A trial supports self-monitoring over clinic readings for titrating antihypertensive therapy. Many physicians review patient-collected blood pressure (BP) readings when titrating antihypertensive medications, but evidence supporting this approach has been mixed.
British researchers randomised 1182 patients with uncontrolled hypertension (office BP, ≥140/90 mm Hg, despite as many as 3 antihypertensives) to usual care (clinic BP readings), self-monitoring (twice-daily BP readings for 1 week each month mailed in; instructions to contact the physician for very high or very low readings), or telemonitoring (twice-daily BP readings for 1 week, submitted via monthly text messaging; prompts to contact the physician for very high or very low readings or elevated average BPs).
At baseline, mean office-measured systolic BP was ≈153 mm Hg in all three groups. After 12 months, mean office-measured systolic BP was significantly lower with self-monitoring and telemonitoring than with usual care (137.0, 136.0, and 140.4 mm Hg, respectively); diastolic BPs remained similar in all three groups. The differences in systolic BP appeared to be driven by a significantly greater number of medications prescribed to the intervention groups than to the usual-care group.