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.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 digital issues and online access to articles
$119.00 per year
only $9.92 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Baral-Grant S, Haque S, Nouwen A, Greenfield S, McManus R . Self-monitoring of blood pressure in hypertension: a UK Primary Care Survey. Int J Hypertens 2012; 2012: 582068.
Cuspidi C, Meani S, Lonati L, Fusi V, Magnaghi G, Garavelli G et al. Prevalence of home blood pressure measurement among selected hypertensive patients: results of a multicenter survey from six hospital outpatient hypertension clinics in Italy. Blood Press 2005; 14: 251–256.
Logan A, Dunai A, McIsaac W, Irvine M, Tisler A . Attitudes of primay care physicians and their patients about home blood pressure monitoring in Ontario. J Hypertens 2008; 26: 446–452.
McManus R, Ryan A, Greenfield S, Pattison H, Clifford S, Marriott J et al. Self measurement of blood pressure: a community survey. J Hum Hypertens 2007; 21: 741–743.
Viera A, Cohen L, Mitchell C, Sloane P . How and why do patients use home blood pressure monitors? Blood Press Monit 2008; 13: 133–137.
Bray E, Holder R, McManus R . Does self-monitoring reduce blood pressure? Meta-analysis with meta-regression of randomized controlled trials. Annu Med 2010; 42: 371–386.
Stryker T, Wilson M, Wilson T . Accuracy of home blood pressure readingsa: monitors and operators. Blood Press Monit 2003; 9: 143–147.
Jones M, Greenfield S, Bray E, Baral-Grant S, Hobbs F, Holder R et al. Patients' experiences of self-monitoring blood pressure and self-titration of medication: the TASMINH2 trial qualitative study. Br J Gen Pract 2011; 62: 135–142.
Mengden T, Chamontin B, Phong Chau N, Luis Palma Gamiz J, Chanudet X . User procedure for self-measurement of blood pressure First International Consensus Conference on Self Blood Pressure Measurement. Blood Press Monit 2000; 5: 111–129.
Parati G, Stergiou G, Asmar R, Bilo G, de Leeuw P, Imai Y et al. European Society of Hypertension guidelines for blood pressure monitoring at home: a summary of the Second International Consensus Conference on Home Blood Pressure Monitoring. J Hypertens 2008; 26: 1505–1530.
McManus R, Glasziou P, Hayen A, Mant J, Padfield P, Potter J et al. Blood pressure self-monitoring:questions and answers from a national conference. BMJ 2009; 337: a2732.
Verbeck W, Kroon A, Kessels A, de Leeuw P . Home blood pressure meansurement: a systematic review. J Am Coll Cardiol 2005; 46: 743–751.
McManus R, Mant J, Bray E, Holder R, Jones M, Greenfield S et al. Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial. Lancet 2010; 17: 631–172.
Zarnke K, Feagan B, Mahon J, Feldman R . A randomized study comparing a patient-directed hypertension management strategy with usual office-based care. Am J Hypertens 1997; 10: 58–67.
Kaambwa B, Bryan S, Jowett S, Bray E, Hobbs F, Holder R et al. Telemonitoring and self-management in the control of hypertension (TASMINH2): a cost-effectiveness analysis. Eur J Prev Cardiol 2013; 21: 1517–1530.
McManus R, Bray E, Mant J, Holder R, Greenfield S, Bryan S et al. Protocol for a randomised controlled trial of telemonitoring and self-management in the control of hypertension: telemonitoring and self-management in hypertension. BMC Cardiovasc Disord 2009; 9: 6.
McManus R, Mant J, Bray E, Holder R, Jones M, Greenfield S et al. Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial. Lancet 2010; 376: 163–172.
Asayama K, Ohkubo T, Kikuya M, Obara T, Metoki H, Inoue R et al. Prediction of stroke by home ‘morning’ versus ‘evening’ blood pressure values: the Ohasama study. Hypertension 2006; 48: 737–743.
McManus R, Roalfe A, Oakes R, Bryan S, Pattison H, Hobbs F . Targets and self monitoring in hypertension: randomised controlled trial and cost effectiveness analysis. BMJ 2005; 331: 493.
Williams B, Poulter N, Brown M, Davis M, McInnes G, Potter J et al. Guidelines for the management of hypertension: report of the fourth working party of the British Hypertension Society, 2004—BHS IV. J Hum Hypertens 2004; 18: 139–185.
O'Brien C, Bray E, Bryan S, Greenfield S, Haque S, Hobbs F et al. Targets and self-management for the control of blood pressure in stroke and at risk groups (TASMIN-SR): protocol for a randomised controlled trial. BMC Cardiovasc Disord 2013; 23: 21.
Watson A, Singh K, Myint-U K, Grant R, Jethwani K, Murachver E et al. Evaluating a web-based self-management program for employees with hypertension and prehypertension: a randomized clinical trial. Am Heart J 2012; 164: 625–631.
Bobrie G, Postel-Vinay N, Delonca J, Corvol P, SETHI Investigators. Self-measurement and self-titration in hypertension: a pilot telemedicine study. Am J Hypertens 2007; 20: 1314–1320.
Margolious D, Bodenheimer T, Bennett H, Wong J, Ngo V, Padilla G et al. Health coaching to improve hypertension treatment in a low-income, minority population. Ann Fam Med 2012; 10: 199–205.
Crowley M, Smith V, Olsen M, Danus S, Oddone E, Bosworth H et al. Treatment intensification in a hypertension telemanagement trial clinical inertia or good clinical judgment? Hypertension 2011; 58: 552–558.
Bosworth H, Powers B, Olsen M, McCant F, Grubber J, Smith V et al. Can home blood pressure management improve blood pressure control: results from a randomized controlled trial. Arch Int Med 2011; 171: 1–8.
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Additional information
Supplementary Information accompanies this paper on the Journal of Human Hypertension website
Supplementary information
Rights and permissions
About this article
Cite this article
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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jhh.2014.108