Do Patients Actually Do What We Ask? Patient Fidelity and Persistence to the TASMIN-SR Blood Pressure Self-Management Intervention

Objective Self-management of hypertension can reduce and control blood pressure (BP) compared to clinic monitoring. However, self-management relies on patients following an algorithm which may be variably adhered to. This study reports fidelity of high-risk patients to the self-management algorithm set by the TASMIN-SR trial. Methods Patients with hypertension, above target clinic BP and one or more of stroke, diabetes, coronary heart disease or chronic kidney disease, were invited to self-monitor following an individualised self-titration algorithm. Home BP readings and medication change details were submitted monthly for 12 months. Readings downloaded from patients’ electronic monitors were compared to written submissions and protocol fidelity was assessed. Results 276 patients were randomised to self-management and 225 (82%) completed the required training sessions. Of these, 166 (74%) completed self-management. 11,385/12,707 (89.6%) submitted readings were accurate compared to corresponding downloaded monitor readings. Mean error rate was 5.2% per patient, which increased with age but not co-morbidities. Patients made 475/683 (69.5%) algorithm recommended medication changes, equating to nearly three medication changes per patient. Mean systolic BP for patients who completed training and made all recommended changes dropped from 141mmHg (95% CI 138.26-144.46) to 121mmHg (95% CI 118.30-124.17mmHg) compared to 129mmHg (95% CI 125.27-136.73mmHg) for patients who made none. Conclusion Most patients randomised to self-management completed training; however, 36% of these had dropped out by 12 months. Self-monitoring was largely undertaken properly and accurately recorded. Fidelity with self-management was associated with lower achieved systolic BP. Successful implementation of self-management into daily practice requires careful training and should be accompanied by monitoring of fidelity.