By Lilian Anekwe
Patients with hypertension who monitor their own blood pressure and titrate their medication have ‘significant and worthwhile’ reductions in blood pressure compared to patients under usual GP care, according to a UK trial.
Researchers randomised 527 patients with blood pressures above 140/90 mmHg from 24 practices into two groups. The self-management group used home monitors and followed a management plan drawn up with their GPs to adjust their anti-hypertensive medication. The other group were managed as usual.
Patients in the self-management group had significantly greater reductions in systolic blood pressure than the control group after six months, with systolic blood pressure 3.7 mmHg lower, and 5.4 mmHg lower after 12 months. Diastolic blood pressures were on average 2.7mmHg lower after 12 months.
Patients in the self-management group took more medication, on average 2.1 drugs compared with 1.7 in the usual care group.
Self-management cost £19 for every 1 mmHg reduction is systolic blood pressure achieved, but compared to usual care, the programme cost just over £5,600 per QALY gained – with an 85% chance of being cost effective at a £20,000 per QALY gained threshold.
Professor Richard McManus, professor of primary care cardiovascular disease at the University of Birmingham and GP in the city, lead the research, presented at the European Meeting on Hypertension in Oslo last week.
He said: ‘Whilst not all patients will wish to self manage, this represents an important new option when blood pressure is not well controlled. It is cost effective as well as leading to reduced blood pressure.’