Abstract:
OBJECTIVES:To assess whether blood pressure control in primary care could be improved with the use of patient held targets and self monitoring in a practice setting, and to assess the impact of these on health behaviours, anxiety, prescribed antihypertensive drugs, patients' preferences, and costs. DESIGN:Randomised controlled trial. SETTING:Eight general practices in south Birmingham. PARTICIPANTS:441 people receiving treatment in primary care for hypertension but not controlled below the target of < 140/85 mm Hg. INTERVENTIONS:Patients in the intervention group received treatment targets along with facilities to measure their own blood pressure at their general practice; they were also asked to visit their general practitioner or practice nurse if their blood pressure was repeatedly above the target level. Patients in the control group received usual care (blood pressure monitoring by their practice). MAIN OUTCOME MEASURES: PRIMARY OUTCOME:change in systolic blood pressure at six months and one year in both intervention and control groups. SECONDARY OUTCOMES:change in health behaviours, anxiety, prescribed antihypertensive drugs, patients' preferences of method of blood pressure monitoring, and costs. RESULTS:400 (91%) patients attended follow up at one year. Systolic blood pressure in the intervention group had significantly reduced after six months (mean difference 4.3 mm Hg (95% confidence interval 0.8 mm Hg to 7.9 mm Hg)) but not after one year (mean difference 2.7 mm Hg (- 1.2 mm Hg to 6.6 mm Hg)). No overall difference was found in diastolic blood pressure, anxiety, health behaviours, or number of prescribed drugs. Patients who self monitored lost more weight than controls (as evidenced by a drop in body mass index), rated self monitoring above monitoring by a doctor or nurse, and consulted less often. Overall, self monitoring did not cost significantly more than usual care (251 pounds sterling (437 dollars; 364 euros) (95% confidence interval 233 pounds sterling to 275 pounds sterling) versus 240 pounds sterling (217 pounds sterling to 263 pounds sterling). CONCLUSIONS:Practice based self monitoring resulted in small but significant improvements of blood pressure at six months, which were not sustained after a year. Self monitoring was well received by patients, anxiety did not increase, and there was no appreciable additional cost. Practice based self monitoring is feasible and results in blood pressure control that is similar to that in usual care.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
McManus RJ,Mant J,Roalfe A,Oakes RA,Bryan S,Pattison HM,Hobbs FDdoi
10.1136/bmj.38558.393669.E0keywords:
subject
Has Abstractpub_date
2005-09-03 00:00:00pages
493issue
7515eissn
0959-8138issn
1756-1833pii
bmj.38558.393669.E0journal_volume
331pub_type
临床试验,杂志文章,多中心研究,随机对照试验abstract:OBJECTIVE:To evaluate the impact and cost effectiveness of a programme to transform adult critical care throughout England initiated in late 2000. DESIGN:Evaluation of trends in inputs, processes, and outcomes during 1998-2000 compared with last quarter of 2000-6. SETTING:96 critical care units in England. PARTICIPA...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b4353
更新日期:2009-11-11 00:00:00
abstract:OBJECTIVE:To determine the prevalence of HIV among pregnant women, in particular those whose behaviour or that of their partners put them at "low risk" of infection. DESIGN:Voluntary named or anonymous HIV testing of pregnant women during 21 months (November 1988 to July 1990). SUBJECTS AND SETTING:All women who plan...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6834.1082
更新日期:1992-04-25 00:00:00
abstract:OBJECTIVE:To identify additional factors, such as maternal age or factors related to previous reproductive outcome or family history, and the corresponding probability of carrying a chromosome abnormality in couples with two or more miscarriages. DESIGN:Nested case-control study. SETTING:Six centres for clinical gene...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.38498.669595.8F
更新日期:2005-07-16 00:00:00
abstract:OBJECTIVES:To identify and calculate the prevalence of spin in studies of spin. DESIGN:Meta-research analysis (research on research). SETTING:35 studies of spin in the scientific literature. MAIN OUTCOME MEASURES:Spin, categorised as: reporting practices that distort the presentation and interpretation of results, c...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.l6202
更新日期:2019-12-18 00:00:00
abstract::The results of a survey of 769 patients attending the St. James's University Fertility Control Clinic, England, for abortion services showed that patients seeing general practitioners were less knowledgeable than those attending specialist clinics. There was a demonstrated need for counseling on pill and condom use a...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6877.556
更新日期:1993-02-27 00:00:00
abstract:OBJECTIVE:To study different nutrients and food additives as risk factors for insulin dependent diabetes mellitus in childhood. DESIGN:Prospective case-control study. Parents of the children being studied were asked to fill in a questionnaire regarding the children's frequency of consumption of various foods. Parents ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.300.6735.1302
更新日期:1990-05-19 00:00:00
abstract:OBJECTIVE:To assess effects on condom use and other sexual behaviour of an HIV prevention programme at school that promotes the use of condoms with and without emergency contraception. DESIGN:Cluster randomised controlled trial. SETTING:40 public high schools in the state of Morelos, Mexico. PARTICIPANTS:10 954 firs...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.38796.457407.80
更新日期:2006-05-20 00:00:00
abstract::Molecular techniques have revolutionised our knowledge of cell and tissue function in both health and disease. We already have new and powerful treatments based on an understanding of communication between cells by messenger molecules called cytokines. Furthermore, there is great therapeutic promise in defining molecu...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.314.7075.203
更新日期:1997-01-18 00:00:00
abstract::Elderly and disabled people have been led to expect great improvements in the quality of community care after April 1993. The choice to live safely at home is to be offered as an alternative to residential care. The financial and organisational relationships are all intended to support this in practice. The Tomlinson ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.305.6866.1418
更新日期:1992-12-05 00:00:00
abstract::According to a London physician, women with epilepsy taking antiepileptic drugs can take combined oral contraceptives (OCs). It is usual to recommend a combined OC preparation containing at least 50 mcg of estrogen (Ovran) from patients taking enzyme-inducing antiepileptic drugs; this can be increased to 60 mcg by ta...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.307.6902.492
更新日期:1993-08-21 00:00:00
abstract:OBJECTIVES:To determine the clinical and radiological features of severe acute respiratory syndrome (SARS) and to evaluate the accuracy of the World Health Organization's guidelines on defining cases of SARS. DESIGN:Prospective observational study. SETTING:A newly set up SARS screening clinic in the emergency departm...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.326.7403.1354
更新日期:2003-06-21 00:00:00
abstract:OBJECTIVES:To examine the individual and combined associations of unhealthy behaviours (low/intermediate physical activity, consuming fruit and vegetables less than once a day, current smoking/short term ex-smoking, never/former/heavy alcohol drinking), assessed at start of follow-up, with hazard of disability among ol...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.f4240
更新日期:2013-07-23 00:00:00
abstract:OBJECTIVE:To determine the implications of variation in mortality associated with use of weapons in different contexts. DESIGN:Literature review. SETTINGS:Armed conflicts and civilian mass shootings, 1929-96. MAIN OUTCOME MEASURE:Mortality from wounds. RESULTS:During the fighting of war the number of people wounded...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.319.7207.407
更新日期:1999-08-14 00:00:00
abstract:OBJECTIVE:To determine patient, institution, and machine characteristics that contribute to variation in radiation doses used for computed tomography (CT). DESIGN:Prospective cohort study. SETTING:Data were assembled and analyzed from the University of California San Francisco CT International Dose Registry. PARTICI...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.k4931
更新日期:2019-01-02 00:00:00
abstract:OBJECTIVE:To investigate the effect of vitamin A supplementation and BCG vaccination at birth in low birthweight neonates. DESIGN:Randomised, placebo controlled, two by two factorial trial. SETTING:Bissau, Guinea-Bissau. PARTICIPANTS:1717 low birthweight neonates born at the national hospital. INTERVENTION:Neonates...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.c1101
更新日期:2010-03-09 00:00:00
abstract::A committee of French bishops has contradicted the Vatican's condemnation of all methods of contraception by acknowledging that condom use may be necessary in order to prevent the spread of HIV and protect against AIDS. The Social Commission of the French Episcopate made this statement in a book entitled AIDS: Societ...
journal_title:BMJ (Clinical research ed.)
pub_type: 新闻
doi:10.1136/bmj.312.7029.462a
更新日期:1996-02-24 00:00:00
abstract:OBJECTIVES:To determine prospectively the rates of change in bone mineral density in elderly people and to examine the relation between lifestyle and demographic factors and these rates of change. DESIGN:Longitudinal population based study. SETTING:Dubbo, New South Wales, Australia. SUBJECTS:Representative sample (n...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:
更新日期:1994-09-17 00:00:00
abstract:OBJECTIVE:To investigate whether users of oral contraceptives and in [corrected] carriers of a hereditary prothrombotic condition (factor V Leiden mutation, protein C, S, or antithrombin deficiency) have an increased risk of cerebral sinus thrombosis. DESIGN:Comparison of a prospective series of cases of cerebral sinu...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.316.7131.589
更新日期:1998-02-21 00:00:00
abstract::The import of the HIV or AIDS epidemic for heterosexuals in Britain is difficult to evaluate at this stage. By June 1988, only 60 cases of heterosexually acquired AIDS are known, out of 1598 reported AIDS cases. Of these, only 6 women and 4 men presumably were infected in Britain, the rest abroad. But, judging from...
journal_title:BMJ (Clinical research ed.)
pub_type: 社论
doi:10.1136/bmj.298.6671.401
更新日期:1989-02-18 00:00:00
abstract:OBJECTIVE:To examine changes in immunisation performance in Grampian region after the introduction of the 1990 contract for general practitioners. DESIGN:Retrospective descriptive study using data held on the Grampian immunisation record system's computer. SETTING:All 95 general practices in Grampian region (313 gene...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6830.816
更新日期:1992-03-28 00:00:00
abstract::The relations among parental reports of respiratory symptoms, bronchospasm measured after exercise, and the presence of visible fungal mould in the home was assessed in a population sample of 7 year old children (n = 873). Wheeze in the past year was the symptom most closely associated with reported dampness and parti...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6658.1223
更新日期:1988-11-12 00:00:00
abstract:OBJECTIVE:To design and evaluate a computer advisory system for the treatment of gestational trophoblastic tumour. DESIGN:A comparison of clinicians' treatment decisions with those of the computer system. Two datasets were used: one to calibrate the system and one to independently evaluate it. SETTING:Department of m...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.305.6857.804
更新日期:1992-10-03 00:00:00
abstract:OBJECTIVE:To determine the association between exposure to radiotherapy for the treatment of prostate cancer and subsequent second malignancies (second primary cancers). DESIGN:Systematic review and meta-analysis of observational studies. DATA SOURCES:Medline and Embase up to 6 April 2015 with no restrictions on year...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.i851
更新日期:2016-03-02 00:00:00
abstract:OBJECTIVE:To assess the effectiveness of teaching general practitioners skills in brief cognitive behaviour therapy. DESIGN:Parallel group, cluster randomised, controlled trial of an educational package on cognitive behaviour therapy. SETTING:General practices in north London. PARTICIPANTS:84 general practitioner pr...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.324.7343.947
更新日期:2002-04-20 00:00:00
abstract:OBJECTIVE:To assess evidence from randomised clinical trials about the effectiveness of extracts of Boswellia serrata (frankincense). DESIGN:Systematic review. DATA SOURCES:Electronic searches on Medline, Embase, Cinahl, Amed, and Cochrane Library. Hand searches of conference proceedings, bibliographies, and departme...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.a2813
更新日期:2008-12-17 00:00:00
abstract:OBJECTIVES:To determine whether measurement of total cholesterol concentration is sufficient to identify most patients at lipoprotein mediated risk of coronary heart disease without measurement of triglyceride and high density lipoprotein (HDL) cholesterol concentrations. DESIGN:Cross sectional screening programme. S...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.301.6752.584
更新日期:1990-09-22 00:00:00
abstract:OBJECTIVE:To characterise the complete case series of influenza A/H7N9 infections as of 27 May 2013, detected by China's national sentinel surveillance system for influenza-like illness. DESIGN:Case series. SETTING:Outpatient clinics and emergency departments of 554 sentinel hospitals across 31 provinces in mainland ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.f3693
更新日期:2013-06-24 00:00:00
abstract:OBJECTIVE:To determine whether diurnal variation occurs in the onset of stroke. DESIGN:Community based study over four years. SETTING:Oxfordshire, United Kingdom. SUBJECTS:105,000 people, of whom 675 had a first ever stroke. 545 had a cerebral infarction, 66 had primary intracerebral haemorrhage, 33 had subarachnoid...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6820.155
更新日期:1992-01-18 00:00:00
abstract:OBJECTIVE:To investigate the relation between total fat intake and body weight in adults and children. DESIGN:Systematic review and meta-analysis of randomised controlled trials and cohort studies. DATA SOURCES:Medline, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials to June 2010. INCLUSION CR...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.e7666
更新日期:2012-12-06 00:00:00
abstract:OBJECTIVE:To compare the effectiveness of manipulative therapy, physiotherapy, treatment by the general practitioner, and placebo therapy in patients with persistent non-specific back and neck complaints. DESIGN:Randomised clinical trial. SETTING:Primary health care in the Netherlands. PATIENTS:256 patients with non...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.304.6827.601
更新日期:1992-03-07 00:00:00