Blood Pressure Control Improved By Patient Self-Management

Prof Richard McManus MA PhD FRCGP NIHR School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire United KingdomMedicalResearch.com Interview with
Prof Richard McManus MA PhD FRCGP
NIHR School for Primary Care Research,
Nuffield Department of Primary Care Health
Sciences, University of Oxford,
Oxford, Oxfordshire United Kingdom

Medical Research: What are the main findings of the study?

Prof. McManus: The TASMIN-SR clinical trial followed 552 patients with an average age of 70 and high blood pressure with pre-existing cardiovascular disease, diabetes or chronic kidney disease.

After training in how to self-monitor blood pressuring using a readily available device, patients took readings twice each morning for the first week of each month, and following an individualised management plan were able to request additional medication from their general practitioner without the need for consultation.

At the end of the study, patients who self-managed had significantly lower blood pressure (by 9.2 / 3.4 mmHg) than those who were visiting their GP for blood pressure monitoring, which would be expected to lower stroke risk by around 30% if sustained.


Medical Research: Were any of the findings unexpected?

Prof. McManus: The TASMIN-SR trial followed on from the TASMINH2 trial (McManus et al Lancet 2010) which tested a similar intervention in people with uncomplicated hypertension. That also found that self-management reduced blood pressure compared to usual care. In TASMIN-SR we expected that it might be harder to get similar reductions because the patient population were older and had more co-morbidities. In fact we found that the intervention worked even better with almost double the drop in blood pressure (9.2mmHg systolic vs 5.4 mmHg).

Medical Research: What should clinicians and patients take away from your report?

Prof. McManus: We have now shown that both in patients at high risk of cardiovascular disease and those with uncomplicated hypertension, enabling them to self-monitor BP and self-titrate their own medication leads to better control of blood pressure. In the UK at least 30% of people with hypertension self-monitor BP and so there is an opportunity to use this intervention more widely. Our oldest patient in TASMIN-SR was 88 years old and over 20% had two or more from diabetes, cardiovascular disease or chronic kidney disease so this is an intervention that can work for a wide range of people.

Medical Research: What recommendations do you have for future research as a result of this study?

Prof. McManus: We now have data from two trials with over 1000 patients showing that self-management of hypertension is effective at reducing blood pressure compared to usual care over 12 months. Future work should assess the longer term impact of self-management and for which people it is most suitable.

Citation:

Effect of Self-monitoring and Medication Self-titration on Systolic Blood Pressure in Hypertensive Patients at High Risk of Cardiovascular Disease: The TASMIN-SR Randomized Clinical Trial

Richard J. McManus FRCGP, Jonathan Mant MD, M. Sayeed Haque PhD, Emma P. Bray PhD, Stirling Bryan PhD, Sheila M. Greenfield PhD, Miren I. Jones PhD, Sue Jowett PhD, Paul Little MD, Cristina Penaloza MA, Claire Schwartz PhD, Helen Shackleford RGN, Claire Shovelton PhD, Jinu Varghese RGN, Bryan Williams MD, F.D. Richard Hobbs FMedSci

JAMA. 2014;312(8):799-808. doi:10.1001/jama.2014.10057

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