Self-monitoring is an effective method for hypertensive patients who are at risk for cardiovascular comorbidity.
After participating in a self-management program, hypertensive patients at high risk for cardiovascular disease had lower systolic blood pressure compared to those who received standard care, according to the results of the Phase III TASMIN-SR trial published August 27, 2014, in JAMA.
Researchers from the University of Oxford in the United Kingdom studied 552 patients aged at least 35 years with hypertension and a history of stroke, coronary heart disease, diabetes, or chronic kidney disease. The patients had baseline blood pressures of at least 130/80 mm Hg and were treated at 59 primary care practices across the United Kingdom between March 2011 and January 2013.
Those in the intervention group were instructed to monitor their own blood pressures using an individualized self-titration algorithm, while those assigned to the control group received usual care, which included seeing their clinician for routine blood pressure measurements and receiving medication adjustments as necessary.
Although the previous Phase II TASMINH2 trial deemed this method effective, the research team “wanted to develop the intervention and trial it in higher risk patients,” lead study author Richard J. McManus, PhD, FRCGP, told Pharmacy Times.
At baseline, the blood pressure of the intervention group was 143.1/80.5 mm Hg, which was similar to the 143.6/79.5 mm Hg baseline blood pressure of the control group.
Although average systolic blood pressure decreased in both groups after 12 months, a more significant decline was found in the intervention group, as the researchers recorded a mean blood pressure of 128.2/73.8 mm Hg in the intervention group, compared to a mean blood pressure of 137.8/76.3 mm Hg in the control group.
The study authors noted the results were comparable in all subgroups and no excessive adverse events were observed.
“We thought that older patients with more comorbidities might not do as well as younger patients, but, in fact, we got better results: 9.2 mm Hg difference versus 5.4 mm Hg difference in systolic blood pressure in TASMIN-SR versus the TASMINH2 trial,” Dr. McManus said when asked about the study’s surprising findings.
As a result, the researchers concluded self-monitoring is a viable option for the long-term treatment of hypertension in patients with high cardiovascular disease risk.
“A group of high-risk individuals…are able to self-monitor and self-titrate antihypertensive treatment following a pre-specified algorithm developed with their family physician and that, in doing so, they achieved a clinically significant reduction in systolic and diastolic blood pressure without an increase in adverse events,” the study authors wrote. “This is a population with the most to gain in terms of reducing future cardiovascular events from the optimized blood pressure control.”
Thus, Dr. McManus urged health care professionals to “consider self-management as an effective approach for lowering blood pressure safely” in patients with “above-target blood pressure and cardiovascular comorbidity.”