Table AIdentified evidence gaps organized by relevant Key Question and PICOD element

Key QuestionCategoryEvidence Gaps (Code*)
Key Question 1. In people with hypertension (adults and children), does SMBP, compared to usual care or other interventions without SMBP, have an effect on clinically important outcomes?

Key Question 1a. How does SMBP monitoring compare to usual care or other interventions without SMBP in its effect on relevant clinical outcomes (cardiovascular events, mortality, patient satisfaction, quality of life, and adverse events related to antihypertensive agents)?

Key Question 1b. How does SMBP compare to usual care or other interventions without SMBP in its effect on relevant surrogate outcomes (cardiac measures: LVH, LVM, LVMI)* and intermediate outcomes BP control, BP treatment adherence, or health care process measures)?
PopulationUnclear if treatments or treatment goals differ if a patient has uncontrolled hypertension, white coat hypertension, or masked hypertension (1P1)
Unclear if effects from SMBP differ in subgroups, for example older patients, those with comorbidities, and minorities (1P2)
Intervention/ComparatorUnclear what the BP treatment goals should be for home BP in relation to clinic BP (1I1)
Unclear how to compare findings across studies, as different studies use different protocols for SMBP, different additional support and different care in the control groups (1I2)
Unclear what the best practice protocol would be for SMBP (1I3)
Unclear what the adherence is to SMBP protocols or devices in the long-term (1I4)
Unclear how the effect of SMBP can be enhanced by particular additional support (1I5)
OutcomesUnclear what the effects are of SMBP on clinical event outcomes, i.e., after longer followup periods (1O1)
Unclear if the effect of SMBP is sustained beyond 1-2 years (1O2)
Unclear what the effect of SMBP is on patient understanding of disease, and how this correlates with attitudes towards and participation in disease management, medication adherence and BP control (1O3)
DesignN/A
Key Question 2. In trials of SMBP monitoring, how do clinical, surrogate, and intermediate outcomes (including SMBP adherence) vary by the type of additional support provided?PopulationN/A
Intervention/ComparatorUnclear what the optimal additional support is for facilitating patient-provider interaction, and medication management including telemedicine (2I)
OutcomesN/A
DesignN/A
Key Question 3. How do different devices for SMBP monitoring compare with each other (specifically semiautomatic or automatic versus manual) in their effects on clinical, surrogate, and intermediate outcomes (including SMBP adherence)?PopulationN/A
Intervention/ComparatorUnclear if the device type impacts adherence, BP control and outcomes (3I)
OutcomesN/A
DesignN/A
Key Question 4. In trials of SMBP monitoring, how does achieving BP control relate to clinical and surrogate outcomes?PopulationN/A
Intervention/ComparatorN/A
OutcomesUnclear what the link is between achieving BP control and clinical outcomes (4O)
DesignNeed for longer term follow up (4D)
Key Question 5. How does adherence with SMBP vary by patient factors?PopulationN/A
PredictorUnclear how patient characteristics, such as demographic and psychosocial variables, affect adherence to SMBP (5P)
OutcomesNeed for validated outcome measures of adherence with SMBP (5O)
DesignN/A

Abbreviations: BP=blood pressure; N/A=not applicable; SMBP=self-measured blood pressure monitoring

*

The parenthetical alphanumeric code is used to label each evidence gap on the analytic framework (Figure A). The first number of the alphanumeric code corresponds to the Key Question, the following letter to the PICOD category, and the final numeral to distinguish among multiple gaps within the same Key Question and Domain (if applicable). Where there is only one gap identified, the last number is dropped.

From: Executive Summary

Cover of Self-Measured Blood Pressure: Future Research Needs
Self-Measured Blood Pressure: Future Research Needs: Identification of Future Research Needs From Comparative Effectiveness Review No. 45 [Internet].
Future Research Needs Papers, No. 16.
Uhlig K, Patel K, Concannon TW, et al.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.