Telemonitoring and Self-Management of Hypertension - TASMINH2

Jul 12, 2010
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
Department of Health Policy Research Programme, National Coordinating Centre for Research Capacity Development, and Midlands Research Practices Consortium.
Date Published:
01/01/2010
Date Updated:
07/12/2010
Original Posted Date:
07/12/2010
References

Description:

The goal of the trial was to evaluate self-monitoring, self-titration, and telemonitoring of home blood pressure measurements compared with usual care among patients with refractory hypertension.

Hypothesis:

Self-monitoring, self-titration, and telemonitoring of home blood pressure measurements would result in improved blood pressure control.

Study Design

  • Stratified
  • Randomized
  • Parallel

Patient Populations:

  • Patients between the ages of 35 and 85 years of age
  • Blood pressure >140/90 mm Hg on ≤2 antihypertensive medications
  • Number of patients enrolled: 527
  • Duration of follow-up: 12 months
  • Mean age: 67 years
  • Percentage female: 53%

Exclusions:

  • Blood pressure >200/100 mm Hg
  • Orthostatic hypotension (>20 mm Hg systolic drop
  • Limited life span
  • Dementia
  • Score >10 on short orientation memory concentration test
  • Hypertension management not managed by family physician
  • Spouse already participating in the study

Primary Endpoints:

  • Change in blood pressure from baseline to 6 months
  • Change in blood pressure from baseline to 12 months

Drug/Procedures Used:

Patients with uncontrolled blood pressure were randomized to self-monitoring, self-titration, and telemonitoring of home blood pressure measurements (n = 263) versus usual care (n = 264).

Home targets were 130/85 mm Hg for nondiabetics and 130/75 mm Hg for diabetics.

Principal Findings:

Overall, 527 patients were randomized. There was no difference in baseline characteristics between the groups. In the intervention group, the mean age was 67 years, 47% were men, blood pressure was 152/85 mm Hg, body mass index was 30 kg/m2, 9% had coronary artery disease, and 8% were diabetics.

In 23% of the intervention group, at least one blood pressure was recorded >200/100 mm Hg or systolic blood pressure <100 mm Hg. Persistently high or low blood pressure readings required a phone call to discuss management in 3% of patients. At 6 months, the intervention group was prescribed an additional 0.32 medications compared with the control group (p = 0.001), and at 12 months an additional 0.46 medications compared with the control group (p = 0.001).

The change in blood pressure from baseline to 6 months was 12.9 mm Hg in the intervention group versus 9.2 mm Hg in the control group (p between groups = 0.013). The change in blood pressure from baseline to 12 months was 17.6 mm Hg in the intervention group versus 12.2 mm Hg in the control group (p between groups = 0.0004). There was no difference in side effects between the groups except leg swelling, which occurred in 32% of the intervention group versus 22% of the control group (p = 0.022).

Interpretation:

Among patients who are not at goal blood pressure despite taking ≤2 antihypertensive medications, a strategy of self-monitoring, self-titration, and telemonitoring of blood pressure measurements was superior to usual care. The intervention group received more medications than the control group during follow-up, and the effect was better systolic blood pressure control in the intervention versus control group (additional 3.7 mm Hg reduction at 6 months and an additional 5.4 mm Hg reduction at 12 months).

Since approximately one-half of hypertension patients are not at goal blood pressure, this strategy may represent a significant development in blood pressure management. Motivated and knowledgeable patients are requisites for self-monitoring and self-titration. Cost-effectiveness analysis of this intervention is warranted.

References:

McManus R, Mant J, Bray EP, et al. Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial. Lancet 2010;366:163-172.

Clinical Topics: Prevention, Atherosclerotic Disease (CAD/PAD), Hypertension

Keywords: Coronary Artery Disease, Follow-Up Studies, Body Mass Index, Hypotension, Blood Pressure Determination, Leg, Hypertension, Diabetes Mellitus


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