual care resulted in lower systolic blood pressure at 12 months.

TRIAL REGISTRATION:

isrctn.org Identifier: ISRCTN87171227.

PMID:
25157723
DOI:
10.1001/jama.2014.10057
[Indexed for MEDLINE]

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