BACKGROUND AND PURPOSE: 

• McManus et al. (The Lancet, 2018) sought to assess the efficacy of self-monitoring blood pressure, with or without telemonitoring, for the purpose of titrating antihypertensive medication.

METHODS: 

• Parallel non-blinded randomized controlled trial (RCT) 
• Primary care setting
• Telemonitoring and/or self-monitoring of blood pressure in hypertension (TASMINH4) study 
• Participants:  >35 years, BP >140/90 mm Hg 
• Patients were randomized to the following  
  • Self-monitoring blood pressure (self-monitoring group) 
  • Self-monitoring blood pressure with telemonitoring (telemonitoring group) 
  • Usual care (clinical blood pressure, usual care group) 
• Patients who were randomized to the self-monitoring group used validated automated electronic sphygmomanometer 
  • Trained to use non-dominant arm, twice each morning and evening for the first week of every month  
• Those in telemonitoring group used text-based service with web-based data entry back-up 
  • Algorithm alerted participants to contact healthcare system if very high or very low readings 
• Those self-monitoring but not in telemonitoring group were trained (using a color chart) to go their provider if BP to high or low 
  • Mailed in records every week  
• Attending clinicians reviewed both self-monitoring and telemonitoring groups’ readings every month and usual care patients as they wished 
• Primary outcome was clinical systolic blood pressure at 12 months 

RESULTS: 

• Data was collected from 1182 participants  
  • 395 in self-monitoring group 
  • 393 in telemonitoring group 
  • 394 in usual care group 
• 1003 total participants were included in primary analyses (85%) 
• Systolic blood pressure was lower in both intervention groups compared to usual care after 1 year  
  • Self-monitoring: 137.0 (SD 16.7) mm Hg 
  • Telemonitoring: 136.0 (SD 16.1) mm Hg  
  • Usual care: 140.4 (SD 16.5)  
• Adjusted mean differences vs usual care:  
  • Self-monitoring: −3.5 mm Hg; 95% CI, −5·8 to −1·2 
  • Telemonitoring: −4·7 mm Hg; 95% CI, –7·0 to −2·4 
• There was significant difference between the self-monitoring and telemonitoring groups 
• No significant differences in adverse events were noted 
• More clinic blood pressure readings were taken in the usual care group compared with the self-monitoring or telemonitoring groups 

CONCLUSION: 

• Self-monitoring as a basis for titration, with or without telemonitoring, resulted in significantly lower blood pressures, then the usual practice of provider-based monitoring  
• Self-monitoring did not increase physician workload, and the authors suggest that this approach could become the ‘cornerstone’ of hypertension management in primary care 
• Telemonitoring may be more efficient and easier from a logistical point of view than having patients return BP records by mail 

Learn More – Primary Sources:  

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

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