Study: High-risk hypertension patients can self-regulate condition

CHICAGO — Among patients with hypertension at high risk of cardiovascular disease, a program where patients measured their blood pressure and adjusted their antihypertensive medication accordingly resulted in lower systolic blood pressure at 12 months compared with patients who received usual care, according to a study in the Aug. 27 issue of JAMA.

 

Data from national and international surveys suggest that despite improvements over the last decade, significant proportions of patients have poor control of their elevated blood pressure. Self-monitoring of blood pressure with self-titration (adjusting) of antihypertensives results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups, according to background information in the article.

 

Richard McManus of the University of Oxford and colleagues randomly assigned 552 patients with hypertension and a history of stroke, coronary heart disease, diabetes or chronic kidney disease to either self-monitoring of blood pressure combined with an individualized self-titration algorithm or a control group (i.e., patients received usual care consisting of seeing their healthcare clinician for routine blood-pressure measurement and adjustment of medication, if necessary).

 

After 12 months, the average systolic blood pressure decreased in both groups, but was lower in the intervention group. Imputation for missing values showed a marginally lower average difference in systolic blood pressure of 8.8 mm Hg. The reduction in diastolic blood pressure also was greater in the self-monitoring group. The results were comparable in all subgroups, without excessive adverse events.

 

"This trial has shown for the first time, to our knowledge, that a group of high-risk individuals, with hypertension and significant cardiovascular comorbidity, are able to self-monitor and self-titrate antihypertensive treatment following a pre­specified algorithm developed with their family physician and that in doing so, they achieved a clinically significant reduction in systolic and diastolic blood pressure without an increase in adverse events," the authors wrote. "This is a population with the most to gain in terms of reducing future cardiovascular events from optimized blood pressure control."