Meeting Highlights


Success with Self-monitoring: Results from the TASMIN-SR Trial

Presented by Richard J. McManus, United Kingdom

The Telemonitoring and Self-Management in the Control of Hypertension trial [TASMINH2], a large study of patients with hypertension, found that those randomized to self-management had significantly lower blood pressure (BP) than controls [McManus RJ et al. Lancet 2010]. Subgroup analyses from TASMINH2 suggested a smaller treatment effect in higher risk patients. The purpose of the subsequent Targets and Self management for the Control of Blood Pressure in Stroke and Other At-risk Groups trial [TASMIN-SR; ISRCTN87171227] was to determine if self-management, consisting of self-monitoring with self-titration of antihypertensives, effectively lowers BP in patients with high-risk conditions such as stroke and diabetes [O’Brien C et al. BMC Cardiovasc Disord 2013]. Richard J. McManus, MA, PhD, University of Oxford, United Kingdom, presented key results from this study.

Eligible patients were aged >35 years with hypertension plus stroke, diabetes mellitus, coronary heart disease or chronic kidney disease, with a BP >130/80 mmHg, not currently taking >3 antihypertensives, and willing to self-monitor and self-titrate their medication. Pregnant women and patients with dementia or terminal disease were excluded.

Participants were randomized to self-management or standard care as determined by their physician. BP targets were 130/80 mmHg in office and 120/75 mmHg for home. A color-coded system instructed patients on what actions to take based on their BP readings (Figure 1). Patients returned for follow-up at 6 and 12 months. The primary outcome measure was systolic BP, with secondary outcomes of diastolic BP, costs, anxiety, health behaviors, and patient preferences. The study was powered to detect a 5 mmHg difference between treatment groups.

A total of 552 patients were enrolled; 276 per treatment group. At the 12-month follow-up, data from 220 (78%) from the self-management group and 230 patients (83%) in the standard care group were available for analysis. Forty-five percent had diabetes, 32% had chronic kidney disease, 31% had coronary heart disease, and 17% had cerebrovascular disease. The mean number of antihypertensive drugs at baseline was 1.6.

In the primary analysis, the self-management group had lower unadjusted mean systolic BP (128.2 mmHg; 95% CI, 125.9 to 130.4) compared with the standard care group (137.8; 95% CI, 135.4 to 140.3) at 12 months. At the 12-month time point, the self-management group was taking more antihypertensive medications (mean, 2.24; 95% CI, 2.09 to 2.39) than the standard care group (1.75, 95% CI, 1.62 to 1.88). There were no significant differences between the 2 groups in the occurrence of side effects. “We have data on health behaviors and resource costs.  Both of these will be important in understanding our trial fully,” Prof. McManus noted.

In this study, self-monitoring with self-titration of antihypertensive medication resulted in lower systolic BP compared with standard care. It is expected that this reduction in BP would significantly lower stroke and coronary heart disease risk. While there was evidence of greater use of antihypertensive medications in the self-management group, this was not accompanied by increased side effects. Prof. McManus concluded that self-management may not be suitable for every patient but should be offered to those willing to try.