Patient-led dosing for hypertension improves BP control

Allowing hypertensive patients to monitor and adjust drug doses under a programme devised by their GP can improve BP control in high-risk patients, a study has found.

BP check: patient-led monitoring and dose adjustment could cut heart risks (Photo: SPL)
BP check: patient-led monitoring and dose adjustment could cut heart risks (Photo: SPL)

Researchers from the University of Oxford showed that a programme developed by a patient’s GP and tailored to the individual could reduce the risk of future cardiovascular problems.

About one-third of UK patients with hypertension self-monitor their BP, following previous research that showed the benefits of the approach.

But the Oxford study is the first time the effects of self-monitoring and patient-led dose adjustment have been assessed in patients with comorbidities placing them at high risk of cardiovascular events.

A total of 552 patients with hypertension and a significant cardiovascular comorbidity were involved in the study. Comorbidities included cardiovascular disease, diabetes and chronic kidney disease.

Half of the participants were randomly assigned to a ‘usual care’ control group. The rest were instructed to self-monitor their condition and use self-titration to adjust their antihypertensive medication, in a care plan individualised to them by their GP.

After a period of 12 months, patients in the self-monitoring group had lower systolic BP by an average of 9.2mmHg, in comparison with those receiving usual care.

Antihypertensive drug prescriptions also increased by more in the intervention group, particularly in the number of calcium-channel blockers and thiazides prescribed.

Despite this, there was no difference in the number of adverse symptoms reported by either group.

The research team, led by Oxfordshire GP Professor Richard McManus, said: ‘This study has shown self-monitoring with self-titration is feasible in a high-risk population, without special equipment.

‘Most management of hypertension is undertaken in primary care, so it is appropriate that interventions are delivered in this setting.’

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