The Pharmaceutical Journal
Vol 272 No 7288 p238
28 February 2004

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Patients not ready for home BP or INR monitoring

Antihypertensive treatment that is adjusted according to blood pressure measurements made by patients themselves provides less long-term control than treatment adjusted according to measurements made at a clinic, say Irish and Belgian researchers (JAMA 2004;291:955).

Meanwhile, researchers from Birmingham suggest that better training is needed before patients can reliably self-manage warfarin treatment by testing their international normalised ratios (BMJ 2004;328:437).

The authors of the first study randomly assigned patients with high blood pressure, as measured at a clinic, to have their medication altered according to either clinic-based readings or self-measurement. More patients assigned to self-monitoring were able to stop treatment (25.6 per cent versus 11.3 per cent), perhaps indicating the prevalence of “white-coat hypertension” (high blood pressure that occurs only during monitoring in a clinic setting).

Although self-monitoring of blood pressure led to less intensive treatment with slightly lower costs, the final blood pressure of patients in this group was, on average, higher than that of patients in the clinic-based group.

The authors say that blood pressure readings made by patients should be used in parallel with readings made at clinics so that white-coat hypertension can be identified. They also call for further studies to establish the normal range of self-measured blood pressure and the thresholds at which treatment should be started or discontinued.

The second trial was designed to evaluate the effectiveness of a training programme for patients to self-manage warfarin treatment. The researchers successfully trained 242 patients but point out that 76 per cent of the patients invited to self-manage their warfarin treatment chose not to take part. “If self-management by patients is to become established, standardisation and dissemination of training are needed, accompanied by practical guidelines to encourage back up from clinicians,” they conclude.