By Andrew M. Seaman
Even people at significant risk for heart attacks and strokes can take an active role in reducing their own high blood pressure, by measuring it themselves and adjusting their medications, according to a new study from the UK.
Researchers found that patients who closely monitored their own blood pressure and medications, using detailed instructions from their doctors, lowered their readings more than patients who relied on their healthcare providers to take periodic readings and make medication changes.
“We’ve previously done a study with a group of people with uncomplicated hypertension (or high blood pressure),” said Dr. Richard McManus, the report’s lead author. “We wanted to see if that intervention would also work with people with greater coronary heart disease and in the elderly.”
The intervention consisted of patients creating a detailed plan with their doctor, measuring their own blood pressure daily and adjusting their medications according to their blood pressure readings and instructions in the plan.
This new approach resulted in better management and lower blood pressure after a year, in part because doctors tend to be reluctant to change medications based on blood pressure readings recorded at a single healthcare visit, the researchers suggest.
Healthcare providers don’t always act on readings that are above target, McManus said.
He and his colleague write in JAMA that other studies have found self monitoring of blood pressure may result in lower readings and many people in the UK already monitor their own blood pressure.
For the new study, the researchers enrolled 552 patients with high blood pressure and a history of other significant health problems, such as strokes, heart attacks, diabetes and kidney disease. The patients were recruited from 59 doctors’ offices in the UK and participated in the trial between 2011 and 2013.
Normal blood pressure is considered to be a systolic (the top number) reading of 120 millimeters of mercury (mmHg) or less and a diastolic (the bottom number) of 80 mmHg or less, according to the U.S. National Institutes of Health.
High blood pressure is usually defined as a systolic reading above 140 mmHg and a diastolic reading of 90m mmHg or more. Any reading between the normal and high categories is considered to be “prehypertension.”
Half of the patients were assigned to take part in the intervention and the other half were assigned to receive usual care, which consisted of periodic visits to their doctors for blood pressure readings and medication adjustment.
At the beginning of the study, the participants in each group had an average blood pressure reading of about 144 mmHg over about 80 mmHg.
Among patients in the self-management group, the number and types of medications taken tended to increase, so that after 12 months, they were taking, on average, 3.3 doses of medication a day compared to 2.6 in the usual care group.
After 12 months, the systolic reading fell in both groups, but significantly more among those who took their own readings and managed their own medications.
People in the usual care group saw their average systolic reading fall to about 138 mmHg after one year, compared to 128 mmHg among those in the intervention group.
“These differences in blood pressure that were observed in this study were quite substantial,” said Dr. Steven Nissen, chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine located on the main campus of Cleveland Clinic in Ohio.
Any reduction in blood pressure of more than 2 or 3 mmHg is a noticeable difference, said Nissen, who wasn’t involved in the new study but coauthored a commentary on it in the journal.
While the results can’t prove whether those in the intervention group went on to have fewer strokes and heart attacks, Nissen said lower blood pressure is tied to better long-term outcomes.
He cautioned that not every person with blood pressure problems will be able to handle their own readings or medication management.
“It just means you can’t go into every community and expect every patient to have the sophistication and means to follow this type of algorithm,” Nissen said.
He added that people have difficulty controlling their blood pressure for a variety of reasons – not just that doctors won’t adjust medication during office visits.
For example, Nissen said, people in the U.S. may also have trouble accessing healthcare and affording prescriptions. He said self treatment is a potential option, however.
“There are a lot of people out there with high blood pressure – a significant number of them (are) still above targeted readings despite treatment,” McManus said. “This is an intervention that could be used in those people.”
He cautioned, however, that people need to talk with their doctors about this type of blood pressure management and should not attempt it on their own.
SOURCE: http://bit.ly/1lwkHSh and http://bit.ly/1opxQqO JAMA, online August 26, 2014.