title: Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial.
abstract: OBJECTIVE
  Self-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups.
  
  
  OBJECTIVE
  To determine the effect of self-monitoring with self-titration of antihypertensive medication compared with usual care on systolic blood pressure among patients with cardiovascular disease, diabetes, or chronic kidney disease.
  
  
  METHODS
  A primary care, unblinded, randomized clinical trial involving 552 patients who were aged at least 35 years with a history of stroke, coronary heart disease, diabetes, or chronic kidney disease and with baseline blood pressure of at least 130/80 mm Hg being treated at 59 UK primary care practices was conducted between March 2011 and January 2013.
  
  
  METHODS
  Self-monitoring of blood pressure combined with an individualized self-titration algorithm. During the study period, the office visit blood pressure measurement target was 130/80 mm Hg and the home measurement target was 120/75 mm Hg. Control patients received usual care consisting of seeing their health care clinician for routine blood pressure measurement and adjustment of medication if necessary.
  
  
  METHODS
  The primary outcome was the difference in systolic blood pressure between intervention and control groups at the 12-month office visit.
  
  
  RESULTS
  Primary outcome data were available from 450 patients (81%). The mean baseline blood pressure was 143.1/80.5 mm Hg in the intervention group and 143.6/79.5 mm Hg in the control group. After 12 months, the mean blood pressure had decreased to 128.2/73.8 mm Hg in the intervention group and to 137.8/76.3 mm Hg in the control group, a difference of 9.2 mm Hg (95% CI, 5.7-12.7) in systolic and 3.4 mm Hg (95% CI, 1.8-5.0) in diastolic blood pressure following correction for baseline blood pressure. Multiple imputation for missing values gave similar results: the mean baseline was 143.5/80.2 mm Hg in the intervention group vs 144.2/79.9 mm Hg in the control group, and at 12 months, the mean was 128.6/73.6 mm Hg in the intervention group vs 138.2/76.4 mm Hg in the control group, with a difference of 8.8 mm Hg (95% CI, 4.9-12.7) for systolic and 3.1 mm Hg (95% CI, 0.7-5.5) for diastolic blood pressure between groups. These results were comparable in all subgroups, without excessive adverse events.
  
  
  CONCLUSIONS
  Among patients with hypertension at high risk of cardiovascular disease, self-monitoring with self-titration of antihypertensive medication compared with usual care resulted in lower systolic blood pressure at 12 months.
  
  
  BACKGROUND
  isrctn.org Identifier: ISRCTN87171227.
authors.affiliation: National Institute for Health Research (NIHR) School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: McManus
authors.affiliation: Primary Care Unit, Strangeways Research Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant
authors.affiliation: Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: M Sayeed
authors.initials: MS
authors.lastname: Haque
authors.affiliation: School of Psychology, University of Central Lancashire, Preston, Lancashire, United Kingdom.
authors.forename: Emma P
authors.initials: EP
authors.lastname: Bray
authors.affiliation: Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada6School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Stirling
authors.initials: S
authors.lastname: Bryan
authors.affiliation: Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Greenfield
authors.affiliation: Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Miren I
authors.initials: MI
authors.lastname: Jones
authors.affiliation: Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Sue
authors.initials: S
authors.lastname: Jowett
authors.affiliation: School of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.affiliation: Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Cristina
authors.initials: C
authors.lastname: Penaloza
authors.affiliation: National Institute for Health Research (NIHR) School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Claire
authors.initials: C
authors.lastname: Schwartz
authors.affiliation: Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Shackleford
authors.affiliation: Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Claire
authors.initials: C
authors.lastname: Shovelton
authors.affiliation: Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Jinu
authors.initials: J
authors.lastname: Varghese
authors.affiliation: Institute of Cardiovascular Sciences, NIHR University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom.
authors.forename: Bryan
authors.initials: B
authors.lastname: Williams
authors.affiliation: National Institute for Health Research (NIHR) School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
authors.forename: F D Richard
authors.initials: FD
authors.lastname: Hobbs
authors.affiliation: West Midlands South: Atherstone Surgery
authors.forename: Trevor
authors.initials: T
authors.lastname: Gooding
authors.affiliation: West Midlands South: Churchfields Surgery
authors.forename: Ian
authors.initials: I
authors.lastname: Morrey
authors.affiliation: West Midlands South: The Marches
authors.forename: Crispin
authors.initials: C
authors.lastname: Fisher
authors.affiliation: West Midlands South: Trinity Court
authors.forename: David
authors.initials: D
authors.lastname: Buckley
mesh_terms: D000368:Aged; D000465:Algorithms; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000150:complications / Q000517:prevention & control*; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012306:Risk; D012646:Self Administration; D020521:Stroke / Q000150:complications
chemical_list: D000959:Antihypertensive Agents