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Self-Management of Hypertension Is Effective in High-Risk Patients

Summary and Comment |
August 28, 2014

Self-Management of Hypertension Is Effective in High-Risk Patients

  1. Thomas L. Schwenk, MD

Self-management lowered systolic blood pressure by 10 mm Hg more than usual care did.

  1. Thomas L. Schwenk, MD

Self-management of hypertension is effective, but most studies have included few patients at high risk for cardiovascular (CV) disease. This primary care U.K. study involved 555 hypertensive patients (blood pressure [BP], >130/80 mm Hg) who had diabetes, coronary disease, cerebrovascular disease, or kidney disease (glomerular filtration rate, 30–59 mL/minute/1.73 m2). Patients with dementia, postural hypotension, or terminal illnesses and those who took >3 antihypertensive medications or were pregnant were excluded.

Patients were randomized to a self-management and self-monitoring protocol or to usual care. Intervention patients were trained during two or three sessions to take their BPs and to follow a predetermined plan in making decisions in response to various readings. For example:

  • A patient with any reading of >181 mm Hg systolic or >101 mm Hg diastolic was prompted to make an appointment with a study physician or nurse within 48 hours.

  • A patient who recorded >4 readings in a single week of 121 to 180 mm Hg systolic or 76 to 100 diastolic in 2 consecutive months was referred to an algorithm for medication changes that had been negotiated previously with his or her primary care physician.

At baseline, mean BP was 143/80 mm Hg. Target BP was 120/70 mm Hg. At 12 months, intervention patients' mean BP was significantly lower than that of usual-care patients (128/74 vs. 139/76 mm Hg). Researchers noted no differences in adverse events between the groups.

Comment

Self-monitoring and self-management of hypertension is done commonly in some Western countries but not in the U.S. Many barriers arise from clinical caution, healthcare system dysfunction, and inadequate reimbursement (to both patients and clinicians); however, this study shows that, in the right system and with the proper training and follow-up, a supervised home-based program of hypertension management can effectively lower BP, even in high-risk patients. However, the clinically important objective of this strategy — lower morbidity and mortality — remains to be demonstrated.

  • Disclosures for Thomas L. Schwenk, MD at time of publication Editorial boards UpToDate

Citation(s):

Reader Comments (2)

CARLOS AKEL Physician, Cardiology

I support the idea of patients getting involved in the control and therapy of hypertension.
Adherence to drugs and improvements are easier.

Carmen Eucker Other Healthcare Professional, Endocrinology, Providence Medical Group Internal Medicine

I have been reading more EBP material to algorithms and self management outcomes which demonstrate patient improvement and efficacy.

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