Can patients, doctors share driver’s seat?

In the early 20th century, doctors and nurses made quite a ritual out of measuring blood pressure. There was a glass tube containing mercury, a blood pressure cuff and tubing to connect them. In addition, the health care professional had to wear a stethoscope to listen to the blood passing through the brachial artery in the elbow.

The process was complicated and required good hearing to detect the on-off Korotkoff sounds. Most health professionals did not think that this procedure could ever be mastered by patients at home.

When digital blood pressure monitors became available, many physicians were skeptical about the accuracy of the instruments. They also doubted the value of having patients measure their own blood pressure.

A new study in The Lancet puts those concerns to rest (March 10, 2018). British researchers recruited physicians from 142 general practices in the U.K. Patients with poorly controlled hypertension (blood pressure readings over 140/90) were randomized to one of three groups.

Nearly 400 participants monitored their blood pressure at home using an Omron M10-IT electronic device (the self-monitoring group). They were asked to measure their blood pressure two times in the morning and twice each evening for the first week of every month. They were asked to record the readings and send them to their general practitioners for oversight.

A comparable number of volunteers recorded their blood pressure at home in a similar manner but sent the information to their doctors via text message and a web-based data entry system (telemonitoring group).

The “usual care” group had their blood pressure readings measured exclusively in the doctor’s office. The study lasted a full year. All participants also were monitored by research nurses who measured the volunteers’ blood pressure at each follow-up appointment. Blood pressure medications were adjusted based on the measurements from all three groups.

The investigators found that self-monitoring, with or without telemonitoring, produced significantly better blood pressure control than clinic-monitored readings. The authors recommend self-monitoring for all patients who wish to use it.

An editorial in the same issue of The Lancet noted that if self-monitoring were sustained, “such reductions in blood pressure could be expected to reduce stroke risk by 20 percent and coronary heart disease risk by 10 percent.”

The physicians who wrote this editorial titled their article: “Hypertension: time for doctors to switch the driver’s seat?” They ask even more controversial questions: “Should not the driver’s seat be co-chaired by health literate patients and dedicated professionals from allied fields? Could it be a valuable option to empower patients whenever possible, introducing them to self-titration and self-initiation of antihypertensive drug therapy?”

We have come a long way from the old-fashioned approach to measuring and treating hypertension. Technology also may enable patients to be more active participants in the treatment of diabetes, irregular heart rhythms and blood-thinning regimens. The expanding self-care movement should lead to shared decision-making between patients and health professionals.

Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.Peoples-Pharmacy.com.

2018 King Features Syndicate