Practice nurses should encourage patients with hypertension to monitor their blood pressure at home and use those readings in their day-to-day care, according to a team of UK researchers.
A study by the universities of Birmingham, Oxford and Cambridge indicated that doing so would counteract the risk of so-called “white coat hypertension”.
“Sixteen million people with high blood pressure should be offered the option of self-monitoring to control their hypertension”
The trial showed that when medication adjustments were based on regular readings taken at home, blood pressure was significantly lower after 12 months compared to those managed only in a clinic.
Called the TASMINH4 trial, it involved more than 1,000 patients with poorly-controlled blood pressure who were recruited through 142 general practices in England.
The study authors noted that doing regular blood pressure checks on hypertension patients could be a “challenge to manage” in primary care, despite the wide availability of effective treatments.
Internationally, they said that surveys had suggested up to 70% of patients with hypertension self-monitored their blood pressure from home, yet in the UK this figure was much lower at around 30%.
But the researchers highlighted that, so far, offering patients their own blood pressure monitor was controversial in the NHS due to contradictory evidence and anxiety concerns about self-monitoring.
In their trial, they compared conventional clinical care for blood pressure management with two forms of home monitoring – reporting readings via post, known as self-monitoring, or telemonitoring via SMS text message.
Patients in the self-monitoring and telemonitoring groups were asked to monitor their own blood pressure twice each morning and evening for the first week of every month using an electronic monitor and report their readings back to the clinic.
“Enabling the patient to text their readings to their GPs and nurses could be particularly advantageous in today’s NHS”
The telemonitoring system automatically alerted patients if the reading was high, low or normal, along with SMS reminders to prompt them to send their readings or contact the clinic if their average pressure meant medication needed to be adjusted.
Primary care staff were able to access a digital “dashboard”, including graphical displays of blood pressure readings, and had the option to message their patients through the system.
In contrast, patients in the postal group only had access to a colour chart to decide whether to contact their clinic for medication adjustment.
After 12 months, systolic blood pressure was lower in both self-monitoring and telemonitoring groups – 137.0mmHg and 136.0mmHg, respectively – compared with usual care – 140.4mmHg.
The researchers also highlighted that after just six months pressure became lower more quickly for those who used the telemonitoring system to report their readings – 139mmHg for telemonitoring, 140.4mmHg for self-monitoring and 142.5mmHg for usual care.
In addition, the trial found no evidence of increased anxiety in patients who self-monitored or telemonitored, according to the findings published in The Lancet.
Neither were any changes in weight, diet, exercise or alcohol consumption observed that could lead to the reductions in blood pressure.
Earlier this month, a similar study concluded that pregnant women with hypertension could safely monitor their blood pressure at home instead of going into a hospital or clinic, as reported by Nursing Times.
Co-author of the new research Professor Jonathan Mant, from Cambridge University, said: “Sixteen million people in the UK have high blood pressure and should be offered the option of self-monitoring to control their hypertension.
“Those who find it particularly challenging to get to their GP due to work commitments would benefit from the telemonitoring system developed in this trial, which could be adapted into a readily-available smartphone app and incorporated into existing clinical patient record systems,” he said.
“We are currently looking at whether telemonitoring is cost-effective to warrant its inclusion in clinical guidelines,” he added.
Home blood pressure monitoring should be ‘commonplace’
Lead author Professor Richard McManus, from Oxford University, said the study provided “conclusive evidence” that using readings from self-monitoring patients could achieve significantly lower blood pressure after 12 months compared with conventional approaches.
“In the longer term, we predict that better blood pressure control could result in significant health benefits for the patient – a likely 20% reduction in stroke risk and 10% reduction in coronary heart disease risk,” he said.
“For faster, more efficient blood pressure reduction, using telemonitoring could be worthwhile for some patients,” noted Professor McManus, who is also a GP in Oxfordshire.
“Enabling the patient to text their readings to their GPs and nurses, with alerts and feedback for both patients and GPs, could be particularly advantageous in today’s NHS where doctors feel increasingly overwhelmed by the quantities of data they deal with on a daily basis,” he said.