Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz

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SHR Neuro Krebs Kardio Lipid

Zweiker, R.
Effect of Self-Monitoring and Medication Self-Titration on Systolic Blood Pressure in Hypertensive Patients at High Risk of Cardiovascular Disease: The TASMIN-SR Randomized Clinical Trial
J HYPERTON. 2015; 19(1): 22-23.
Web of Science

 

Autor/innen der Med Uni Graz:
Zweiker Robert
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Abstract:
Importance: Self-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups. Objective: To determine the effect of self-monitoring with self-titration of antihypertensive medication compared with usual care on systolic blood pressure among patients with cardiovascular disease, diabetes, or chronic kidney disease. Design, Setting, and Patients: A primary care, unblinded, randomized clinical trial involving 552 patients who were aged at least 35 years with a history of stroke, coronary heart disease, diabetes, or chronic kidney disease and with baseline blood pressure of at least 130/80 mmHg being treated at 59 UK primary care practices was conducted between March 2011 and January 2013. Interventions: Self-monitoring of blood pressure combined with an individualized self-titration algorithm. During the study period, the office visit blood pressure measurement target was 130/80 mmHg and the home measurement target was 120/75 mmHg. Control patients received usual care consisting of seeing their health care clinician for routine blood pressure measurement and adjustment of medication if necessary. Main Outcomes and Measures: The primary outcome was the difference in systolic blood pressure between intervention and control groups at the 12-month office visit. Results: Primary outcome data were available from 450 patients (81 %). The mean baseline blood pressure was 143.1/80.5 mmHg in the intervention group and 143.6/79.5 mmHg in the control group. After 12 months, the mean blood pressure had decreased to 128.2/73.8 mmHg in the intervention group and to 137.8/76.3 mmHg in the control group, a difference of 9.2 mmHg (95-% CI, 5.7-12.7) in systolic and 3.4 mmHg (95-% CI, 1.8-5.0) in diastolic blood pressure following correction for baseline blood pressure. Multiple imputation for missing values gave similar results: the mean baseline was 143.5/80.2 mmHg in the intervention group vs 144.2/79.9 mmHg in the control group, and at 12 months, the mean was 128.6/73.6 mmHg in the intervention group vs 138.2/76.4 mmHg in the control group, with a difference of 8,8 mmHg (95-% CI, 4.9-12.7) for systolic and 3.1 mmHg (95-% CI, 0.7-5.5) for diastolic blood pressure between groups. These results were comparable in all subgroups, without excessive adverse events. Conclusions and Relevance: Among patients with hypertension at high risk of cardiovascular disease, self-monitoring with self-titration of antihypertensive medication compared with usual care resulted in lower systolic blood pressure at 12 months.

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