It’s not quite DIY yet, but some people may be able to self-manage their blood pressure drugs with good results.
Today’s medications are remarkably effective in controlling dangerous high blood pressure (hypertension). But the drugs don’t work for everyone, and some people don’t take their medications as prescribed. To compound the problem, doctors are often slow to make changes to a patient’s drug regimen even when they see blood pressure readings that are clearly outside of the desired range.
A long history of self-management
People with diabetes have a long and successful track record of checking their blood sugar readings and tailoring their drug dosages accordingly. “Many people with diabetes routinely use blood glucose monitors and adjust their insulin dose based on treatment plans from their doctors,” says Dr. Paul Conlin, professor of medicine at Harvard Medical School and and chief of medicine at the VA Boston Healthcare System. Similar monitoring is also done in people with heart failure, primarily in response to weight changes.
A new approach to blood pressure management may allow some people to be more actively involved in their health care.
Adapting this approach to blood pressure management has been trickier. Blood pressure measurements vary widely from day to day and even from minute to minute, depending on your natural body cycles and what’s going on around you. Individual blood pressure readings give only a snapshot, when what you really need is a motion picture. And unlike the HbA1c test, which shows average blood sugar levels over the past three months, there’s no similar test for blood pressure.
With these considerations in mind, doctors in England conducted a small study among people who had high blood pressure combined with other risky cardiovascular conditions. Half were asked to stick to a strict home monitoring schedule, which included taking blood pressure readings twice each morning during the first week of the month for two consecutive months. If their blood pressures were outside the target range four or more times in a week, they were allowed to adjust the dose of their blood pressure medicine or add a new drug based on an individualized treatment plan developed by their doctor. They were instructed to call the doctor’s office if they had a reading that was extremely high or low. The other half received standard care from their doctors. At the end, the self-regulators had consistently lower blood pressure than the standard-care group. No one in the study encountered problems from a dose of blood pressure medicine that was too high.
Coming to a doctor’s office near you?
While this program didn’t require any fancy technology, it’s probably not ready for general practice just yet. Interestingly, only a minority of people who were invited to join the study took part. Most who declined to participate did not feel comfortable with monitoring their blood pressure and adjusting medications by themselves. However, with appropriate training and guidance from a physician, people who measure their blood pressure at home could learn to make changes to manage their hypertension, says Dr. Conlin. For people who aren’t currently measuring their blood pressure at home, access to this type of program may spark an interest in becoming more engaged in their care.
Choosing and using a home blood pressure monitor