Monitoring Blood Pressure at Home May Help Keep It Low
WEDNESDAY July 7, 2010 -- With proper training, people with high blood pressure may be able to control it more effectively on their own at home than through conventional methods, British researchers contend.
Through telemonitoring of their blood pressure and adjusting their medications according to guidelines agreed upon in advance, patients assigned to self-managed care saw greater reductions in blood pressure after six and 12 months than patients receiving standard care through health professionals, the study found.
"Self-management represents an important new intervention for people with hypertension treated in primary care," said lead researcher Dr. Richard J. McManus, a professor of primary care cardiovascular research and honorary consultant at the University of Birmingham in England.
Self-management should be considered for people with hypertension, particularly if their blood pressure is not controlled with standard care, McManus added.
But the self-managed approach is not without drawbacks, McManus noted.
"Caveats are that not everyone will want to do self-management and that family doctors need to be involved in setting up the titration schedules for individuals to follow," he said.
High blood pressure is a major risk factor for heart attack, heart failure, stroke and renal (kidney) failure, but only half the people treated for it have their blood pressure controlled, according to background information in the study.
For the study, published in the July 8 online edition of The Lancet, McManus's team randomly assigned 527 patients with high blood pressure, also known as hypertension, to either self-managed care or to standard care.
Taking daily blood pressure readings over six months, patients managing their own care saw a drop in systolic blood pressure (the top number in a 120/80 reading) of 12.9 mm Hg, while patients on standard therapy saw only a 9.2 mm Hg drop in systolic pressure, the researchers found.
After a year, systolic pressure in the self-managed group fell 17.6 mm Hg, compared with 12.2 mm Hg in the standard care group.
Patients without diabetes were encouraged to aim for 130/85 mm Hg, and diabetics were to target 130/75 mm Hg, according to the study.
Side effects were generally the same in both groups, except that leg swelling occurred more often in the self-managed group (32 percent versus 22 percent), the researchers note.
The self-managed patients attended two training sessions to learn to use automated sphygmomanometers (blood pressure monitors), and they were also taught how to transmit their blood pressure readings to the doctor via an automated modem device.
Drug-adjustment schedules were agreed to by the patients and their family doctor.
McManus thinks that working actively to control blood pressure is the reason the self-management approach was so successful.
"The effect seems to be due to increased antihypertensive treatment in people who self-manage," he said. For example, patients who missed their targets two months in a row made medication changes.
Dr. Gregg C. Fonarow, professor of medicine and director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California, Los Angeles, said self-management has been shown to improve risk factor control or outcomes in patients with other conditions, such as diabetes and heart failure.
"This exciting new study demonstrates that the combination of telemonitoring of home blood pressure measurements combined with self-management of hypertension following a simple algorithm was more effective than usual care in the primary care setting," Fonarow said.
"This represents a very practical, broadly applicable, likely cost-effective new approach to achieve improved blood pressure control," he said.
For more information on hypertension, visit the U.S. National Library of Medicine.
Posted: July 2010
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