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Hypertension self-management may be included in NICE guidelines update

Getting patients to self-titrate their blood pressure medications could soon become part of NICE hypertension guidance, UK researchers said, after publishing research showing it can help certain high-risk patients achieve significant improvements in control of their blood pressure.

The study – published today in JAMA and previously reported by Pulse at the Society of Academic Primary Care conference – involved 550 older patients, with a mean age of 69, who were at high risk because of a history of stroke, diabetes, cardiovascular disease or chronic kidney disease. Patients assigned to the intervention self-monitored their blood pressure and self-titrated their antihypertensive drugs, according to a written plan agreed with the GP.

After 12 months, systolic blood pressure among patients who self-managed in this way dropped by 9 mmHg over and above that of control patients who continued with usual care. The researchers said the improved blood pressure control appeared to be due to increased use of antihypertensive medication, as both the number and dose of drugs used increased, but there was no increase in any side effects.

Lead author Professor Richard McManus, professor of primary care at the University of Oxford, told Pulse the findings were similar for specific subgroups of patients and after further analyses to account for missing blood pressure values, ‘suggesting that these results are robust’.

Professor McManus said the team is now looking at the cost-effectiveness of the approach with the hope of introducing it in the NICE guidelines next year.

He said: ‘We are working on the cost-effectiveness analysis and hope that this will be published in time for self-management to be considered as an option in forthcoming national and international guidelines – NICE is due to review new evidence in hypertension in 2015.’

JAMA 2014; available online 27 August

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