A Self-Management Approach to Managing Hypertension Associated with CKD: A Feasibility Randomized Trial

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.

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.

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).

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.