Can you self-titrate your blood pressure drugs?

An alarmingly high number of people with high blood pressure — up to 75% — don't have the condition under control. This glaring problem has many causes, but a few themes rise to the top (see "Uncontrolled high blood pressure: Why so common?"). Also called hypertension, it's is a leading cause of heart attacks and strokes.

Could getting people more actively involved in reaching their blood pressure targets help? Possibly, according to a study of people who self-adjusted their medications based on home monitoring results. Compared to people who received routine care for their poorly controlled hypertension, those in the self-adjustment group, guided by doctors, had lower blood pressure values at the end of the two-year study.

But the study, published May 10, 2024, in JAMA Network Open, has some limitations, says Dr. Naomi D.L. Fisher, director of the Hypertension Service at Harvard-affiliated Brigham and Women's Hospital. For example, both groups experienced an average drop of around 20 points in their systolic blood pressure, the first number in a reading. "That fall is far greater than we'd expect in a control group who received routine care. It's also greater than expected from adding one medication, suggesting that other factors influenced the findings," she says. Sometimes, knowing you're being closely watched (as trial participants are) spurs you toward healthier habits.

Home monitoring benefits

Still, the findings help highlight the value of monitoring blood pressure at home. These pressures are better at predicting your risk of heart attack and stroke than office blood pressure readings, Dr. Fisher says. "Blood pressure is very dynamic and can easily vary by 20 points within a given day. By taking multiple blood pressure readings in a systematic way over the course of a week, we can reduce the challenge of variability," she says.

Usually, that means taking your blood pressure twice in the morning and twice in the evening, for one week. (For tips on choosing and using a home blood pressure monitor, see the June 2024 Heart Letter "Device of the month" column.) The duplicate readings should be done in succession and before taking any blood pressure drugs.

Of course, just checking your blood pressure at home isn't enough — there has to be another intervention. Simply waiting until your next doctor's appointment to get feedback and a dose adjustment may take a while, which is why health care systems throughout the country (including Brigham and Women's Hospital) have been exploring more efficient ways to track and treat people with high blood pressure.

"We've had tremendous success using remote monitoring and algorithmic care to manage hypertension," says Dr. Fisher. Patients receive a home blood pressure device that automatically transmits their readings to the hospital. A computer program averages a weekly set of blood pressures to determine if their medication regimen needs adjusting. The program can access relevant health conditions for each person from the electronic medical record, which allows for customized advice and avoids safety issues. Patient navigators call each person to relay and discuss all titration instructions.

What you can do

If you have high blood pressure, make sure you know your target blood pressure (ask your doctor if you don't). Check your blood pressure for a few days with a home monitor to make sure you're close to your goal. If your readings are high, continue checking for a full week and calculate an average of all 28 readings. Still above target? Contact your doctor's office for advice, which may include reviewing your readings and providing guidance for self-adjusting your medications.

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