title: Patients' experiences of self-monitoring blood pressure and self-titration of medication: the TASMINH2 trial qualitative study.
abstract: BACKGROUND
  Self-management of hypertension, comprising self-monitoring of blood pressure with self-titration of medication, improves blood pressure control, but little is known regarding the views of patients undertaking it.
  
  
  OBJECTIVE
  To explore patients'  views of self-monitoring blood pressure and self-titration of antihypertensive medication.
  
  
  METHODS
  Qualitative study embedded within the randomised controlled trial TASMINH2 (Telemonitoirng and Self Management in the Control of Hypertension) trial of patient  self-management of hypertension from 24 general practices in the West Midlands.
  
  
  METHODS
  Taped and transcribed semi-structured interviews with 23 intervention patients were used. Six family members were also interviewed. Analysis was by a constant comparative method.
  
  
  RESULTS
  Patients were confident about self-monitoring and many felt their multiple home readings were more valid than single office readings taken by their GP. Although many patients self-titrated medication when required, others lacked the confidence to increase medication  without reconsulting with their GP. Patients were more comfortable with titrating medication if their blood pressure readings were substantially above target, but were reluctant to implement such a change if readings were borderline. Many planned to continue self-monitoring after the study  finished and report home readings to their GP, but few wished to continue with a self-management plan.
  
  
  CONCLUSIONS
  Participants valued the additional information and many felt confident in both self-monitoring blood pressure and self-titrating medication. The reluctance  to change medication for borderline readings suggests behaviour similar to the clinical inertia seen for physicians in analogous circumstances. Additional support for those lacking in confidence to implement prearranged medication changes may allow more patients to undertake self-management.
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham.
authors.forename: Miren I
authors.initials: MI
authors.lastname: Jones
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Greenfield
authors.forename: Emma P
authors.initials: EP
authors.lastname: Bray
authors.forename: Sabrina
authors.initials: S
authors.lastname: Baral-Grant
authors.forename: F D Richard
authors.initials: FD
authors.lastname: Hobbs
authors.forename: Roger
authors.initials: R
authors.lastname: Holder
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant
authors.forename: Satnam K
authors.initials: SK
authors.lastname: Virdee
authors.forename: Bryan
authors.initials: B
authors.lastname: Williams
authors.forename: Richard J
authors.initials: RJ
authors.lastname: McManus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D018660:Blood Pressure Monitoring, Ambulatory / Q000523:psychology; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010465:Perception; D012307:Risk Factors; D012646:Self Administration; D012648:Self Care; D017216:Telemedicine
chemical_list: D000959:Antihypertensive Agents