Participant training and intervention description
| Patients |
| Patients randomised to self-monitoring were shown how to use a validated automated electronic sphygmomanometer at enrolment stage. They were asked to monitor their own BP in their non-dominant arm, twice each morning and evening, for the first week of every month using standard recommendations, and their GPs were asked to use the self-monitored measurements for titration of antihypertensive medication. |
| Self-monitoring alone using paper-based diaries |
| For participants randomised to self-monitoring using a paper-based diary, a simple colour chart was used to train participants to attend their practice for BP checks in the light of very high or very low readings. At the end of each monitoring week they were asked to record their readings on paper and send them for review to their practice in a reply-paid envelope. |
| Self-monitoring with telemonitoring |
| Participants randomised to self-monitoring using telemonitoring (mHealth) were trained to send readings via a simple free SMS text-based telemonitoring service with web-based data entry back-up. The telemonitoring system incorporated an algorithm that alerted participants to contact their surgery in the light of very high or very low readings, reminded them if insufficient readings were transmitted, prompted them to contact their practice if their average BP was above target, and presented readings to attending clinicians via a web interface. This secure web page automatically calculated mean BP for each monitoring week, highlighted very high or very low readings, and presented a graphical display of BP measurements. |
| Healthcare professionals |
| Healthcare professionals and relevant practice staff were trained in study procedures at the beginning of the trial by a standardised presentation delivered by the study research team or local clinical network facilitators. This included the methods by which patients in different intervention groups reported their BP readings. The package included a discussion of the key aspects of data monitoring and management according to participation in an RCT. Healthcare professionals were given autonomy to tailor their implementation of the self-monitoring interventions alongside routine clinical practice, titrating and prescribing medication as appropriate. |
BP = blood pressure. RCT = randomised controlled trial.