Do-it-yourself BP control: Hypertension treatment puts patients in charge

The best way to reduce a patient’s blood pressure may be by getting the patient more involved. Hypertension patients not only effectively self-managed, but saw a greater reduction in mean blood pressure compared to those who did not, according to a study published in the Aug. 27 issue of JAMA.

High, uncontrolled blood pressure puts patients at risk for heart attacks and stroke. However, there has been a lot of debate recently over how low and how much control is appropriate. Further questions have arisen about costs and benefits associated with blood pressure and home monitoring. Self- and home-monitoring appears to be the new frontier in managing hypertension.

Richard J. McManus, FRCGP, of the Nuffield Department of Primary Care Health Sciences of the University of Oxford in the U.K., and colleagues were determined to take it one step further by making patients responsible for adjusting medications, turning them into active and aware participants in their healthcare, in hopes of seeing greater blood pressure reductions.

These patients, with a little education and some tools provided to their doctors by The Targets and Self-Management for the Control of Blood Pressure in Stroke and at Risk Groups (TASMIN-SR) study, were monitored over the course of 12 months and compared with a group receiving standard care.

Patients who were self-monitoring and adjusting their medications accordingly had a mean systolic blood pressure difference of 6.1 mm Hg at six months and a diastolic mean difference of 3 mm Hg below those receiving standard care. At 12 months, the self-managing group was 9.2 mm Hg mean systolic and 3.4 mm Hg diastolic lower than the standard care group.

Mean daily dosage for the patients in the intervention at 12 months was 3.34, while the dosage for the control group was 2.61.

Patients had little significant difference in adverse symptoms or outcomes.

McManus et al noted that another benefit of this study was how little validated, semi-automated blood pressure monitors cost “as little as US $25, meaning that with training delivered by nurses, this intervention could be implemented widely.”

Peter M Nilsson, MD, PhD, of Skåne University Hospital in Sweden, and Fredrik H. Nystrom, MD, PhD, of Linköping University, Sweden, wrote in an editorial that the findings of McManus et al were promising, but noted further studies on the effects of self-adjustment of blood pressure medications on cardiovascular events were needed. “In many countries antihypertensive drugs are now available as inexpensive generic drugs. The time has come to fully use these noncostly medications and to design optimal individualized care of patients,” Nilsson and Nystrom wrote.

It’s a possibility McManus et al seem to see. They wrote that at least 30 percent of patients in the U.K. with hypertension already self-monitor. With the risks placed on hypertensive patients, especially those with comorbidities, control is important. They wrote, “Patients at risk of cardiovascular disease whose blood pressure is not optimally controlled could be considered for self-management.”