Lancet: Telemonitoring, self-care is wave of future for hypertension
Self-managing blood pressure measurements via telemonitoring can help reduce systolic blood pressure levels and could be a viable care option for hypertensive patients, according to the TASMINH2 trial published online July 8 in the Lancet.
“Control of blood pressure is a key component of cardiovascular disease prevention, but is difficult to achieve and until recently has been the sole preserve of health professionals,” the authors wrote. “There is a potentially important role for novel interventions to lower blood pressure, especially in primary care, where management of hypertension mainly takes place.”
Richard J. McManus, PhD, of the University of Birmingham and National Institute for Health Research (NIHR) National School for Primary Care Research in Birmingham, England, and colleagues evaluated whether patient self-management of hypertension, including the use of telemonitoring and self-titration of antihypertensive drugs, could reduce high blood pressure.
During the prospective, randomized TASMINH2 (Telemonitoring and Self-Management of Hypertension) trial, researchers enrolled 527 patients with blood pressure levels of 140/90 mm Hg or higher, age 35 to 85, who were receiving two or less antihypertensive drug treatments into control (264 patients) or intervention arms (263 patients).
The study, which took place between March 2007 and May 2008 at 24 sites in the U.K., assessed how telemonitoring and self-titration could reduce and control blood pressure.
Patients in the intervention group were trained to monitor their own blood pressure levels with a sphygmomanometer (Omron Healthcare's Omron 705IT) and a modem device to record and input data (Netmedical's i-modem).
For the intervention group, target blood pressure levels were 130/85 mm Hg and 130/75 mm Hg for diabetic patients. The researchers used the change in systolic blood pressure between baseline and six and 12 months as the primary endpoint.
Patients in the self-management group took two blood pressure measurements each morning for one week. If a patient’s measurement were above the target, he or she self-adjusted medication.
Results of the study showed that for patients in the intervention group, systolic blood pressure levels were 3.7 mm Hg lower than those in the control group at six months and 5.4 mm Hg lower at 12 months.
“The absolute reduction in BP (5.4 mm Hg) is equivalent to a reduction in risk of stroke of more than 20 percent and in coronary heart disease of more than 10 percent,” the authors wrote.
For patients with low index of multiple deprivation (IMD) scores, declines in systolic blood pressure levels were lower than in patients with high IMD scores, 5.3 mm Hg at six months and 1.6 mm Hg at 12 months.
In addition, the researchers found that levels of diastolic blood pressure did not differ significantly between the two study arms.
In the intervention arm, of the 210 who self-managed hypertension for the full 12 month period, 70 percent had a change in antihypertensive drugs—thiazides or calcium antagonists.
The researchers noted that for both groups, leg swelling was the greatest concern and most common side effect; however, anxiety scores are between the two groups were not statistically significant, 5.4 mm Hg versus 9 mm Hg at 12 months.
The study concludes that self-management of hypertension provides greater declines in BP than standard care methods. Authors attributed the decline to the increased use of medication therapy and also to lifestyle modifications, telemonitoring and BP targets.
“A common theme from this evidence is the importance of self-management interventions that empower patients to self-titrate their own medication,” the authors said.
“Self-management represents an important new addition to the control of hypertension in primary care,” they concluded.
In an accompanied editorial, Gbenga Ogedegbe, MD, of the New York University School of Medicine, said the study would “profoundly affect the way we treat patients with uncomplicated hypertension.” However, some existing problems must be solved, Ogedegbe wrote.
Questions that must be answered include how to find the most optimal duration for self-monitoring and self-titration schedules, what the minimum follow-up period would be, and what are the cost implications of self-monitoring via telemonitoring.
“Although findings of the TASMINH2 trial suggest that self-titration of antihypertensive drugs has come of age in terms of its feasibility, safety and efficacy, its widespread dissemination into primary care practices might be premature until these findings are replicated by other investigators, especially in low-income, low-literate patients who receive care in low-resource, non-academic settings,” Ogedegbe said.
“Control of blood pressure is a key component of cardiovascular disease prevention, but is difficult to achieve and until recently has been the sole preserve of health professionals,” the authors wrote. “There is a potentially important role for novel interventions to lower blood pressure, especially in primary care, where management of hypertension mainly takes place.”
Richard J. McManus, PhD, of the University of Birmingham and National Institute for Health Research (NIHR) National School for Primary Care Research in Birmingham, England, and colleagues evaluated whether patient self-management of hypertension, including the use of telemonitoring and self-titration of antihypertensive drugs, could reduce high blood pressure.
During the prospective, randomized TASMINH2 (Telemonitoring and Self-Management of Hypertension) trial, researchers enrolled 527 patients with blood pressure levels of 140/90 mm Hg or higher, age 35 to 85, who were receiving two or less antihypertensive drug treatments into control (264 patients) or intervention arms (263 patients).
The study, which took place between March 2007 and May 2008 at 24 sites in the U.K., assessed how telemonitoring and self-titration could reduce and control blood pressure.
Patients in the intervention group were trained to monitor their own blood pressure levels with a sphygmomanometer (Omron Healthcare's Omron 705IT) and a modem device to record and input data (Netmedical's i-modem).
For the intervention group, target blood pressure levels were 130/85 mm Hg and 130/75 mm Hg for diabetic patients. The researchers used the change in systolic blood pressure between baseline and six and 12 months as the primary endpoint.
Patients in the self-management group took two blood pressure measurements each morning for one week. If a patient’s measurement were above the target, he or she self-adjusted medication.
Results of the study showed that for patients in the intervention group, systolic blood pressure levels were 3.7 mm Hg lower than those in the control group at six months and 5.4 mm Hg lower at 12 months.
“The absolute reduction in BP (5.4 mm Hg) is equivalent to a reduction in risk of stroke of more than 20 percent and in coronary heart disease of more than 10 percent,” the authors wrote.
For patients with low index of multiple deprivation (IMD) scores, declines in systolic blood pressure levels were lower than in patients with high IMD scores, 5.3 mm Hg at six months and 1.6 mm Hg at 12 months.
In addition, the researchers found that levels of diastolic blood pressure did not differ significantly between the two study arms.
In the intervention arm, of the 210 who self-managed hypertension for the full 12 month period, 70 percent had a change in antihypertensive drugs—thiazides or calcium antagonists.
The researchers noted that for both groups, leg swelling was the greatest concern and most common side effect; however, anxiety scores are between the two groups were not statistically significant, 5.4 mm Hg versus 9 mm Hg at 12 months.
The study concludes that self-management of hypertension provides greater declines in BP than standard care methods. Authors attributed the decline to the increased use of medication therapy and also to lifestyle modifications, telemonitoring and BP targets.
“A common theme from this evidence is the importance of self-management interventions that empower patients to self-titrate their own medication,” the authors said.
“Self-management represents an important new addition to the control of hypertension in primary care,” they concluded.
In an accompanied editorial, Gbenga Ogedegbe, MD, of the New York University School of Medicine, said the study would “profoundly affect the way we treat patients with uncomplicated hypertension.” However, some existing problems must be solved, Ogedegbe wrote.
Questions that must be answered include how to find the most optimal duration for self-monitoring and self-titration schedules, what the minimum follow-up period would be, and what are the cost implications of self-monitoring via telemonitoring.
“Although findings of the TASMINH2 trial suggest that self-titration of antihypertensive drugs has come of age in terms of its feasibility, safety and efficacy, its widespread dissemination into primary care practices might be premature until these findings are replicated by other investigators, especially in low-income, low-literate patients who receive care in low-resource, non-academic settings,” Ogedegbe said.