September 10, 2014
Hypertension Self-Management Works for Some
High-Risk Patients 

Oxford, England—Allowing patients at high risk of cardiovascular disease to self-manage their hypertension medications lowered systolic blood pressure after a year compared to patients who still depended on healthcare professionals to adjust their medications, according to a British study.

The report, published recently in the Journal of the American Medical Association, was about a British program in which patients measured their blood pressure and adjusted their antihypertensive medications at home.

Background information in the article notes that this was the first study looking at patients in a high-risk group, although previous research has shown the effectiveness of self-monitoring among a larger population of people with high blood pressure.

The study, led by researchers from the University of Oxford, randomly assigned 552 patients with hypertension and a history of stroke, coronary heart disease, diabetes, or chronic kidney disease to self-monitoring of blood pressure combined with an individualized self-titration algorithm or a control group where patients received usual care—i.e., seeing their healthcare provider for routine blood pressure measurement and adjustment of medication if necessary.

The average systolic blood pressure decreased in both groups after 12 months but was lower in the intervention group (128.2/73.8 mm Hg vs. 137.8/76.3 mm Hg). The results were comparable in all subgroups, without excessive adverse events.

Antihypertensive medication usage increased in both groups but went up more in the intervention group, especially related to calcium channel blockers and thiazides, according to the report.

“This trial has shown for the first time, to our knowledge, that a group of high-risk individuals, with hypertension and significant cardiovascular comorbidity, are able to self-monitor and self-titrate antihypertensive treatment following a pre-specified algorithm developed with their family physician and that in doing so, they achieved a clinically significant reduction in systolic and diastolic blood pressure without an increase in adverse events,” the authors write.

“This is a population with the most to gain in terms of reducing future cardiovascular events from optimized blood pressure control.”

In an accompanying editorial, two commentators from Sweden suggest the findings “represent an important gain in knowledge about efficacy and safety of self-titration of antihypertensive drugs based on home blood pressure recordings using fairly inexpensive oscillometric devices. What makes the study of particular clinical importance is the recruitment of patients who were at high risk of cardiovascular disease (i.e., a history of stroke or transient ischemic attack, coronary bypass graft surgery, myocardial infarction, angina, diabetes, or stage 3 chronic kidney disease), and the demonstration that the patient-centered technique was safe with no increase in adverse events compared with traditional treatment in a randomized setting.”

Yet, the trial “does not settle all questions regarding self-titration based on self-measurement, [but] is an important step toward adaptation of treatment for patients who want to actively take part in their own risk-factor control,” write Peter M. Nilsson, MD, PhD, of Skane University Hospital, Malmo, Sweden, and Fredrik H. Nystrom, MD, PhD, of Linkoping University, Linkoping, Sweden.

“Future trials studying the effects of self-titration on cardiovascular events are needed,” according to Nilsson and Nystrom. “With the gain in knowledge from [this trial], it may be possible to make the recruitment of patients less restricted, to incorporate education about self-measurement as a standard procedure and focus on which scheme for titration to use, or to study the timing of the home blood pressure recordings. In many countries antihypertensive drugs are now available as inexpensive generic drugs. The time has come to fully use these non-costly medications and to design optimal individualized care of patients.”

The commentators caution, however, that the study did not specifically address which medications were appropriate for self-titration and that fewer than 8% of the participants were randomized.

U.S. Pharmacist Social Connect