À compter du 1er décembre 2023, l’accès à POEMs et à Essential Evidence Plus ne fera plus partie des avantages offerts aux membres de l’AMC.
Question clinique
Does self-monitoring of blood pressure improve outcomes in patients with hypertension compared with standard office-based monitoring?
L’Essentiel
After one year, self-monitoring and self-monitoring plus telemonitoring of blood pressure results in small, nonclinically significant improvements in systolic blood pressure over usual office-based care. Regardless, the real question is whether patients are better off as a result. 1b
Référence
Plan de l'etude: Randomized controlled trial (nonblinded)
Financement: Government
Cadre: Outpatient (primary care)
Sommaire
These authors identified patients from primary care practices in England who had uncomplicated hypertension and systolic blood pressure higher than 145 mm Hg. The included patients (N = 1182) were older than 35 years and took no more than 3 antihypertensive medications. The researchers then randomized the patients to 1 of 3 interventions: usual care managed by the primary care clinician, self-monitoring, and self-monitoring plus telemonitoring. The patients in the usual care group attended follow-up sessions and had medications titrated at the discretion of the clinician. The self-monitoring patients were asked to obtain 2 blood pressure readings twice daily during the first week of each month. They received a simple color chart that prompted office visits in the event of very high or very low readings, otherwise they mailed in their readings. The patients in the combined self- and tele-monitoring group sent their blood pressure readings via standard text messaging. The system also prompted the patient to seek care for very high or very low readings. For the latter 2 groups, the clinicians were able to titrate the patients' medications based on patient-specific blood pressure goals determined by age, diabetes status, and other clinician-specific judgments. At baseline, the average blood pressure among the participants was 153/86. After 12 months, 15% of the participants had dropped out of the study. At the end of 12 months, the average systolic blood pressure was statistically significantly lower in the 2 self-monitoring groups (usual care = 140 mm Hg; self-monitoring = 137 mm Hg; self-monitoring plus telemonitoring = 136 mm Hg). This difference is unlikely to be clinically significant. Adherence and adverse event rates were similar across all 3 treatment groups. The overall rate of office visits was also similar. In this era of registry-driven health quality measures, having patients with controlled blood pressures will benefit primary care physicians in terms of quality ratings and other quality-driven payment schemes.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Commentaires
The important issue in at home BP monitoring is to then treat the patient's BP vigorously and then it would be expected to have an effect on outcome
Good poem
importantly, although there were differences in BP, they were not clinically significant.
not clinically relevant as per outcome of this study but only better for physician pay ! / ?
this study made no reference to other lifestyle changes. Patients who are on self-monitoring programs usually are also more adherent to diet and exercise, which can also contribute to lowering the blood pressure.