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a blood pressure monitor imageMarch 2 2018

GPs are being asked to encourage hypertensive patients to self-monitor their blood pressure as it leads to better blood pressure control.

New research has found that when GPs adjust medication based on regular blood pressure readings taken by patients at home, blood pressure is significantly lower after 12 months when compared with those who are managed exclusively in the clinic setting.

The study was conducted through 142 general practices in the UK, and monitored 1,182 participants. These were adults aged 35 or older with blood pressure higher than 140/90 mmHg. They were assigned to one of three groups:

  • self-monitoring blood pressure;
  • self-monitoring blood pressure with telemonitoring;
  • usual care (blood pressure taken at the clinic).

The researchers found that systolic blood pressure was lower in both intervention groups compared with usual care after 12 months. The self-monitoring systolic average was 137 mmHg, self-monitoring with telemonitoring averaged 136 mmHg, while usual care averaged 140 mmHg.

“Self-monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings,” said the researchers.

“With most general practitioners and many patients using self-monitoring, it could become the cornerstone of hypertension management in primary care.”

The National Institute for Health Research, which funded the study, points out that hypertension affects more than 16 million people.

Professor McManus is an Oxfordshire GP as well as an NIHR Professor of Primary Care at Oxford University’s Nuffield Department of Primary Care Health Sciences. He said: “We now have conclusive evidence that GPs can use the readings from patients who self-monitor their own blood pressure to achieve significantly lower blood pressure after 12 months compared with conventional approaches.

“This reduction in blood pressure comes with no additional workload for the GP, and the self-monitoring system is cheap and simple for patients to use. In the longer term, we predict that better blood pressure control could result in significant health benefits for the patient – a likely 20% reduction in stroke risk and 10% reduction in coronary heart disease risk.”

Links:
NIHR announcement   
RJ McManus et al. Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial. The Lancet. Published online February 27 2018  

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