Self monitoring of blood pressure at home

Whilst highlighting that home blood pressure readings can be lower
and more reliable than those taken in the clinic, the authors seem
reluctant to recommend extensive use of the practice or take the next step
of empowering patients to take action based on these results.

However we already know that patients adjust their medicines, or even
stop taking them altogether without consulting a doctor or looking at
their latest blood pressure readings. An estimated 50% of medicines for
long term conditions are not taken as prescribed and research shows that
patients’ beliefs about medicines are the biggest predictor of compliance,
with beliefs about the necessity of the medicine weighed against concerns
about side effects and dependency [1]. People are therefore more likely
to benefit from therapy when they balance these beliefs in a more informed
way, through better understanding of the diagnosis and treatment and being
actively involved in decisions about the management of the condition. So
for some patients, a combination of home monitoring of blood pressure and
self-adjustment of medication with professional support could be a more
effective way of finding their optimum level of control than just being
instructed to ‘follow doctor’s orders’.

Despite this, research to date has focussed on self-monitoring with
comparatively few studies investigating the potential for informed self-
regulation of medicines. However, small-scale studies on self-monitoring
and self-medication in hypertension [2] and anticoagulation management [3]
already give positive signs that this is an avenue to pursue. Patients
successfully completed training in monitoring and medication-adjustment
techniques and carried them out in a home setting without complication.
They valued the method and some improvement in control was reported. A
recent Cochrane review also reported better lung function outcomes in
those who adjusted their medication using a written plan than in those
whose medication was adjusted by a doctor [4].

Medicines Partnership are currently developing a pilot with
Hillingdon Hospital and Hillingdon PCT to test the approach in a UK
setting involving patients with diabetes who have high blood pressure. We
feel it may be particularly suitable to patients with diabetes who are
already accustomed to self-management and adjustment of insulin or oral
medication on the basis of self-testing. We recognise that this approach
will not be for everybody and that it is important not to impose a regime
that will add to somebody’s anxiety. However, we feel self-regulation on
the basis of home monitoring could be an effective option in an area where
control is critical but current methods are not always effective.

More information about this and other Medicines Partnership projects
are available at http://www.medicines-partnership.org/projects/current-
projects. You can contact us at info@medicines-partnership.org.

References:
[1] Horne R & Weinman J (1999) Patients’ beliefs about prescribed
medicines & their role in adherence to treatment in chronic illness.
Journal of Psychosomatic Research 47(6): 555-567
[2] Zarnke KB, Feagan BG, Mahon JL, Feldman RD. A randomized study
comparing a patient-directed hypertension management strategy with usual
office-based care. Am J Hypertens. 1997 Jan;10(1):58-67.

[3] Murray E, Fitzmaurice D, McCahon D, Fuller C, Sandhur H. Training
for patients in a randomised controlled trial of self management of
warfarin treatment. BMJ. 2004 Feb 21;328(7437):437-8.

[4] Gibson PG, Powell H, Coughlan J et al. Self-management education
and regular practitioner review for adults with asthma. Cochrane database
Syst Rev 2003; (1): CD001117.

Competing interests:
None declared