Patients adjusting their medications and controlling blood pressure

We are no longer surprised when a patient is asked if they take their blood pressure medicines every day, and we are told “it depends.”

Yes, it can be amusing to hear how one member of a couple decides that they know more than their physician, and makes decisions based on home blood pressure measurements. Sample quotes may include “she thinks she is a doctor”, or “I decide what to give him/her after I take the pressure”. This can not only be amusing, but frustrating to the physician attempting to achieve blood pressure control in order to reduce the risk of heart disease and stroke, among other conditions.

Now British physicians have published a study in The Lancet. Their study, Telemonitoring and Self-Management in the Control of Hypertension (TASMINH2) was reported in July. They showed for the first time that patients adjusting their medications according to rules specified by their physicians could do a better job of controlling blood pressure. This study was well designed, and included several key elements.

Patients were first trained in how to adjust medicines, and which ones to adjust. The schedules for measurement and adjustment were agreed upon with their physicians. The blood pressure was only measured for one week per month. If the readings were above a target blood pressure on two consecutive months, an adjustment could be made.  Blood pressure readings were transmitted to the physicians conducting the study.

What has happened here is very important. It demonstrates the power of educating patients, and of giving them responsibility for their own care. With the correct type of patient, this is a powerful way to improve care. It may not apply to every patient, however. More work will be done to see how these techniques can apply to people of various educational levels and ethnic backgrounds. These studies are in progress.

The health care system will need to change in order to support physicians and nurses that are ready to implement these changes, and involve the patient more closely in their own care.

Steven Rudolph is a neurologist who blogs at Thoughts on Technology and Medicine.

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