News & Commentary

It Helps When Patients Monitor Their Own Blood Pressure

Patients who monitor their own blood pressure show a clinically significant improvement in outcomes, according to a study done in the U.K. and reported recently in JAMA. They have lower systolic blood pressure after one year compared with those treated in the usual manner, and that could lead to huge savings.

“Based on systematic reviews of clinical outcome trials, the blood- pressure difference observed in those self-managing would be expected to be associated with an approximate 30% reduction in stroke risk should it be sustained,” says the study, “Effect of Self-Monitoring and Medication Self-Titration on Systolic Blood Pressure in Hypertensive Patients at High Risk of Cardiovascular Disease.”

The study points out, “The potential advantage from optimal blood-pressure control in patients at higher cardiovascular risk is large because the absolute benefit increases with absolute risk.”

Research was conducted between March 2011 and January 2013 in 59 British primary care practices and included 450 patients.

Subjects had to be at least 35 and have one of these high-risk conditions: cardiovascular disease, diabetes, stage 3 chronic kidney disease, or coronary heart disease. They also had to have a minimum blood-pressure of 130/80 mm Hg at the initial examination.

Patients were excluded if they could not monitor themselves because they had dementia, if they were taking more than three antihypertensive medications, or if they had blood pressure greater than 180/100 mm Hg.

In two or three one-hour sessions, participants were trained to monitor their blood pressure. They “took their blood pressure twice each morning for the first week of each month…,” the study reports. “Four or more blood-pressure readings recorded during the measurement week for two consecutive months that were higher than the target necessitated a change in medication pursuant to the predetermined plan.” When requesting such a change in medication and/or dosage, patients needed only to send a form to their family physician without consultation.

The mean initial blood pressure for the intervention group was 143.1/80.5 mm Hg; in the control group, which received usual care, it was 143.6/79.5 mm Hg.

After a year, the mean blood pressure for the intervention group was 128.2/73.8 mm Hg; in the control group it was 137.8/76.3 mm Hg.

“This study has shown that self-monitoring with self-titration of antihypertensives 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 study states, adding that “no additional adverse events were observed.”

The self-monitoring devices cost about $25, notes the report, “meaning that with training delivered by nurses, this intervention could be implemented widely.”

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