A Self-Management Approach to Managing Hypertension Associated with CKD

BACKGROUND: Despite its importance, blood pressure control in CKD remains challenging, prompting a focus on self-management approaches. We conducted a randomised feasibility trial of a blood pressure self-management intervention in persons with CKD: the Self-Management and Realisation of Target BP in CKD (SMaRT BP CKD) trial. METHODS: Eligible participants were recruited from nephrology clinics and randomised to standard care or intervention. The intervention comprised of monthly home blood pressure monitoring and participant-led assessment and escalation of therapy based on pre-agreed plan. Standardised office blood pressure readings were taken at baseline, 6 and 12 months. Primary outcomes assessed feasibility of the intervention and trial design. RESULTS: Of 390 persons invited, 58 (15%) were enrolled; 23 participants in the intervention and 29 in standard care group completed 12 months of follow up (90%). Median (IQR) baseline systolic blood pressure for the cohort was 143 (135-154)mmHg and diastolic blood pressure 79 (70-89)mmHg. Median eGFR for the cohort was 32 (28-53)ml/min/1.73m2 and urine ACR 220.4 (47.8-731) mg/g. The median number of home readings in the intervention group was 41 (28-42) of an expected 42 (98%) in months 0-6 and 35 (19-42) (83%) in months 6-12. There were more treatment escalations in the intervention group, median 2 (0-3) versus 1 (0-1.5) in standard care (p=0.04). However, there were also more anti-hypertensives discontinued in the intervention group. At six months there was a non-significant -5.8 (-14.4 to 2.6)mmHg difference in systolic blood pressure between groups (p=0.18) and at twelve months this was 3.9 (-4.7 to 12.5)mmHg (p=0.37). CONCLUSIONS: Participants were willing to be randomised to a self-management blood pressure intervention and the intervention was feasible in a secondary care CKD population. The results of this trial have highlighted potential protocol amendments for a future larger, trial including additional targeted educational material and enhanced research team support.