A RANDOMIZED STUDY COMPARING A PATIENT DIRECTED HYPERTENSION MANAGEMENT STRATEGY WITH USUAL OFFICE-BASED CARE

This study aimed to compare the efficacy of a patient-directed managem ent strategy with office-based management in maintaining blood pressur e control in patients with chronic stable hypertension using a randomi zed trial of two months duration. The subjects had chronic stable esse ntial hypertension without secondary causes or unstable cardiovascular disease and were selected through the offices of 11 family physicians and a tertiary care hypertension research unit. Patients were randoml y assigned (2:1 ratio) to either a patient-directed management strateg y using home blood pressure monitoring to adjust drug therapy if readi ngs consistently exceeded defined limits, or office-based management t hrough physician visits. The primary endpoint was the change from base line in mean arterial pressure as determined by automatic ambulatory b lood pressure monitoring. Secondary endpoints were changes in complian ce, quality of life, and health care resource use. Ninety-one potentia l subjects were screened and 31 were randomized. Subjects in the patie nt-directed management group employed the drug adjustment protocols ap propriately without complications. A significant difference in change in mean blood pressure was observed, favoring the patient-directed man agement (-0.95 mm Hg and +1.90 mm Hg, respectively, for patient-direct ed management and office-based management, P = .039). Compliance rates and quality of life scores were not significantly different between g roups. Physician visits were more frequent in the patient-directed man agement group (1.05 v 0.20 visits/8 weeks, respectively, for patient-d irected management and office-based management groups, P = .045). A pa tient-directed hypertensive management strategy may be feasible for pa tients with chronic stable hypertension. Such a strategy may improve b lood pressure control compared with usual office-based care. However, physician visits may be increased using this strategy, at least in the short term. (C) 1997 American Journal of Hypertension, Ltd.