| 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... 1163428 - Minoxidil in severe hypertension: value when conventional drugs have failed. 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: 2011-02-23 |
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. |
Affiliation:
|
Primary Care Clinical Sciences, University of Birmingham and National Institute for Health Research (NIHR) National School for Primary Care Research, Birmingham, UK. r.j.mcmanus@bham.ac.uk |
| 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:
|
//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:
|
J Clin Hypertens (Greenwich). 2011 Feb;13(2):138-40
[PMID:
21272203
]
Praxis (Bern 1994). 2010 Oct 20;99(21):1302-3 [PMID: 20960403 ] Lancet. 2010 Nov 20;376(9754):1737; author reply 1737-8 [PMID: 21093645 ] Lancet. 2010 Jul 17;376(9736):144-6 [PMID: 20619449 ] 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.