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Clinical trial shows that stroke risk could be lowered by up to 30% in patients with a high risk of heart disease.

Self managing hypertension can reduce blood pressure for high risk patients
We have shown that people can measure their own blood pressure, adjust their own medication and achieve better results than standard care without an increase in adverse events.
- Professor Richard McManus, Nuffield Department of Primary Care Health Sciences.

Patients at high risk of heart disease and stroke who monitor their own blood pressure and adjust their medication from home have a significantly lower blood pressure after 12 months than those managed directly by their general practitioner, according to research published in the Journal of the American Medical Association (JAMA).

Led by primary care researchers at the University of Oxford, the clinical trial followed 552 patients with an average age of 70 and high blood pressure with pre-existing cardiovascular disease, diabetes or chronic kidney disease.

After training in how to self-monitor blood pressuring using a readily available device, patients took readings twice each morning for the first week of each month, and following an individualised management plan were able to request additional medication from their general practitioner without the need for consultation.

At the end of the study, patients who self-managed had significantly lower blood pressure (by 9.2 / 3.4 mmHg) than those who were visiting their GP for blood pressure monitoring. This would be expected to lower stroke risk by around 30% if sustained.

Raised blood pressure (hypertension) is the most important risk factor for heart disease and stroke globally. In England and Wales more than 7 million people currently receive treatment for hypertension, however the blood pressure of at least one third of these remains high despite this treatment. Previous research has shown that when people with uncomplicated hypertension self-monitor blood pressure and adjust their own medications, this results in lower blood pressure. The current research aimed to investigate whether this would also apply to older, high-risk patients.

Professor Richard McManus, Nuffield Department of Primary Care Health Sciences at the University of Oxford, who led the study, said:

Richard McManus“Controlling blood pressure is a key target in reducing heart disease and strokes. We have shown that people can measure their own blood pressure, adjust their own medication and achieve better results than standard care without an increase in adverse events. This is possible even for people with previous strokes, heart attacks, diabetes and kidney disease.

“Blood pressure monitors are now widely available, costing as little as £15, and our oldest patient was 88, so self-management is possible for people of all ages.”

The research is funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR).

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