Nonadherence and poor persistence in taking antihypertensive medications result in uncontrolled high blood pressure, poor clinical outcomes, and preventable health care costs. Two important developments in blood pressure measurement make self-titration appealing for the treatment of hypertension: the ubiquitous use of automated home blood pressure monitoring devices, and the availability of telemonitoring capability with reliable transfer of patients' data to primary care practices.
The TASMINH2 randomised controlled trial was undertaken in 24 general practices in the UK. Patients aged 35—85 years were eligible for enrolment if they had blood pressure more than 140/90 mm Hg despite antihypertensive treatment and were willing to self-manage their hypertension. Participants were randomly assigned in a 1:1 ratio to self-management (n=234 included in the primary analysis), consisting of self-monitoring of blood pressure and self-titration of antihypertensive drugs, combined with telemonitoring of home blood pressure measurements or to usual care (n=264). Mean systolic blood pressure decreased in both groups with a significant difference of 3·7 mm Hg (0·8—6·6; p=0·013) in the self-management group from baseline to 6 months, and of 5·4 mm Hg (2·4—8·5; p=0·0004) from baseline to 12 months.
These results are promising, but titration schedules and safety limits were agreed in advance between participants in the intervention groups and their family doctor, and the research team telemonitored patients, calling them in case they did not request a blood pressure check by the practice while exceeding the safety limits. Moreover of 7637 patients invited to participate, 5987 (78%) declined, and out of the remaining 1650, only 32% - 7% of the total- were eligible. Therefore this approach does not seem easily transferable in a busy practice at the moment.