• Hypertensive Disease Clinical Trials

Self-management of hypertension with self-monitoring of blood pressure (BP) levels and self-titration of antihypertensive medications results in significantly lower systolic blood pressure (SBP) compared with usual care, according to findings from the Telemonitoring And Self-Management In The Control Of Hypertension (TASMINH2) trial.

Recent improvements in automated BP meters have lead to the widespread use of self-monitoring by patients with hypertension. However, the effectiveness of a self-management intervention that combines self-monitoring with self-titration of antihypertensive medication in the primary care setting is unknown. Richard J. McManus, University of Birmingham, Birmingham, UK, reported findings from the TASMINH2 trial (ISRCTN17585681), which was designed to evaluate the role of dual-intervention self-management in reducing BP levels in patients with poorly controlled hypertension.

The TASMINH2 trial included 480 patients with elevated BP levels (>140/90 mm Hg) who had previously been treated with up to 2 antihypertensive medications. Patients were randomly assigned to self-management (n=246) or usual care (n=234). Patients in the self-management group agreed to perform monthly self-monitoring of BP levels. Based on BP findings, patients in the self-management group also followed medication titration schedules that were individually tailored to each patient's guideline-recommended BP goals. The primary endpoint was SBP at 6 and 12 months.

Self-management was associated with greater reductions in mean SBP compared with usual care at 6 months (−12.9 mm Hg vs −9.2 mm Hg; p=0.013) and at 12 months (−17.6 mm Hg vs −12.2 mm Hg; p=0.0004). At 6 months, patients in the self-management and usual-care groups showed similar decreases in diastolic BP (DBP; −5.4 mm Hg vs −4.2 mm Hg; p=0.108). However, by 12 months, self-management showed a significant advantage in DBP reduction compared with usual care (−7.6 mm Hg vs −5.0 mm Hg; p=0.001).

Greater BP control within the self-management group may be due to increased use of antihypertensive medication. Overall, 212 patients (80%) in the self-management group adhered to the self-monitoring and self-management regimen for the full 12 months of the study. Of these, 148 patients (70%) made at least one change to their antihypertensive treatment regimen during the course of the study. Indeed patients in the self-management group were significantly more likely than those in the usual care group to change medications during the study, with a mean of 0.46 more changes by month 12 (p=0.001). The most common agents added to the antihypertension treatment regimens were thiazide diuretics and calcium channel blockers.

Self-management was well tolerated. Patients had similar rates of side effects in both treatment arms with the exception of leg swelling, which occurred more frequently in the self-management group than in the usual care group (32% vs 22%; p=0.022).

Findings from TASMINH2 demonstrate the effectiveness of the self-monitoring of BP levels and the self-titration of BP medication in patients with uncontrolled hypertension. Self-management represents an important new intervention in the management of hypertension in primary care, Prof. McManus concluded.

• © 2010 MD Conference Express