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
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
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DOI：
10.1001/jama.2014.10057
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发表时间：
2014-08-27
影响因子：
120.7
通讯作者：
Hobbs, F. D. Richard
中科院分区：
文献类型：
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作者：
McManus, Richard J.;Mant, Jonathan;Hobbs, F. D. Richard
重要性自我监测血压与自我滴定的抗高血压药自我管理可以降低高血压患者的血压，但没有关于高危人群的数据。目的确定自我监测与自我滴定抗高血压药物与常规护理相比对心血管疾病、糖尿病或慢性肾脏病患者收缩压的影响。设计，一项初级保健、非盲、随机临床试验，涉及552名年龄至少35岁、有卒中、冠心病、糖尿病、或慢性肾脏疾病和基线血压至少130/80毫米汞柱正在接受治疗的59英国初级保健的做法之间进行了2011年3月和2013年1月。血压监测结合个体化自我滴定算法。研究期间，诊室访视血压测量目标为130/80 mm Hg，家庭测量目标为120/75 mm Hg。对照患者接受常规护理，包括去医疗保健临床医生那里进行常规血压测量，并在必要时调整药物治疗。主要结果和指标主要结果是干预组和对照组在12个月办公室访视时收缩压的差异。结果主要结果数据来自450名患者（81%）。干预组的平均基线血压为143.1/80.5 mm Hg，对照组为143.6/79.5 mm Hg。12个月后，干预组的平均血压降至128.2/73.8 mm Hg，对照组降至137.8/76.3 mm Hg，相差9.2 mm Hg（95% CI，5.7-12.7），舒张压为3.4 mmHg（95% CI，1.8-5.0）。缺失值的多重插补得到了相似的结果：干预组的平均基线值为143.5/80.2 mm Hg，对照组为144.2/79.9 mm Hg，12个月时，干预组的平均值为128.6/73.6 mm Hg，对照组为138.2/76.4 mm Hg，组间收缩压差异为8.8 mm Hg（95% CI，4.9-12.7），舒张压差异为3.1 mm Hg（95% CI，0.7-5.5）。这些结果是在所有亚组，没有过多的不良事件。结论和相关性高血压患者在高风险的心血管疾病，自我监测与自我滴定的抗高血压药物与常规护理相比，导致收缩压较低，在12个月。版权所有2014年美国医学会。All rights reserved.
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. Copyright 2014 American Medical Association. All rights reserved.