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Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial

Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial
Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial
Background: control of blood pressure is a key component of cardiovascular disease prevention, but is difficult to achieve and until recently has been the sole preserve of health professionals. This study assessed whether self-management by people with poorly controlled hypertension resulted in better blood pressure control compared with usual care.

Methods: this randomised controlled trial was undertaken in 24 general practices in the UK. Patients aged 35–85 years were eligible for enrolment if they had blood pressure more than 140/90 mm Hg despite antihypertensive treatment and were willing to self-manage their hypertension. Participants were randomly assigned in a 1:1 ratio to selfmanagement, consisting of self-monitoring of blood pressure and self-titration of antihypertensive drugs, combined with telemonitoring of home blood pressure measurements or to usual care. Randomisation was done by use of a central web-based system and was stratified by general practice with minimisation for sex, baseline systolic blood pressure, and presence or absence of diabetes or chronic kidney disease. Neither participants nor investigators were masked to group assignment. The primary endpoint was change in mean systolic blood pressure between baseline and each follow-up point (6 months and 12 months). All randomised patients who attended follow-up visits at 6 months and 12 months and had complete data for the primary outcome were included in the analysis, without imputation for missing data. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN17585681.

Findings: 527 participants were randomly assigned to self-management (n=263) or control (n=264), of whom 480 (91%; self-management, n=234; control, n=246) were included in the primary analysis. Mean systolic blood pressure decreased by 12·9 mm Hg (95% CI 10·4–15·5) from baseline to 6 months in the self-management group and by 9·2 mm Hg (6·7–11·8) in the control group (difference between groups 3·7 mm Hg, 0·8–6·6; p=0·013). From baseline to 12 months, systolic blood pressure decreased by 17·6 mm Hg (14·9–20·3) in the self-management group and by 12·2 mm Hg (9·5–14·9) in the control group (difference between groups 5·4 mm Hg, 2·4–8·5; p=0·0004). Frequency of most side-effects did not differ between groups, apart from leg swelling (self-management, 74 patients [32%]; control, 55 patients [22%]; p=0·022).

Interpretation: self-management of hypertension in combination with telemonitoring of blood pressure measurements represents an important new addition to control of hypertension in primary care.

Funding: department of Health Policy Research Programme, National Coordinating Centre for Research Capacity Development, and Midlands Research Practices Consortium.
0140-6736
163-172
McManus, Richard J.
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Mant, Jonathan
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Bray, Emma P.
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Holder, Roger
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Jones, Miren I.
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Greenfield, Sheila
a983610e-aa36-442b-9f11-9af5721d7542
Kaambwa, Billingsley
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Banting, Miriam
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Bryan, Stirling
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Little, Paul
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Williams, Bryan
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Hobbs, F.D. Richard
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McManus, Richard J.
481f6284-d599-4c77-8869-d1c6b63b9b02
Mant, Jonathan
0d1a0061-0f04-45c7-b20a-15798b1f465c
Bray, Emma P.
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Holder, Roger
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Jones, Miren I.
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Greenfield, Sheila
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Kaambwa, Billingsley
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Banting, Miriam
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Bryan, Stirling
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Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Williams, Bryan
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Hobbs, F.D. Richard
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McManus, Richard J., Mant, Jonathan, Bray, Emma P., Holder, Roger, Jones, Miren I., Greenfield, Sheila, Kaambwa, Billingsley, Banting, Miriam, Bryan, Stirling, Little, Paul, Williams, Bryan and Hobbs, F.D. Richard (2010) Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial. The Lancet, 376 (9736), 163-172. (doi:10.1016/S0140-6736(10)60964-6). (PMID:20619448)

Record type: Article

Abstract

Background: control of blood pressure is a key component of cardiovascular disease prevention, but is difficult to achieve and until recently has been the sole preserve of health professionals. This study assessed whether self-management by people with poorly controlled hypertension resulted in better blood pressure control compared with usual care.

Methods: this randomised controlled trial was undertaken in 24 general practices in the UK. Patients aged 35–85 years were eligible for enrolment if they had blood pressure more than 140/90 mm Hg despite antihypertensive treatment and were willing to self-manage their hypertension. Participants were randomly assigned in a 1:1 ratio to selfmanagement, consisting of self-monitoring of blood pressure and self-titration of antihypertensive drugs, combined with telemonitoring of home blood pressure measurements or to usual care. Randomisation was done by use of a central web-based system and was stratified by general practice with minimisation for sex, baseline systolic blood pressure, and presence or absence of diabetes or chronic kidney disease. Neither participants nor investigators were masked to group assignment. The primary endpoint was change in mean systolic blood pressure between baseline and each follow-up point (6 months and 12 months). All randomised patients who attended follow-up visits at 6 months and 12 months and had complete data for the primary outcome were included in the analysis, without imputation for missing data. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN17585681.

Findings: 527 participants were randomly assigned to self-management (n=263) or control (n=264), of whom 480 (91%; self-management, n=234; control, n=246) were included in the primary analysis. Mean systolic blood pressure decreased by 12·9 mm Hg (95% CI 10·4–15·5) from baseline to 6 months in the self-management group and by 9·2 mm Hg (6·7–11·8) in the control group (difference between groups 3·7 mm Hg, 0·8–6·6; p=0·013). From baseline to 12 months, systolic blood pressure decreased by 17·6 mm Hg (14·9–20·3) in the self-management group and by 12·2 mm Hg (9·5–14·9) in the control group (difference between groups 5·4 mm Hg, 2·4–8·5; p=0·0004). Frequency of most side-effects did not differ between groups, apart from leg swelling (self-management, 74 patients [32%]; control, 55 patients [22%]; p=0·022).

Interpretation: self-management of hypertension in combination with telemonitoring of blood pressure measurements represents an important new addition to control of hypertension in primary care.

Funding: department of Health Policy Research Programme, National Coordinating Centre for Research Capacity Development, and Midlands Research Practices Consortium.

Full text not available from this repository.

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e-pub ahead of print date: 8 July 2010
Published date: 17 July 2010
Organisations: Faculty of Medicine, Community Clinical Sciences

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Local EPrints ID: 168101
URI: http://eprints.soton.ac.uk/id/eprint/168101
ISSN: 0140-6736
PURE UUID: dd7f63d0-a4c7-4f95-9889-560b473ac305

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Date deposited: 24 Nov 2010 12:23
Last modified: 05 Oct 2018 12:12

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Contributors

Author: Richard J. McManus
Author: Jonathan Mant
Author: Emma P. Bray
Author: Roger Holder
Author: Miren I. Jones
Author: Sheila Greenfield
Author: Billingsley Kaambwa
Author: Miriam Banting
Author: Stirling Bryan
Author: Paul Little
Author: Bryan Williams
Author: F.D. Richard Hobbs

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