Self-management improves BP lowering
Self-management of hypertension at home could help some patients improve control of their blood pressure (BP), suggests a UK study.
The randomised trial in some 500 patients with poorly controlled BP, from 24 general practices, showed that patients assigned to self-management achieved significantly greater reductions in systolic BP levels compared with patients assigned to conventional care.
As reported in The Lancet, patients in the self-management group had a 3.7-mmHg greater fall in systolic BP from baseline to 6 months than those receiving usual care; this increased to a 5.4-mmHg bigger reduction by 12 months.
Speaking to MedWire News, lead author Professor Richard McManus (University of Birmingham, UK) explained: "About 80% of the patients were able to do the self-management for the full 12 months; of those, 70% increased their medication so that by the end of the trial those on self-management were taking on average about half a medication [additional class of drug] more than patients on usual care.
"So that suggests that people who self-manage are able to uptitrate their medication more effectively than those receiving usual care."
Telemonitoring was used to check that patients did not ignore unsafe BP levels, but few patients needed reminders to take action if they had particularly high or low readings.
McManus commented: "On the basis of one trial in only 500 patients, it's perhaps a bit early to start implementing this. But we did follow people for a decent length of time - and we saw a bigger difference at 12 months than we did at 6 months.
"I think the caveat is that it's not for everyone and you need well motivated patients who want to do it and are confident to take their own BP."
McManus and colleagues are continuing their research to see if the same results can be achieved without telemonitoring, and if the system can be simplified to enable more patients to adopt it.
GP News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Caroline Price