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Performance and persistence of a blood pressure self-management intervention: telemonitoring and self-management in hypertension (TASMINH2) trial

Journal of Human Hypertension volume 29, pages 436–441 (2015)Cite this article

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Abstract

This study aimed to evaluate, in detail, the implementation of the self-management intervention used in the TASMINH2 trial. The intervention, comprising self-monitoring for the first week of each month and an individualised treatment self-titration schedule, was developed from a previous trial of self-management. Two hundred and sixty-three patients with poorly controlled but treated hypertension were randomised to receive this intervention and underwent training over two or three sessions. Participants were followed up for 12 months during which time process data were collected regarding the persistence and fidelity of actual behaviour compared with intervention recommendations. Two hundred and forty-one (92%) patients completed training of whom 188 (72%) self-managed their BP and completed at least 90% of expected self-monitoring measurements for the full year of the study. Overall, 268/483 (55%) of recommended medication changes were implemented. Only 25 (13%) patients had controlled BP throughout the year and so were not recommended any medication changes. Adherence to the protocol reduced over time as the number of potential changes increased. Of those self-managing throughout, 131 (70%) made at least one medication change, with 77 (41%) implementing all their recommended changes. In conclusion, self-management of hypertension was possible in practice with most participants making at least one medication change. Although adherence to the intervention reduced over time, implementation of treatment recommendations appeared better than equivalent trials using physician titration. Future self-management interventions should aim to better support patients’ decision making, perhaps through enhanced use of technology.

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Acknowledgements

We thank Helen Shackleford and Jinu Varghese for helping with the data extraction for this study. Amanda Davies was the trial secretary. This work would not have been possible without the help of participating patients and practices. The Departments of Primary Care in Birmingham and Oxford also receive funding as founder members of the NIHR National School for Primary Care Research. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN17585681. The work was supported by the UK Department of Health Policy Research Programme, the National Institute of Health Research, Primary Care Clinical Research and Trials Unit (PCCRTU) and the Midlands Research Practices Consortium. The funding sources had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review and approval of the manuscript; or decision to submit this manuscript for publication. BW and FDRH are National Institute for Health Research Senior Investigators. RM is a National Institute for Health Research, Research Professor.

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Authors and Affiliations

  1. School of Psychology, University of Central Lancashire, Preston, UK

    E P Bray

  2. Primary Care Clinical Sciences, University of Birmingham, Edgbaston, UK

    M I Jones, M Banting & S Greenfield

  3. Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, UK

    F D R Hobbs & R J Mcmanus

  4. School of Medicine, University of Southampton, Southampton, UK

    P Little

  5. University College London (UCL) and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, UK

    B Williams

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  1. E P Bray
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  2. M I Jones
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  3. M Banting
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  4. S Greenfield
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  5. F D R Hobbs
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  6. P Little
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  7. B Williams
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  8. R J Mcmanus
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Correspondence to R J Mcmanus.

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Supplementary Information accompanies this paper on the Journal of Human Hypertension website

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Bray, E., Jones, M., Banting, M. et al. Performance and persistence of a blood pressure self-management intervention: telemonitoring and self-management in hypertension (TASMINH2) trial. J Hum Hypertens 29, 436–441 (2015). https://doi.org/10.1038/jhh.2014.108

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  • DOI: https://doi.org/10.1038/jhh.2014.108

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