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Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial

Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial
Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial
Importance Self-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups.

Objective To determine the effect of self-monitoring with self-titration of antihypertensive medication compared with usual care on systolic blood pressure among patients with cardiovascular disease, diabetes, or chronic kidney disease.

Design, Setting, and Patients A primary care, unblinded, randomized clinical trial involving 552 patients who were aged at least 35 years with a history of stroke, coronary heart disease, diabetes, or chronic kidney disease and with baseline blood pressure of at least 130/80 mm Hg being treated at 59 UK primary care practices was conducted between March 2011 and January 2013.

Interventions Self-monitoring of blood pressure combined with an individualized self-titration algorithm. During the study period, the office visit blood pressure measurement target was 130/80 mm Hg and the home measurement target was 120/75 mm Hg. Control patients received usual care consisting of seeing their health care clinician for routine blood pressure measurement and adjustment of medication if necessary.

Main Outcomes and Measures The primary outcome was the difference in systolic blood pressure between intervention and control groups at the 12-month office visit.

Results Primary outcome data were available from 450 patients (81%). The mean baseline blood pressure was 143.1/80.5 mm Hg in the intervention group and 143.6/79.5 mm Hg in the control group. After 12 months, the mean blood pressure had decreased to 128.2/73.8 mm Hg in the intervention group and to 137.8/76.3 mm Hg in the control group, a difference of 9.2 mm Hg (95% CI, 5.7-12.7) in systolic and 3.4 mm Hg (95% CI, 1.8-5.0) in diastolic blood pressure following correction for baseline blood pressure. Multiple imputation for missing values gave similar results: the mean baseline was 143.5/80.2 mm Hg in the intervention group vs 144.2/79.9 mm Hg in the control group, and at 12 months, the mean was 128.6/73.6 mm Hg in the intervention group vs 138.2/76.4 mm Hg in the control group, with a difference of 8.8 mm Hg (95% CI, 4.9-12.7) for systolic and 3.1 mm Hg (95% CI, 0.7-5.5) for diastolic blood pressure between groups. These results were comparable in all subgroups, without excessive adverse events.

Conclusions and Relevance Among patients with hypertension at high risk of cardiovascular disease, self-monitoring with self-titration of antihypertensive medication compared with usual care resulted in lower systolic blood pressure at 12 months.

0098-7484
799-808
McManus, Richard J.
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Mant, Jonathan
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Haque, Sayeed
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Bray, Emma P.
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Bryan, Stirling
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Greenfield, Sheila M.
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Jones, Miren I.
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Jowett, Sue
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Little, Paul
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Penaloza, Cristina
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Schwartz, Claire
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Shackleford, Helen
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Shovelton, Claire
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Varghese, Jinu
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Williams, Bryan
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Hobbs, Richard
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McManus, Richard J.
481f6284-d599-4c77-8869-d1c6b63b9b02
Mant, Jonathan
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Haque, Sayeed
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Bray, Emma P.
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Bryan, Stirling
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Greenfield, Sheila M.
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Jones, Miren I.
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Jowett, Sue
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Little, Paul
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Penaloza, Cristina
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Schwartz, Claire
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Shackleford, Helen
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Shovelton, Claire
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Varghese, Jinu
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Williams, Bryan
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Hobbs, Richard
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McManus, Richard J., Mant, Jonathan, Haque, Sayeed, Bray, Emma P., Bryan, Stirling, Greenfield, Sheila M., Jones, Miren I., Jowett, Sue, Little, Paul, Penaloza, Cristina, Schwartz, Claire, Shackleford, Helen, Shovelton, Claire, Varghese, Jinu, Williams, Bryan and Hobbs, Richard (2014) Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial. JAMA, 312 (8), 799-808. (doi:10.1001/jama.2014.10057).

Record type: Article

Abstract

Importance Self-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups.

Objective To determine the effect of self-monitoring with self-titration of antihypertensive medication compared with usual care on systolic blood pressure among patients with cardiovascular disease, diabetes, or chronic kidney disease.

Design, Setting, and Patients A primary care, unblinded, randomized clinical trial involving 552 patients who were aged at least 35 years with a history of stroke, coronary heart disease, diabetes, or chronic kidney disease and with baseline blood pressure of at least 130/80 mm Hg being treated at 59 UK primary care practices was conducted between March 2011 and January 2013.

Interventions Self-monitoring of blood pressure combined with an individualized self-titration algorithm. During the study period, the office visit blood pressure measurement target was 130/80 mm Hg and the home measurement target was 120/75 mm Hg. Control patients received usual care consisting of seeing their health care clinician for routine blood pressure measurement and adjustment of medication if necessary.

Main Outcomes and Measures The primary outcome was the difference in systolic blood pressure between intervention and control groups at the 12-month office visit.

Results Primary outcome data were available from 450 patients (81%). The mean baseline blood pressure was 143.1/80.5 mm Hg in the intervention group and 143.6/79.5 mm Hg in the control group. After 12 months, the mean blood pressure had decreased to 128.2/73.8 mm Hg in the intervention group and to 137.8/76.3 mm Hg in the control group, a difference of 9.2 mm Hg (95% CI, 5.7-12.7) in systolic and 3.4 mm Hg (95% CI, 1.8-5.0) in diastolic blood pressure following correction for baseline blood pressure. Multiple imputation for missing values gave similar results: the mean baseline was 143.5/80.2 mm Hg in the intervention group vs 144.2/79.9 mm Hg in the control group, and at 12 months, the mean was 128.6/73.6 mm Hg in the intervention group vs 138.2/76.4 mm Hg in the control group, with a difference of 8.8 mm Hg (95% CI, 4.9-12.7) for systolic and 3.1 mm Hg (95% CI, 0.7-5.5) for diastolic blood pressure between groups. These results were comparable in all subgroups, without excessive adverse events.

Conclusions and Relevance Among patients with hypertension at high risk of cardiovascular disease, self-monitoring with self-titration of antihypertensive medication compared with usual care resulted in lower systolic blood pressure at 12 months.

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Published date: 27 August 2014
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 368567
URI: https://eprints.soton.ac.uk/id/eprint/368567
ISSN: 0098-7484
PURE UUID: 6104f905-effb-4290-9c62-1fcd11b214c4

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Date deposited: 04 Sep 2014 11:22
Last modified: 15 Jul 2019 21:46

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Contributors

Author: Richard J. McManus
Author: Jonathan Mant
Author: Sayeed Haque
Author: Emma P. Bray
Author: Stirling Bryan
Author: Sheila M. Greenfield
Author: Miren I. Jones
Author: Sue Jowett
Author: Paul Little
Author: Cristina Penaloza
Author: Claire Schwartz
Author: Helen Shackleford
Author: Claire Shovelton
Author: Jinu Varghese
Author: Bryan Williams
Author: Richard Hobbs

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