Targets and self monitoring in hypertension: randomised controlled trial and cost effectiveness analysis.
OBJECTIVE
To assess whether blood pressure control in primary care could be improved with the use of patient held targets and self monitoring in a practice setting, and to assess the impact of these on health behaviours, anxiety, prescribed antihypertensive drugs, patients' preferences, and costs.


METHODS
Randomised controlled trial.


METHODS
Eight general practices in south Birmingham.


METHODS
441 people receiving treatment in primary care for hypertension but not controlled below the target of < 140/85 mm Hg.


METHODS
Patients in the intervention group received treatment targets along with facilities to measure their own blood pressure at their general practice; they were also asked to visit their general practitioner or practice nurse if their blood pressure was repeatedly above the target level. Patients in the control group received usual care (blood pressure monitoring by their practice).


METHODS



METHODS
change in systolic blood pressure at six months and one year in both intervention and control groups.


RESULTS
change in health behaviours, anxiety, prescribed antihypertensive drugs, patients' preferences of method of blood pressure monitoring, and costs.


RESULTS
400 (91%) patients attended follow up at one year. Systolic blood pressure in the intervention group had significantly reduced after six months (mean difference 4.3 mm Hg (95% confidence interval 0.8 mm Hg to 7.9 mm Hg)) but not after one year (mean difference 2.7 mm Hg (- 1.2 mm Hg to 6.6 mm Hg)). No overall difference was found in diastolic blood pressure, anxiety, health behaviours, or number of prescribed drugs. Patients who self monitored lost more weight than controls (as evidenced by a drop in body mass index), rated self monitoring above monitoring by a doctor or nurse, and consulted less often. Overall, self monitoring did not cost significantly more than usual care (251 pounds sterling (437 dollars; 364 euros) (95% confidence interval 233 pounds sterling to 275 pounds sterling) versus 240 pounds sterling (217 pounds sterling to 263 pounds sterling).


CONCLUSIONS
Practice based self monitoring resulted in small but significant improvements of blood pressure at six months, which were not sustained after a year. Self monitoring was well received by patients, anxiety did not increase, and there was no appreciable additional cost. Practice based self monitoring is feasible and results in blood pressure control that is similar to that in usual care.
McManus
R J
RJ
Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT. r.j.mcmanus@bham.ac.uk
Mant
J
J
Roalfe
A
A
Oakes
R A
RA
Bryan
S
S
Pattison
H M
HM
Hobbs
F D R
FD
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001007:Anxiety / Q000209:etiology; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory / Q000191:economics / Q000592:standards*; D003362:Cost-Benefit Analysis; D005260:Female; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000191:economics / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D013599:Systole
D000959:Antihypertensive Agents