In the Journals

BP medication titration most effective after self-monitoring

Self-monitoring of BP with or without telemedicine conferred better antihypertensive medication titration than the usual care, according to findings published in The Lancet.

For the TASMINH4 trial, researchers randomly assigned 1,182 patients with hypertension aged 35 years or older to self-monitoring of BP, self-monitoring of BP with telemonitoring or to the usual care of relying on medication titration by clinic BP.

The primary outcome was clinic systolic BP at 12 months. Eighty-five percent of patients had enough data to be included in the primary analysis.

Differences in BP

At 12 months, systolic BP was lower in the self-monitoring group (137 mm Hg; standard deviation, 16.7) and the telemonitoring group (136 mm Hg; standard deviation, 16.1) than in the usual care group (140.4 mm Hg; standard deviation, 16.5), according to the researchers.

The adjusted mean difference between the self-monitoring group and the usual care group was –3.5 mm Hg (95% CI, –5.8 to –1.2) and the adjusted mean difference between the telemonitoring group and the usual care group was –4.7 mm Hg (95% CI, –7 to –2.4), the researchers wrote.

However, they wrote, the adjusted mean difference between the self-monitoring group and the telemonitoring group was not significant (–1.2 mm Hg; 95% CI, –3.5 to 1.2).

Sensitivity analyses did not change the results, and there were no significant differences between the groups in adverse events.

“To the best of our knowledge, this is the first trial in primary care of antihypertensive titration using self-monitored blood pressure, with or without telemonitoring, to show a benefit in terms of blood pressure after 12 months,” Richard J. McManus, PhD, from the Nuffield Department of Primary Care Health Sciences at the University of Oxford, and colleagues wrote. “Differences in blood pressure recorded at 6 months were amplified by 1 year, suggesting that the intervention increased in efficacy in the second 6 months. This was achieved without increased workload and using internationally recommended targets for home and clinic blood pressure.”

Implications for the future

“A feasible future scenario could be GPs acting as highly educated central health-care managers who not only treat individual patients but also orchestrate community health through a digital infrastructure, designed in conjunction with the medical end-user and relying on dedicated artificial intelligence,” Ernst R. Rietzschel, MD, PhD, and Marc L. De Buyzere, MSc, both from University Hospital Ghent, Belgium, wrote in a related editorial. “This forward-looking strategy could be equally applicable to middle-income and low-income countries where there is often a shortage of physicians and a high burden of untreated and undiagnosed hypertension — a driver’s seat allowing doctors to efficiently achieve both clinical and population outcomes. This should not be viewed as an abdication of responsibility but as an embracing of a far more wide-ranging collective responsibility.” – by Erik Swain

Disclosures: The BP monitors used in the study were provided for free by Omron. McManus and De Buyzere report no relevant financial disclosures. Rietzschel reports he has received an unrestricted educational grant to his institution from Amgen and Sanofi/Regeneron and has received speakers’ fees to his institution from Merck Sharpe & Dohme and Teva. One author reports he received research support from Roche Diagnostics.

Self-monitoring of BP with or without telemedicine conferred better antihypertensive medication titration than the usual care, according to findings published in The Lancet.

For the TASMINH4 trial, researchers randomly assigned 1,182 patients with hypertension aged 35 years or older to self-monitoring of BP, self-monitoring of BP with telemonitoring or to the usual care of relying on medication titration by clinic BP.

The primary outcome was clinic systolic BP at 12 months. Eighty-five percent of patients had enough data to be included in the primary analysis.

Differences in BP

At 12 months, systolic BP was lower in the self-monitoring group (137 mm Hg; standard deviation, 16.7) and the telemonitoring group (136 mm Hg; standard deviation, 16.1) than in the usual care group (140.4 mm Hg; standard deviation, 16.5), according to the researchers.

The adjusted mean difference between the self-monitoring group and the usual care group was –3.5 mm Hg (95% CI, –5.8 to –1.2) and the adjusted mean difference between the telemonitoring group and the usual care group was –4.7 mm Hg (95% CI, –7 to –2.4), the researchers wrote.

However, they wrote, the adjusted mean difference between the self-monitoring group and the telemonitoring group was not significant (–1.2 mm Hg; 95% CI, –3.5 to 1.2).

Sensitivity analyses did not change the results, and there were no significant differences between the groups in adverse events.

“To the best of our knowledge, this is the first trial in primary care of antihypertensive titration using self-monitored blood pressure, with or without telemonitoring, to show a benefit in terms of blood pressure after 12 months,” Richard J. McManus, PhD, from the Nuffield Department of Primary Care Health Sciences at the University of Oxford, and colleagues wrote. “Differences in blood pressure recorded at 6 months were amplified by 1 year, suggesting that the intervention increased in efficacy in the second 6 months. This was achieved without increased workload and using internationally recommended targets for home and clinic blood pressure.”

Implications for the future

“A feasible future scenario could be GPs acting as highly educated central health-care managers who not only treat individual patients but also orchestrate community health through a digital infrastructure, designed in conjunction with the medical end-user and relying on dedicated artificial intelligence,” Ernst R. Rietzschel, MD, PhD, and Marc L. De Buyzere, MSc, both from University Hospital Ghent, Belgium, wrote in a related editorial. “This forward-looking strategy could be equally applicable to middle-income and low-income countries where there is often a shortage of physicians and a high burden of untreated and undiagnosed hypertension — a driver’s seat allowing doctors to efficiently achieve both clinical and population outcomes. This should not be viewed as an abdication of responsibility but as an embracing of a far more wide-ranging collective responsibility.” – by Erik Swain

Disclosures: The BP monitors used in the study were provided for free by Omron. McManus and De Buyzere report no relevant financial disclosures. Rietzschel reports he has received an unrestricted educational grant to his institution from Amgen and Sanofi/Regeneron and has received speakers’ fees to his institution from Merck Sharpe & Dohme and Teva. One author reports he received research support from Roche Diagnostics.