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Targets and self monitoring in hypertension: randomised controlled trial and cost effectiveness analysis

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.38558.393669.E0 (Published 01 September 2005) Cite this as: BMJ 2005;331:493
  1. R J McManus, clinical senior lecturer (r.j.mcmanus{at}bham.ac.uk)1,
  2. J Mant, clinical senior lecturer1,
  3. A Roalfe, medical statistician1,
  4. R A Oakes, project officer1,
  5. S Bryan, professor2,
  6. H M Pattison, senior lecturer3,
  7. F D R Hobbs, professor1
  1. 1 Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT
  2. 2 Health Economics Facility, University of Birmingham, Health Services Management Centre, B15 2RT
  3. 3 Psychology, School of Life and Health Sciences, Birmingham B4 7ET
  1. Correspondence to: R McManus
  • Accepted 19 July 2005

Abstract

Objectives To assess whether blood pressure control in primary care could be improved with the use of patient held targets and self monitoring in a practice setting, and to assess the impact of these on health behaviours, anxiety, prescribed antihypertensive drugs, patients' preferences, and costs.

Design Randomised controlled trial.

Setting Eight general practices in south Birmingham.

Participants 441 people receiving treatment in primary care for hypertension but not controlled below the target of < 140/85 mm Hg.

Interventions Patients in the intervention group received treatment targets along with facilities to measure their own blood pressure at their general practice; they were also asked to visit their general practitioner or practice nurse if their blood pressure was repeatedly above the target level. Patients in the control group received usual care (blood pressure monitoring by their practice).

Main outcome measures Primary outcome: change in systolic blood pressure at six months and one year in both intervention and control groups. Secondary outcomes: change in health behaviours, anxiety, prescribed antihypertensive drugs, patients' preferences of method of blood pressure monitoring, and costs.

Results 400 (91%) patients attended follow up at one year. Systolic blood pressure in the intervention group had significantly reduced after six months (mean difference 4.3 mm Hg (95% confidence interval 0.8 mm Hg to 7.9 mm Hg)) but not after one year (mean difference 2.7 mm Hg (– 1.2 mm Hg to 6.6 mm Hg)). No overall difference was found in diastolic blood pressure, anxiety, health behaviours, or number of prescribed drugs. Patients who self monitored lost more weight than controls (as evidenced by a drop in body mass index), rated self monitoring above monitoring by a doctor or nurse, and consulted less often. Overall, self monitoring did not cost significantly more than usual care (£251 ($437; 364 euros) (95% confidence interval £233 to £275) versus £240 (£217 to £263).

Conclusions Practice based self monitoring resulted in small but significant improvements of blood pressure at six months, which were not sustained after a year. Self monitoring was well received by patients, anxiety did not increase, and there was no appreciable additional cost. Practice based self monitoring is feasible and results in blood pressure control that is similar to that in usual care.

Footnotes

  • Contributors RJMcM had the original idea, recruited the practices and patients, led the study clinics, and wrote the first draft of this paper. JM and FDRH helped to oversee the trial progress, do the analysis, and write the manuscript. HMP and SB provided specialist expertise on psychological and economic aspects respectively. RAO and RJMcM collected and entered the data. RJMcM and AR did the analyses. All authors participated in the development of the protocol, have access to the original data, contributed to subsequent drafts of the paper, and approved the final version.

  • Funding Funding for the study was provided under a national primary care researcher development award to RJMcM from the NHS Executive. Approved funding from Support for Science was administered via the Midlands Research Practice Consortium. The funder had no involvement in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

  • Competing interests FDRH sits on the boards of the British Cardiac Society, the British Society of Heart Failure, and the Primary Care Cardiovascular Society; he is chairman of the Secondary Prevention Board of the British Heart Foundation and serves on the European Society of Cardiology Working Group for Heart Failure. He has received travel sponsorship and honorariums from a number of multinational biotechnology and pharmaceutical companies with cardiovascular products for plenary talks and attendance at major cardiology scientific congresses and conferences. To the best of his knowledge, none of these interests conflicts with the work contained in this paper.

  • Ethical approval Ethical approval was received from South Birmingham (ref 5694) and Sandwell (ref SEC 320/060701) Local Research Ethics Committees.

  • Accepted 19 July 2005
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