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Telemonitoring and Self-Management of Hypertension - TASMINH2
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.
Keywords: Coronary Artery Disease, Follow-Up Studies, Body Mass Index, Hypotension, Blood Pressure Determination, Leg, Hypertension, Diabetes Mellitus
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