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Patients at high cardiovascular risk can self-monitor and self-titrate antihypertensives, a new study suggests, potentially cutting stroke risk by 30 per cent.

The randomised clinical trial enrolled 552 patients aged at least 35 years from 59 UK primary care practices. Patients had a history of stroke, coronary heart disease, diabetes or chronic kidney disease and a baseline blood pressure of at least 130/80mmHg.

Patients monitored their blood pressure and modified antihypertensives according to an individualised algorithm. Target blood pressures were 130/80mmHg when measured in the surgery and 120/75mmHg at home. In the control group, clinicians measured blood pressure and adjusted medication.

Mean baseline blood pressure was 143.1/ 80.5mmHg in the self-management group and 143.6/79.5mmHg among controls. After 12 months, the corrected differences were 9.2mmHg and 3.4mmHg in systolic and diastolic blood pressure respectively. The mean defined daily antihypertensive dose increased more in the self-management group compared to controls at 12 months by 3.34 and 2.61 respectively. Prescriptions of CCBs and thiazides increased significantly in the self-management group.

The authors note that the benefits offered by self-management “were sustained and increasing” and estimated that, if maintained, the blood pressure difference “would be expected to” reduce stroke risk by about 30 per cent