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Peralta, Nickale M.

BSN 3-2
Journal

Hypertension self-management program helps reduce blood pressure for
high-risk patients

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 (adjusting) of antihypertensives results in lower blood pressure in
patients with hypertension, but there are no data about patients in high-risk groups, according to
background information in the article.
Richard J. McManus, F.R.C.G.P., of the University of Oxford, and colleagues randomly assigned 552
patients with hypertension and a history of stroke, coronary heart disease, diabetes, or chronic kidney
disease to self-monitoring of blood pressure combined with an individualized self-titration algorithm or
a control group (patients received usual care consisting of seeing their health care clinician for routine
blood pressure measurement and adjustment of medication if necessary).
After 12 months, the average systolic blood pressure decreased in both groups, but was lower in the
intervention group (128.2/73.8 mm Hg vs 137.8/76.3 mm Hg). Imputation for missing values showed a
marginally lower average difference in systolic blood pressure of 8.8 mm Hg. The reduction in diastolic
blood pressure was also greater in the self-monitoring group. The results were comparable in all
subgroups, without excessive adverse events.
"This trial has shown for the first time, to our knowledge, that a group of high-risk individuals, with
hypertension and significant cardiovascular comorbidity, are able to self-monitor and self-titrate
antihypertensive treatment following a prespecified algorithm developed with their family physician and
that in doing so, they achieved a clinically significant reduction in systolic and diastolic blood pressure
without an increase in adverse events," the authors write. "This is a population with the most to gain in
terms of reducing future cardiovascular events from optimized blood pressure control."
Editorial: Self-titration of Antihypertensive Therapy in High-Risk Patients: Bring It Home
"Although the trial by McManus et al does not settle all questions regarding self-titration based on self-
measurement, it is an important step toward adaptation of treatment for patients who want to actively
take part in their own risk-factor control," write Peter M. Nilsson, M.D., Ph.D., of Skane University
Hospital, Malmo, Sweden, and Fredrik H. Nystrom, M.D., Ph.D., of Linkoping University, Linkoping,
Sweden, in an accompanying editorial.
"Future trials studying the effects of self-titration on cardiovascular events are needed. With the gain in
knowledge from [this trial], it may be possible to make the recruitment of patients less restricted, to
incorporate education about self-measurement as a standard procedure and focus on which scheme for
titration to use, or to study the timing of the home blood pressure recordings. In many countries
antihypertensive drugs are now available as inexpensive generic drugs. The time has come to fully use
these noncostly medications and to design optimal individualized care of patients."
"Based on these findings, a 'bring it home' blood pressure-lowering strategy appears suitable for
patients with hypertension and comorbidities."
Source: JAMA - Journal of the American Medical Association



Summary:
In this article it says that patients have poor control of their elevated blood pressure. They did a
study where among patients with hypertension at high risk of cardiovascular disease, a program
that consisted of patients measuring their blood pressure and adjusting their antihypertensive
medication accordingly resulted in lower systolic blood pressure at 12 months compared to
patients who received usual care, according to a study.

Reaction:
I agree with this article because the study showed that the patients blood pressure can be
reduce by often monitoring their own blood pressure at home and self-titrating or adjusting to
their antihypertensive agents without an increase in adverse events and thus reducing the risk
of developing more severe complication. This article shows that the patient does not need to
visit their physicians every time they need to get their blood pressure check when they can just
do interventions independently to reduce the risk which saves time and effort. Controlling
blood pressure is a key target in reducing heart disease and strokes. The home blood pressure
monitoring readings both influenced their adherence to diet and exercise and provided certain
reassurance when they experienced symptoms as well. The patient can just monitor their blood
pressure anytime they want. This could be an effective strategy for achieving significant
reductions in blood pressure, as well as preventing strokes and heart attacks. This is an
effective strategy thats why we should promote more independent intervention such as
monitoring their own blood pressure and adjust their medications accordingly to lower blood
pressure and help reduce the risk.

Theory:
Dorothea Orem- Self-Care Model
I can relate this theory since the patient is on self-management program where the patient
monitors their own blood pressure and self-titrate to their medications to help reduce blood
pressure. The patient perform these interventions independently to promote and maintain
person well-being. Patient should be self-reliant, and responsible for their care, as well as
others in their family who need care. The responsibility of the nurse is to teach, guide and
support the client on doing this kind of intervention.