Home Blood Pressure Monitoring for Treatment Titration
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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.
KeywordsBlood pressure Monitoring Medication titration Self-management
- 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
- 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
- 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.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.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
- 17.Scale-up blood pressure project: University of Edinburgh; 2018. https://www.ed.ac.uk/usher/telescot/projects/scale-up-bp.
- 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
- 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
- 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