Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial

McManus, Richard J; Mant, Jonathan; Bray, Emma P; Holder, Roger; Jones, Matthew A.; Greenfield, Sheila; Kaambwa, Billingsley; Banting, Miriam; Bryan, Stirling; Little, Paul; Williams, Bryan; Hobbs, FD Richard

doi:10.1016/s0140-6736(10)60964-6

Cited by 496 publications

(529 citation statements)

References 30 publications

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“…10 Previous studies provide evidence for improved BP control using telemanagement models in selected patient populations. [11][12][13] Compared with clinic BP measurement, home telemonitoring may also better predict cardiovascular risk and is less subject to observer bias (white-coat hypertension and masked hypertension). 14 -18 The Hypertension Intervention Nurse Telemedicine Study (HINTS) was an 18-month randomized, controlled trial designed to circumvent factors contributing to clinical inertia.…”

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confidence: 99%

Treatment Intensification in a Hypertension Telemanagement Trial

et al. 2011

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Abstract-Clinical inertia represents a barrier to hypertension management. As part of a hypertension telemanagement trial designed to overcome clinical inertia, we evaluated study physician reactions to elevated home blood pressures. We studied 296 patients from the Hypertension Intervention Nurse Telemedicine Study who received telemonitoring and study physician medication management. When a patient's 2-week mean home blood pressure was elevated, an "intervention alert" prompted study physicians to consider treatment intensification. We examined treatment intensification rates and subsequent blood pressure control. Patients generated 1216 intervention alerts during the 18-month intervention. Of 922 eligible intervention alerts, study physicians intensified treatment in 374 (40.6%). Study physician perception that home blood pressure was acceptable was the most common rationale for nonintensification (53.7%).When "blood pressure acceptable" was the reason for not intensifying treatment, the mean blood pressure was lower than for intervention alerts where treatment intensification occurred (135. Previous studies provide evidence for improved BP control using telemanagement models in selected patient populations. [11][12][13] Compared with clinic BP measurement, home telemonitoring may also better predict cardiovascular risk and is less subject to observer bias (white-coat hypertension and masked hypertension). 14 -18 The Hypertension Intervention Nurse Telemedicine Study (HINTS) was an 18-month randomized, controlled trial designed to circumvent factors contributing to clinical inertia. 19 We examined data from the medication management arms of HINTS to determine how physicians reacted to elevated BP values, why they reacted as they did, and how their decisions impacted subsequent patient BP control after episodes of elevated BP. Our goal was to determine whether clinical inertia persisted in HINTS despite the efforts to overcome it. Methods HINTS DesignHINTS randomized 593 eligible veterans into 4 groups: (1) a nurse-administered behavioral management intervention; (2) a nurse-administered, physician-directed medication management intervention using a validated clinical decision support system; (3) a combined behavioral management and medication management intervention; and (4) usual care. Eligible patients received primary care at the Durham Veterans Affairs Medical Center, had a diagnosis of hypertension, used BP-lowering medication, and had inadequate BP control (Ͼ140/90 mm Hg for all patients) based on the average of the previous 12 months' clinic BP measurements obtained from electronic medical charts. Exclusion criteria were receipt of dialysis; a serum creatinine Ͼ2.5 or no documentation of renal function; history of organ transplant; hospitalization for stroke, myocardial infarction, or coronary artery revascularization within 3 months of contact; diagnosis of metastatic cancer or dementia; lack of a home telephone; residence in a nursing home; receipt of home health care; or severely impaired hearing ...

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confidence: 99%

Treatment Intensification in a Hypertension Telemanagement Trial

et al. 2011

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“…Moreover, the difference may be due to increased adherence to drug treatment. We should point out that some studies have shown even better results when allowed and directed the patient to do self-adjustment on doses of drugs, according to SMBP 5,9 .…”

Section: Discussionmentioning

confidence: 99%

“…In addition, hypertensive patients accompanied with the SMBP have better blood pressure control compared to those followed by the casual measurement. This improvement is slight, but significant, and it can still be implemented in the use of methodologies that allow the self-adjustment of the medication by the patient, monitored remotely by health professionals 5,9 . It is interesting to notice that, even with a few measures, the SMBP has better predictive value for stroke (CVA) of the casual measurement, however, the greater the number of measures, the better the risk prediction 10 .…”

Section: Introductionmentioning

confidence: 99%

Automedida da pressão arterial para o controle das cifras tensionais e para a adesão ao tratamento

Souza¹,

Jardim²,

Brito³

et al. 2012

Arq. Bras. Cardiol.

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“…65,66 Improvements in BP control by means of such telemedicine have been reported. 61,64,[67][68][69][70][71] 4) HOME BP AND BP CONTROL The Japanese and International guidelines recognize home BP measurements as an optimal tool for long-term BP control. [17][18][19][20] The introduction of home BP measurements in the diagnosis and treatment of hypertension facilitates the attainment of a goal BP compared with BP management based on clinic BP alone.…”

Section: ) Home Bp and Prognosismentioning

confidence: 99%

“…79 As home BP is measured and interpreted by the patients themselves, the possibility of self-regulation of antihypertensive medication according to home BP has become relevant in hypertension management. 71,80,81 5) HOME BP AND ADHERENCE Home BP measurements require an active commitment by the patients themselves in medical care and health management, and results in a marked improvement in the adherence to medication. 82,83 High adherence to home BP measurements has also been reported to improve BP control.…”

Section: ) Home Bp and Prognosismentioning

confidence: 99%

The Japanese Society of Hypertension Guidelines for Self-monitoring of Blood Pressure at Home (Second Edition)

et al. 2012

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INTRODUCTIONSince Riva-Rocci invented indirect brachial cuff sphygmomanometry in 1896 1 and Korotkoff proposed the auscultatory method in 1905, 2 the method for blood pressure (BP) measurements has remained essentially unchanged for the past 100 years.In 1969, Posey et al. 3 identified mean BP on the basis of the cuff-oscillometric method. With subsequent theoretical and technical improvements, the method to determine systolic and diastolic BP (S and D, respectively) was introduced to the cuff-oscillometric method. As a result, many of the automatic electronic sphygmomanometers available today have adopted this method, and those different from the auscultatory method have begun to be used in general clinical practice. Since the advent of indirect methods for sphygmomanometry, the past century has developed the practical and clinical sciences of hypertension. However, BP information necessary for the diagnosis and treatment of hypertension is still obtained essentially on the basis of casual measurements at the outpatient clinic (clinic BP). However, the reliability of clinic BP was called into question 40 years after the advent of indirect sphygmomanometry. In 1940, Ayman and Goldshine 4 widely adopted the concept of self-BP measurements in the field of clinic BP measurements and demonstrated discrepancies between clinic BP and self-BP measurements. Bevan, 5 in the United Kingdom, first reported the results of ambulatory BP (ABP) monitoring (ABPM) using a direct arterial BP measurement method in 1969, and showed that human BP changes markedly with time. The quantity and quality of BP information vary greatly according to different methods, and the problem of interpreting clinic BP, which is obtained specifically in a medical environment, has been an issue in the clinical practice of hypertension during the past 50 years.However, the practice and epidemiology of hypertension still depend entirely on BP information obtained in a medical environment (clinic BP/BP at a health examination), resulting in the

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Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial

Cited by 496 publications

References 30 publications

Treatment Intensification in a Hypertension Telemanagement Trial

Treatment Intensification in a Hypertension Telemanagement Trial

Automedida da pressão arterial para o controle das cifras tensionais e para a adesão ao tratamento

The Japanese Society of Hypertension Guidelines for Self-monitoring of Blood Pressure at Home (Second Edition)

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