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Home Blood Pressure Monitoring for Treatment Titration

  • Richard J. McManusEmail author
  • Jonathan Mant
  • Takayoshi Ohkubo
  • Yutaka Imai
  • Kazuomi Kario
Chapter
Part of the Updates in Hypertension and Cardiovascular Protection book series (UHCP)

Abstract

Titration of antihypertensives using self-monitored blood pressure is a prerequisite for a successful management strategy for hypertension that utilises self-monitoring appropriately. Initial trials in the area suggested that the use of self-monitored blood pressure might lead to suboptimal care due to increased clinic blood pressure and fewer medications. These trials were flawed by the use of equivalent blood pressure targets for both home and clinic blood pressure. More recent trials using average home blood pressure over several days as the basis for titration with standard lower targets (135/85 mmHg) have shown equivalent outcome in terms of end organ damage and lower clinic blood pressure measured objectively by research staff. Self-management, where patients self-titrate using self-monitored blood pressure readings, is also effective and cost-effective. Taken together, these results suggest that self-monitored blood pressure is appropriate to use and probably superior to clinic blood pressure for the titration of antihypertensives, whether by professionals or their patients.

Keywords

Blood pressure Monitoring Medication titration Self-management 

References

  1. 1.
    Effects of Treatment on Morbidity in Hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mmHg. JAMA. 1967;202(11):1028–34.CrossRefGoogle Scholar
  2. 2.
    Hypertension Detection and Follow-Up Program Cooperative Group. Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. JAMA. 1979;242(23):2562–71.CrossRefGoogle Scholar
  3. 3.
    Xu W, Goldberg SI, Shubina M, Turchin A. Optimal systolic blood pressure target, time to intensification, and time to follow-up in treatment of hypertension: population based retrospective cohort study. BMJ. 2015;350:h158.CrossRefGoogle Scholar
  4. 4.
    Stevens SL, McManus RJ, Stevens RJ. Current practice of usual clinic blood pressure measurement in people with and without diabetes: a survey and prospective ‘mystery shopper’ study in UK primary care. BMJ Open. 2018;8(4):e020589.CrossRefGoogle Scholar
  5. 5.
    Staessen JA, Den Hond E, Celis H, Fagard R, Keary L, Vandenhoven G, et al. Antihypertensive treatment based on blood pressure measurement at home or in the physician’s office: a randomized controlled trial. JAMA. 2004;291(8):955–64.CrossRefGoogle Scholar
  6. 6.
    Verberk WJ, Kroon AA, Kessels AG, Dirksen C, Nelemans PJ, Lenders JW, et al. Home versus office blood pressure MEasurements: reduction of unnecessary treatment study: rationale and study design of the HOMERUS trial. Blood Press. 2003;12(5–6):326–33.CrossRefGoogle Scholar
  7. 7.
    McManus RJ, Mant J, Franssen M, Nickless A, Schwartz C, Hodgkinson J, et al. Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial. Lancet. 2018;391(10124):949–59.CrossRefGoogle Scholar
  8. 8.
    Imai Y, Ohkubo T, Hozawa A, Tsuji I, Matsubara M, Araki T, et al. Usefulness of home blood pressure measurements in assessing the effect of treatment in a single-blind placebo-controlled open trial. J Hypertens. 2001;19(2):179–85.CrossRefGoogle Scholar
  9. 9.
    McManus RJ, Mant J, Haque MS, Bray EP, Bryan S, Greenfield SM, et al. Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial. JAMA. 2014;312(8):799–808.CrossRefGoogle Scholar
  10. 10.
    McManus RJ, Mant J, Bray EP, Holder R, Jones MI, Greenfield S, et al. Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial. Lancet. 2010;376(9736):163–72.CrossRefGoogle Scholar
  11. 11.
    Verberk WJ, Kroon AA, Lenders JW, Kessels AG, van Montfrans GA, Smit AJ, et al. Self-measurement of blood pressure at home reduces the need for antihypertensive drugs: a randomized, controlled trial. Hypertension. 2007;50(6):1019–25.CrossRefGoogle Scholar
  12. 12.
    Krause T, Lovibond K, Caulfield M, McCormack T, Williams B. Management of hypertension: summary of NICE guidance. BMJ. 2011;343:d4891.CrossRefGoogle Scholar
  13. 13.
    Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology American Heart Association task force on clinical practice guidelines. Hypertension. 2018;71(6):1269–24.CrossRefGoogle Scholar
  14. 14.
    Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36(10):1953–2041.CrossRefGoogle Scholar
  15. 15.
    Stergiou GS, Karpettas N, Destounis A, Tzamouranis D, Nasothimiou E, Kollias A, et al. Home blood pressure monitoring alone vs. combined clinic and ambulatory measurements in following treatment-induced changes in blood pressure and organ damage. Am J Hypertens. 2014;27(2):184–92.CrossRefGoogle Scholar
  16. 16.
    McKinstry B, Hanley J, Wild S, Pagliari C, Paterson M, Lewis S, et al. Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial. BMJ. 2013;346:f3030.CrossRefGoogle Scholar
  17. 17.
    Scale-up blood pressure project: University of Edinburgh; 2018. https://www.ed.ac.uk/usher/telescot/projects/scale-up-bp.
  18. 18.
    Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D. Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society Of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008;52(1):10–29.CrossRefGoogle Scholar
  19. 19.
    Maciejewski ML, Bosworth HB, Olsen MK, Smith VA, Edelman D, Powers BJ, et al. Do the benefits of participation in a hypertension self-management trial persist after patients resume usual care? Circ Cardiovasc Qual Outcomes. 2014;7(2):269–75.CrossRefGoogle Scholar
  20. 20.
    Monahan M, Jowett S, Nickless A, Franssen M, Grant S, Greenfield S, Hobbs FDR, Hodgkinson J, Mant J, McManus RJ. Cost-effectiveness of telemonitoring and self-monitoring of blood pressure for antihypertensive titration in primary care (TASMINH4). Hypertension. 2019;73(6):1231–9.  https://doi.org/10.1161/HYPERTENSIONAHA.118.12415.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Zarnke KB, Feagan BG, Mahon JL, Feldman RD. A randomized study comparing a patient-directed hypertension management strategy with usual office-based care. Am J Hypertens. 1997;10(1):58–67.CrossRefGoogle Scholar
  22. 22.
    Crowley MJ, Smith VA, Olsen MK, Danus S, Oddone EZ, Bosworth HB, et al. Treatment intensification in a hypertension telemanagement trial: clinical inertia or good clinical judgment? Hypertension. 2011;58(4):552–8.CrossRefGoogle Scholar
  23. 23.
    Schwartz CL, Seyed-Safi A, Haque S, Bray EP, Greenfield S, Hobbs FDR, et al. Do patients actually do what we ask: patient fidelity and persistence to the targets and self-Management for the Control of blood pressure in stroke and at risk groups blood pressure self-management intervention. J Hypertens. 2018;36(8):1753–61.CrossRefGoogle Scholar

Copyright information

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG, part of Springer Nature 2020

Authors and Affiliations

  • Richard J. McManus
    • 1
    Email author
  • Jonathan Mant
    • 2
  • Takayoshi Ohkubo
    • 3
    • 4
  • Yutaka Imai
    • 4
  • Kazuomi Kario
    • 5
  1. 1.Nuffield Department of Primary Care Health SciencesUniversity of Oxford, Radcliffe Observatory QuarterOxfordUK
  2. 2.Primary Care Unit, Strangeways Research Laboratory, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
  3. 3.Department of Hygiene and Public HealthTeikyo University School of MedicineTokyoJapan
  4. 4.Tohoku Institute for Management of Blood PressureSendaiJapan
  5. 5.Division of Cardiovascular Medicine, Department of MedicineJichi Medical University School of Medicine (JMU)TochigiJapan

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