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Self-monitoring leads to significantly lower blood pressure, study finds

GPs should encourage patients to monitor their blood pressure at home and use the self-taken readings to adjust antihypertensive medications, researchers have said.

Titrating blood pressure medications using blood pressure readings taken at home leads to significantly lower blood pressure at no increased workload for the GP, a study has found.

The study, carried out by researchers at the universities of Oxford, Cambridge and Birmingham, included just under 1200 patients whose clinic blood pressure was not controlled below 140/90mmHg.

Patients were assigned to either usual care, with their GP adjusting their medication based on clinic blood pressure readings, or self-monitoring with or without telemonitoring, where their GP titrated their medication using readings taken by the patient at home and either posted in or sent to the GP via an SMS system.

Patients who self-monitored were taught to use a validated monitor to take their blood pressure in the morning and evening for the first week of each month.

The researchers found that patients in the intervention groups had significantly lower systolic blood pressure after 12 months than patients who received usual care, at 137 and 136mmHg in the self-monitoring and telemonitoring groups respectively, compared to 140mmHg in the usual care group.

They also found that the number of GP consultations during the study were similar between all three groups.

They said in the paper: ‘Self-monitoring can be recommended for the ongoing management of hypertension in primary care in all patients who wish to use it, and will require provision of validated blood pressure monitors for home use, ideally with integrated telemonitoring systems.

‘GPs should incorporate self-monitored readings into their titration of blood pressure medications.’

Lead author Professor Richard McManus, an Oxfordshire GP and NIHR professor of primary care at Oxford University, described the findings as ‘conclusive evidence’ that GPs can use self-taken readings to help patients achieve lower blood pressure.

He said: ‘This reduction in blood pressure comes with no additional workload for the GP, and the self-monitoring system is cheap and simple for patients to use.

‘In the longer term we predict that better blood pressure control could result in significant health benefits for the patient – a likely 20% reduction in stroke risk and 10% reduction in coronary heart disease risk.’

Dr Andrew Green, BMA GP Committee clinical and prescribing policy lead, commented: ‘This study is to be welcomed and will come as no great surprise to GPs, most of whom have been encouraging patients to self-monitor for many years, and this can be done without any fancy or expensive IT intervention.’

‘Initial worries about patients becoming over-concerned about small changes in their blood pressures can be dealt with by simple explanation, and well-organised practices will find workload reduced. I would also anticipate a reduction in patient harms as inappropriate treatment due to ‘white coat’ syndrome can be avoided.’

Lancet 2018; avaialble online 27th February


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