Hypertension Self-Management Lowers BP in High-Risk Patients

(HealthDay News) — Self-monitoring with self-titration of antihypertensive medications is associated with lower blood pressure for patients with hypertension at risk for cardiovascular disease, according to a study published in the Journal of the American Medical Association.

Richard J. McManus, PhD, from the University of Oxford in the United Kingdom, and colleagues examined the effect of self-monitoring with self-titration of antihypertensive medication vs. usual care among patients with hypertension and cardiovascular disease (CVD), diabetes or chronic kidney disease. 

Data were included for 450 patients, aged at least 35 years, with baseline blood pressure (BP) of at least 130/80 mm Hg treated at 59 practices. Patients were randomly assigned to self-monitoring of BP combined with an individualized self-titration algorithm or usual care.

Baseline BP was 143.1/80.5 mm Hg and 143.6/79.5 mm Hg in the intervention and control groups, respectively, according to the researchers. Mean BP decreased after 12 months to 128.2/73.8 mm Hg and 137.8/76.3 mm Hg, respectively, a difference of 9.2 mm Hg and 3.4 mm Hg in systolic and diastolic BPs, respectively, after adjustment for baseline BP. 

Results were similar after multiple imputation for missing values. Comparable results were obtained in all subgroups, without excessive adverse events.

“Among patients with hypertension at high risk of cardiovascular disease, self-monitoring with self-titration of antihypertensive medication compared with usual care resulted in lower systolic blood pressure at 12 months,” the researchers wrote.

In an accompanying editorial, Peter M. Nilsson, MD, PhD, of Skane University Hospital, Malmo, Sweden, and Fredrik H. Nystrom, MD, PhD, of Linkoping University, Linkoping, Sweden, noted that these data do not answer all questions about self-titration based on self-measurement, but they do add to the evidence base for patients who actively participate in their own care.

“Future trials studying the effects of self-titration on cardiovascular events are needed. With the gain in knowledge from [this trial], it may be possible to make the recruitment of patients less restricted, to incorporate education about self-measurement as a standard procedure and focus on which scheme for titration to use, or to study the timing of the home blood pressure recordings,” they wrote.

“Based on these findings, a ‘bring it home’ blood pressure-lowering strategy appears suitable for patients with hypertension and comorbidities.”

Several study authors disclosed financial ties to the medical device and health care industries.


  1. McManus RJ et al. JAMA. 2014;312(8):799-808.
  2. Nilsson PM, Nystrom FH. JAMA 2014;312(8):795-796.