Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial

Research output: Contribution to journalArticle

Authors

  • Richard J McManus
  • Jonathan Mant
  • Marloes Franssen
  • Alecia Nickless
  • Peter Bradburn
  • Andrew Farmer
  • Carl Heneghan
  • Sue Jowett
  • Siobhan Milner
  • Mark Monahan
  • Sam Mort
  • Emma Ogburn
  • Rafael Perera-Salazar
  • Syed Ahmar Shah
  • Ly-Mee Yu
  • L Tarassenko
  • F. D. Richard Hobbs

Colleges, School and Institutes

External organisations

  • Nuffield Department of Primary Care Health Sciences
  • NIHR School for Primary Care Research
  • University of Oxford
  • University of Cambridge
  • OXFORD UNIVERSITY

Abstract

Background
Studies evaluating titration of antihypertensive medication using self-monitoring give contradictory findings and the precise place of telemonitoring over self-monitoring alone is unclear. The TASMINH4 trial aimed to assess the efficacy of self-monitored blood pressure, with or without telemonitoring, for antihypertensive titration in primary care, compared with usual care.

Methods
This study was a parallel randomised controlled trial done in 142 general practices in the UK, and included hypertensive patients older than 35 years, with blood pressure higher than 140/90 mm Hg, who were willing to self-monitor their blood pressure. Patients were randomly assigned (1:1:1) to self-monitoring blood pressure (self-montoring group), to self-monitoring blood pressure with telemonitoring (telemonitoring group), or to usual care (clinic blood pressure; usual care group). Randomisation was by a secure web-based system. Neither participants nor investigators were masked to group assignment. The primary outcome was clinic measured systolic blood pressure at 12 months from randomisation. Primary analysis was of available cases. The trial is registered with ISRCTN, number ISRCTN 83571366.

Findings
1182 participants were randomly assigned to the self-monitoring group (n=395), the telemonitoring group (n=393), or the usual care group (n=394), of whom 1003 (85%) were included in the primary analysis. After 12 months, systolic blood pressure was lower in both intervention groups compared with usual care (self-monitoring, 137·0 [SD 16·7] mm Hg and telemonitoring, 136·0 [16·1] mm Hg vs usual care, 140·4 [16·5]; adjusted mean differences vs usual care: self-monitoring alone, −3·5 mm Hg [95% CI −5·8 to −1·2]; telemonitoring, −4·7 mm Hg [–7·0 to −2·4]). No difference between the self-monitoring and telemonitoring groups was recorded (adjusted mean difference −1·2 mm Hg [95% CI −3·5 to 1·2]). Results were similar in sensitivity analyses including multiple imputation. Adverse events were similar between all three groups.

Interpretation
Self-monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings. With most general practitioners and many patients using self-monitoring, it could become the cornerstone of hypertension management in primary care.

Details

Original languageEnglish
Pages (from-to)949-959
JournalThe Lancet
Volume391
Issue number10124
Early online date27 Feb 2018
Publication statusPublished - 10 Mar 2018