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Open Access Highly Accessed Study protocol

Protocol for a randomised controlled trial of telemonitoring and self-management in the control of hypertension: Telemonitoring and self-management in hypertension. [ISRCTN17585681]

Richard J McManus1*, Emma P Bray1, Jonathan Mant2, Roger Holder1, Sheila Greenfield1, Stirling Bryan3, Miren I Jones1, Paul Little4, Bryan Williams5 and FD Richard Hobbs1

Author Affiliations

1 Primary Care Clinical Sciences, Primary Care and Clinical Sciences Building, University of Birmingham, Birmingham, UK

2 General Practice and Primary Care Research Unit, University of Cambridge, Cambridge, UK

3 Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada

4 Community Clinical Sciences, University of Southampton, Southampton, UK

5 Department of Cardiovascular Sciences, University of Leicester, Leicester, UK

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BMC Cardiovascular Disorders 2009, 9:6  doi:10.1186/1471-2261-9-6

Published: 16 February 2009

Abstract

Background

Controlling blood pressure with drugs is a key aspect of cardiovascular disease prevention, but until recently has been the sole preserve of health professionals. Self-management of hypertension is an under researched area in which potential benefits for both patients and professionals are great.

Methods and design

The telemonitoring and self-management in hypertension trial (TASMINH2) will be a primary care based randomised controlled trial with embedded economic and qualitative analyses in order to evaluate the costs and effects of increasing patient involvement in blood pressure management, specifically with respect to home monitoring and self titration of antihypertensive medication compared to usual care. Provision of remote monitoring results to participating practices will ensure that practice staff are able to engage with self management and provide assistance where required. 478 patients will be recruited from general practices in the West Midlands, which is sufficient to detect clinically significant differences in systolic blood pressure between self-management and usual care of 5 mmHg with 90% power. Patients will be excluded if they demonstrate an inability to self monitor, their blood pressure is below 140/90 or above 200/100, they are on three or more antihypertensive medications, have a terminal disease or their blood pressure is not managed by their general practitioner.

The primary end point is change in mean systolic blood pressure (mmHg) between baseline and each follow up point (6 months and 12 months). Secondary outcomes will include change in mean diastolic blood pressure, costs, adverse events, health behaviours, illness perceptions, beliefs about medication, medication compliance and anxiety. Modelling will evaluate the impact of costs and effects on a system wide basis. The qualitative analysis will draw upon the views of users, informal carers and professionals regarding the acceptability of self-management and prerequisites for future widespread implementation should the trial show this approach to be efficacious.

Discussion

The TASMINH2 trial will provide important new evidence regarding the costs and effects of self monitoring with telemonitoring in a representative primary care hypertensive population.

Trial Registration

ISRCTN17585681