Self-management of Hypertension

Long-term Outcomes

Medscape: Would it be possible to look at the effects of home BP management on outcomes over a longer period?

Prof McManus: We are currently doing some modeling work to look at what would happen over time if this kind of intervention was sustained and how long it would need to be sustained to reach the National Institute for Health and Care Excellence (NICE) cost-effectiveness threshold range (£20,000-30,000 per quality-adjusted life year). We hope that this work will be published next year. We have already published a modeling exercise using our TASMINH2 data that showed the intervention was cost-effective.^[30] TASMIN-SR showed that we have an intervention that was more effective and probably costs less, so one would anticipate that this would be cost-effective, but we will have to wait for the modeling results before we can be sure about that.

Medscape: Are you still following the intervention patients? We know that after similar sorts of intervention trials with diet, weight loss, etc, patients tend to revert to pretrial values.

Prof McManus: All TASMIN-SR patients have consented to be followed up. The main reason that we are continuing to follow them is to see over a long period of time whether there are any effects on CV events. It is completely passive follow-up; we are no longer doing any active intervention. It would be interesting to go back and see how many of the patients are still self-monitoring, but one has to be careful because ethics committees these days are keen that patients know what they are signing up for and that you don't keep going back to the same patients.

Medscape: What do you think will happen to their BP values if they go back to office measurements?

Prof McManus: We don't know what exactly will happen, but given that the people who were self-monitoring had good control, there is no particular reason to think that that control would suddenly become worse again. You would probably expect that, over time, the control groups might get slightly better, but given that their control wasn't bad at the end of the trial, they could stay very much the same. If that happens, one would expect a long-term benefit for the people in the intervention group. We know from our previous qualitative work that the patients are quite surprised at how much lower their BP is at home compared with having it measured in an office setting, and a nice thing about these interventions is that the patients are motivated and more involved in their care. This likely means that they will be able to say so when they think their office BP measurement is too high compared with the value they measured at home.

Cite this: Self-management of Hypertension: Are Patients and Providers Ready to Partner? - Medscape - Nov 24, 2014.

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