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Self-management of hypertension combined with telemonitoring of BP significantly reduces SBP relative to usual care, UK trial finds

Tuesday, July 27 2010 | Comments

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What's This? The use of a self-management strategy for hypertension, in which patients are allowed to monitor their blood pressure (BP) at home and titrate their antihypertensive drugs, combined with telemonitoring of BP by health care professionals significantly reduces systolic BP (SBP) relative to usual primary care, according to findings from the TASMINH2 trial.
 
The trial included 527 patients aged 35 to 85 years in 24 general practices in the United Kingdom. All participants had a BP >140/90 mm Hg despite treatment and indicated that they were willing to self-manage their hypertension.
 
The participants were randomized to receive a self-management intervention or usual care. The intervention consisted of self-monitoring of BP and self-titration of antihypertensive drugs as well as telemonitoring of BP (ie, readings collected at home were relayed to health care professionals who could ensure that patients were not ignoring very high or very low readings).
 
The primary endpoint was the change in mean SBP from baseline at 6 and 12 months.
 
Of the 527 patients randomized, 480 (91%) attended follow-up visits and provided complete data for the primary outcome; these patients were included in the primary analysis.
 
The data showed that, from baseline to month 6, mean SBP decreased 12.9 mm Hg (95% CI, 10.4-15.5 mm Hg) in the intervention group compared with a decline of 9.2 mm Hg (95% CI, 6.7-11.8 mm Hg) in the control group (between-group difference, 3.7 mm Hg [95% CI, 0.8-6.6 mm Hg]; P=.013).
 
At 12 months, mean SBP declined 17.6 mm Hg (14.9-20.3 mm Hg) and 12.2 mm Hg (95% CI, 9.5-14.9 mm Hg) in the 2 groups, respectively, yielding a between-group difference of 5.4 mm Hg (95% CI, 2.4-8.5 mm Hg; P=.0004).
 
The between-group difference in the magnitude of diastolic BP (DBP) reduction did not differ significantly at 6 months (1.3 mm Hg [95% CI, -0.3 to +2.6 mm Hg]; P=.108), but there was a significant between-group difference of 2.7 mm Hg (95% CI, 1.1-4.2 mm Hg) at 12 months (P=.001). The pattern of the trend with time in mean DBP reduction did not differ significantly between the 2 groups (P=.092).
 
The study authors noted that the greater reduction in BP observed in the intervention group was most likely due to the greater use of antihypertensive drugs among these participants (P=.001).
 
Rates of adverse events did not differ between the 2 groups, except for leg swelling, which was more common in the intervention group (32% vs 22%; P=.022). The increased rate of leg swelling in the intervention group was most likely due to greater use of calcium-channel blockers in these patients, the researchers suggested.
 
The investigators noted that the additional reductions in BP observed with self-management at 12 months (5.4/2.7 mm Hg) correspond to a reduction in stroke risk of >20% and a reduction in coronary heart disease risk of >10%. (McManus RJ, et al. Lancet 2010;376:163-172.)

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