Self-Monitored Blood Pressure +/- Telemonitoring

Study Questions:

Does self-monitoring of blood pressure with or without telemonitoring improve blood pressure management?

Methods:

This was a randomized controlled trial of hypertensive patients (age >35 years) who received care in 142 general practices in the United Kingdom. Participants had to have blood pressure >140/90 mm Hg. Participants were randomized to self-monitoring their blood pressure or self-monitoring with telemonitoring; a third group received usual care. Neither participants nor investigators were masked to group assignment. The primary outcome of interest was systolic blood pressure (SBP) at 12 months. Primary analysis was of available cases.

Results:

A total of 1,182 participants were randomized to the three groups (self-monitoring alone [n = 395], telemonitoring group + self-monitoring [n = 393], or usual care [n = 394]), of whom 1,003 (85%) were included in the primary analysis. At 12 months, SBP was lower in both intervention groups compared with usual care (self-monitoring, 137.0 [standard deviation 16.7] mm Hg and telemonitoring, 136.0 [16.1] mm Hg vs. usual care, 140.4 [16.5] mm Hg). The adjusted mean difference compared to the usual care group was –3.5 mm Hg (95% confidence interval [CI], –5.8 to –1.2) for the self-monitoring alone, and –4.7 mm Hg (95% CI, –7.0 to –2.4) for the telemonitoring + self-monitoring. No difference was observed between the self-monitoring group and the telemonitoring + self-monitoring (adjusted mean difference, –1.2 mm Hg; 95% CI, –3.5 to 1.2). Adverse events were similar between all three groups.

Conclusions:

The authors concluded that self-monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings. With most general practitioners and many patients using self-monitoring, it could become the cornerstone of hypertension management in primary care.

Perspective:

Given the recent US hypertension recommendations, improving patient involvement through self-monitoring may improve efficacy of hypertension management in the primary care setting.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Hypertension

Keywords: Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Blood Pressure Monitors, General Practice, Hypertension, Hypotension, Metabolic Syndrome X, Patient Participation, Primary Health Care, Primary Prevention


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