Control of BP is a key component of CVD prevention, but is difficult to achieve and until recently has been the sole preserve of health professionals. This study assessed whether self-management by people with poorly controlled HTN resulted in better BP control compared with usual care.

This randomized controlled trial was undertaken in 24 general practices in the UK. Pts aged 35-85 years were eligible for enrolment if they had BP >140/90 mm Hg despite anti-hypertensive ttt and were willing to self-manage their HTN. Participants were randomly assigned in a 1:1 ratio to self-management, consisting of self-monitoring of BP and self-titration of antihypertensive drugs, combined with telemonitoring of home BP measurements or to usual care. Randomization was done by use of a central web-based system and was stratified by general practice with minimization for sex, baseline systolic BP, and presence or absence of diabetes or chronic kidney disease. Neither participants nor investigators were masked to group assignment.

The primary endpoint was change in mean systolic BP between baseline and each FU point (6 months and 12 months). All randomised pts who attended FU visits at 6 months and 12 months and had complete data for the primary outcome were included in the analysis, without imputation for missing data. This study is registered as an International Standard Randomized Controlled Trial, number ISRCTN17585681.

527 participants were randomly assigned to self-management (n=263) or control (n=264), of whom 480 (91%; self-management, n=234; control, n=246) were included in the primary analysis. Mean systolic BP decreased by 12.9 mm Hg (95% CI 10.4-15.5) from baseline to 6 months in the self-management group and by 9.2 mm Hg (6.7-11.8) in the control group (difference between groups 3.7 mm Hg, 0.8-6.6; p=0.013). From baseline to 12 months, systolic BP decreased by 17.6 mm Hg (14.9-20.3) in the self-management group and by 12.2 mm Hg (9.5-14.9) in the control group (difference between groups 5.4 mm Hg, 2.4-8.5; p=0.0004). Frequency of most side-effects did not differ between groups, apart from leg swelling (self-management, 74 patients [32%]; control, 55 patients [22%]; p=0.022).

Self-management of HTN in combination with telemonitoring of BP measurements represents an important new addition to control of HTN in primary care.  

References:

1. McManus RJ, et al. Lancet. 2010 Jul 17;376(9736):163-72.