Document Detail


Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial.
MedLine Citation:
PMID:  20619448     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Control of blood pressure is a key component of cardiovascular disease prevention, but is difficult to achieve and until recently has been the sole preserve of health professionals. This study assessed whether self-management by people with poorly controlled hypertension resulted in better blood pressure control compared with usual care.
METHODS: This randomised controlled trial was undertaken in 24 general practices in the UK. Patients aged 35-85 years were eligible for enrolment if they had blood pressure more than 140/90 mm Hg despite antihypertensive treatment and were willing to self-manage their hypertension. Participants were randomly assigned in a 1:1 ratio to self-management, consisting of self-monitoring of blood pressure and self-titration of antihypertensive drugs, combined with telemonitoring of home blood pressure measurements or to usual care. Randomisation was done by use of a central web-based system and was stratified by general practice with minimisation for sex, baseline systolic blood pressure, and presence or absence of diabetes or chronic kidney disease. Neither participants nor investigators were masked to group assignment. The primary endpoint was change in mean systolic blood pressure between baseline and each follow-up point (6 months and 12 months). All randomised patients who attended follow-up visits at 6 months and 12 months and had complete data for the primary outcome were included in the analysis, without imputation for missing data. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN17585681.
FINDINGS: 527 participants were randomly assigned to self-management (n=263) or control (n=264), of whom 480 (91%; self-management, n=234; control, n=246) were included in the primary analysis. Mean systolic blood pressure decreased by 12.9 mm Hg (95% CI 10.4-15.5) from baseline to 6 months in the self-management group and by 9.2 mm Hg (6.7-11.8) in the control group (difference between groups 3.7 mm Hg, 0.8-6.6; p=0.013). From baseline to 12 months, systolic blood pressure decreased by 17.6 mm Hg (14.9-20.3) in the self-management group and by 12.2 mm Hg (9.5-14.9) in the control group (difference between groups 5.4 mm Hg, 2.4-8.5; p=0.0004). Frequency of most side-effects did not differ between groups, apart from leg swelling (self-management, 74 patients [32%]; control, 55 patients [22%]; p=0.022).
INTERPRETATION: Self-management of hypertension in combination with telemonitoring of blood pressure measurements represents an important new addition to control of hypertension in primary care.
FUNDING: Department of Health Policy Research Programme, National Coordinating Centre for Research Capacity Development, and Midlands Research Practices Consortium.
Authors:
Richard J McManus; Jonathan Mant; Emma P Bray; Roger Holder; Miren I Jones; Sheila Greenfield; Billingsley Kaambwa; Miriam Banting; Stirling Bryan; Paul Little; Bryan Williams; F D Richard Hobbs
Related Documents :
8606538 - Comparative effects of diltiazem and lisinopril on left ventricular structure and filli...
1728908 - The trial of antihypertensive interventions and management (taim) study. adequate weigh...
8757028 - Diurnal systolic blood pressure variability is the strongest predictor of early carotid...
23162388 - Anesthesia for thoracic surgery: a survey of middle eastern practice.
17083608 - Differences in need for hemodynamic support in horses anesthetized with sevoflurane as ...
12423278 - Late hemodynamic changes following controlled hemorrhage and volume restitution with bl...
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-07-08
Journal Detail:
Title:  Lancet     Volume:  376     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-19     Completed Date:  2010-07-29     Revised Date:  2014-03-17    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  163-72     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Elsevier Ltd. All rights reserved.
Data Bank Information
Bank Name/Acc. No.:
ISRCTN/ISRCTN17585681
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / administration & dosage
Adult
Aged
Aged, 80 and over
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors / administration & dosage
Antihypertensive Agents / administration & dosage*
Blood Pressure / drug effects*
Blood Pressure Monitoring, Ambulatory*
Calcium Channel Blockers / administration & dosage
Drug Administration Schedule
Family Practice
Female
Humans
Hypertension / complications,  drug therapy*,  ethnology,  physiopathology*
Male
Middle Aged
Patient Selection
Self Administration
Thiazides / administration & dosage
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
CDF/01/017//Department of Health; //Department of Health
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Angiotensin Receptor Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Calcium Channel Blockers; 0/Thiazides
Comments/Corrections
Comment In:
Lancet. 2010 Jul 17;376(9736):144-6   [PMID:  20619449 ]
Lancet. 2010 Nov 20;376(9754):1737; author reply 1737-8   [PMID:  21093645 ]
Praxis (Bern 1994). 2010 Oct 20;99(21):1302-3   [PMID:  20960403 ]
J Clin Hypertens (Greenwich). 2011 Feb;13(2):138-40   [PMID:  21272203 ]
Evid Based Med. 2011 Feb;16(1):17-8   [PMID:  21109677 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  A surveillance pathway monitors the fitness of the endoplasmic reticulum to control its inheritance.
Next Document:  Self-titration for treatment of uncomplicated hypertension.