Elevated blood pressure (hypertension) is the leading risk factor for global disease burden. Data from national and international surveys suggest that, despite improvements over the last decade, significant proportions of patients have poor control of their elevated blood pressure.

Self-monitoring of blood pressure with self-titration of antihypertensives (where patients monitor their condition and adjust their blood pressure medication themselves) is known to result in lower blood pressure in patients with hypertension, but there has been no data about patients in high-risk groups.

A collaboration between Oxford, Birmingham and the Primary Care Unit in Cambridge (Professor Jonathan Mant) conducted a new trial, the TASMIN-SR Randomized Clinical Trial, involving 559 high risk patients with hypertension and a history of stroke, coronary heart disease, diabetes, or chronic kidney disease, at 59 UK primary care practices. Self-monitoring with self-titration of antihypertensive medication, compared with usual care, resulted in lower systolic blood pressure after 12 months.

Only a modest amount of training and additional family physician input was required, without special equipment, so that this intervention could be implemented widely. At least 30% of patients with hypertension are already self-monitoring in the United Kingdom and more internationally. This trial shows that patients at high risk of cardiovascular disease whose blood pressure is not optimally controlled could be considered for self-management. For more information see JAMA