After a year, systolic pressure in the self-managed group fell 17.6 mm Hg, compared with 12.2 mm Hg in the standard care group.
Patients without diabetes were encouraged to aim for 130/85 mm Hg, and diabetics were to target 130/75 mm Hg, according to the study.
Side effects were generally the same in both groups, except that leg swelling occurred more often in the self-managed group (32 percent versus 22 percent), the researchers note.
The self-managed patients attended two training sessions to learn to use automated sphygmomanometers (blood pressure monitors), and they were also taught how to transmit their blood pressure readings to the doctor via an automated modem device.
Drug-adjustment schedules were agreed to by the patients and their family doctor.
McManus thinks that working actively to control blood pressure is the reason the self-management approach was so successful.
"The effect seems to be due to increased antihypertensive treatment in people who self-manage," he said. For example, patients who missed their targets two months in a row made medication changes.
Dr. Gregg C. Fonarow, professor of medicine and director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California, Los Angeles, said self-management has been shown to improve risk factor control or outcomes in patients with other conditions, such as diabetes and heart failure.
"This exciting new study demonstrates that the combination of telemonitoring of home blood pressure measurements combined with self-management of hypertension following a simple algorithm was more effective than usual care in the primary care setting," Fonarow said.
"This represents a very practical, broadly applicable, likely cost-effective new approach to achieve improved blood pressure control," he said.
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