Self-monitoring BP leads to lower blood pressure compared with office monitoring

Reference

McManus RJ, Mant J, Franssen M, et al, for the TASMINH4 investigators. Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial. Lancet 2018;391(10124):949-959.

Synopsis

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.