I studien ingick 552 brittiska patienter med förhållandevis hög risk för ny kardiovaskulär sjukdom, då de redan drabbats av sådan sjukdom eller hade diabetes eller kronisk njursjukdom.

De lottades till att själva få styra sin medicinering eller gå på sedvanliga kontroller hos sin husläkare.

Forskarna framhåller att den aktuella gruppen av patienter har mest att tjäna på en mer optimerad blodtryckskontroll.

Vidare konstaterar de att interventionen inte krävde någon särskild utrustning, förutom en blodtrycksmätare, och bara en ”blygsam” utbildningsinsats.

En begränsning var att bara 8 procent av de inbjudna deltagana gick med i studien. Det framhåller de bägge svenska forskarna Peter Nilsson och Fredrik Nyström, vid Lunds respektive Linköpings universitet, som skrivit en ledarkommentar i tidskriften. Enligt referat på www.dagensmedicin.se Carl-Magnus Hake

Icke desto mindre anser de att studien är ett ”viktigt steg mot en modern behandling av högt blodtryck där patienten står i centrum”.

Nu efterlyser Nilsson och Nyström mer forskning om vilken tidpunkt under dygnet som är mest lämplig för egenmätning av blodtryck och exakt vilket schema som ska användas för att justera behandlingen.

Nyhetsinfo

www red DiabetologNytt

http://jama.jamanetwork.com/article.aspx?articleid=1899205

  • Richard McManus med flera. 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: 799–808. DOI: 10.1001/jama.2014.10057 
  • Abstract
  • Effect of Self-monitoring and Medication Self-titration on Systolic Blood Pressure in Hypertensive Patients at High Risk of Cardiovascular DiseaseThe TASMIN-SR Randomized Clinical Trial
    Richard J. McManus, FRCGP1; Jonathan Mant, MD2; M. Sayeed Haque, PhD3; Emma P. Bray, PhD4; Stirling Bryan, PhD5,6; Sheila M. Greenfield, PhD3; Miren I. Jones, PhD3; Sue Jowett, PhD7; Paul Little, MD8; Cristina Penaloza, MA7; Claire Schwartz, PhD1; Helen Shackleford, RGN3; Claire Shovelton, PhD3; Jinu Varghese, RGN3; Bryan Williams, MD9; F.D. Richard Hobbs, FMedSci1
    [+] Author Affiliations
    JAMA. 2014;312(8):799-808. doi:10.1001/jama.2014.10057.
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    ABSTRACT
    ABSTRACT | INTRODUCTION | METHODS | RESULTS | DISCUSSION | CONCLUSIONS | ARTICLE INFORMATION | REFERENCES

    Importance  Self-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups.

    Objective  To determine the effect of self-monitoring with self-titration of antihypertensive medication compared with usual care on systolic blood pressure among patients with cardiovascular disease, diabetes, or chronic kidney disease.

    Design, Setting, and Patients  A primary care, unblinded, randomized clinical trial involving 552 patients who were aged at least 35 years with a history of stroke, coronary heart disease, diabetes, or chronic kidney disease and with baseline blood pressure of at least 130/80 mm Hg being treated at 59 UK primary care practices was conducted between March 2011 and January 2013.

    Interventions  Self-monitoring of blood pressure combined with an individualized self-titration algorithm. During the study period, the office visit blood pressure measurement target was 130/80 mm Hg and the home measurement target was 120/75 mm Hg. Control patients received usual care consisting of seeing their health care clinician for routine blood pressure measurement and adjustment of medication if necessary.

    Main Outcomes and Measures  The primary outcome was the difference in systolic blood pressure between intervention and control groups at the 12-month office visit.

    Results  Primary outcome data were available from 450 patients (81%). The mean baseline blood pressure was 143.1/80.5 mm Hg in the intervention group and 143.6/79.5 mm Hg in the control group. After 12 months, the mean blood pressure had decreased to 128.2/73.8 mm Hg in the intervention group and to 137.8/76.3 mm Hg in the control group, a difference of 9.2 mm Hg (95% CI, 5.7-12.7) in systolic and 3.4 mm Hg (95% CI, 1.8-5.0) in diastolic blood pressure following correction for baseline blood pressure. Multiple imputation for missing values gave similar results: the mean baseline was 143.5/80.2 mm Hg in the intervention group vs 144.2/79.9 mm Hg in the control group, and at 12 months, the mean was 128.6/73.6 mm Hg in the intervention group vs 138.2/76.4 mm Hg in the control group, with a difference of 8.8 mm Hg (95% CI, 4.9-12.7) for systolic and 3.1 mm Hg (95% CI, 0.7-5.5) for diastolic blood pressure between groups. These results were comparable in all subgroups, without excessive adverse events.

    Conclusions and Relevance  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.

    Trial Registration  isrctn.org Identifier: ISRCTN87171227