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PLoS Med. 2017 Sep 19;14(9):e1002389. doi: 10.1371/journal.pmed.1002389. eCollection 2017 Sep.

Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis.

Author information

1
Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom.
2
Center for Health Services Research in Primary Care, Durham VAMC, Durham, North Carolina, United States of America.
3
Cardiology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States of America.
4
School of Psychology, University of Central Lancashire, Preston, United Kingdom.
5
Thomas Addison Diabetes Unit, St. George's NHS Trust, London, United Kingdom.
6
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia.
7
Family Medicine, Memorial University of Newfoundland, St. John's, Canada.
8
Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States of America.
9
Department of Health Services, University of Washington School of Public Health, Seattle, Washington, United States of America.
10
Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland.
11
Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom.
12
Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, Mallorca, Spain.
13
Colorado School of Public Health, University of Colorado, Denver, Colorado, United States of America.
14
Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
15
HealthPartners Institute for Education and Research, Minneapolis, Minnesota, United States of America.
16
Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom.
17
Icahn School of Medicine at Mount Sinai New York, New York, New York, United States of America.
18
Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy.
19
Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, Langone School of Medicine, New York University, New York, New York, United States of America.
20
Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy.
21
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
22
Primary Care Clinical Sciences, University of Birmingham, Birmingham, United Kingdom.
23
Division of Prevention and Primary Care, New York City Department of Health & Mental Hygiene, New York, New York, United States of America.
24
Cardiovascular Research Institute Maastricht and Departments of Internal Medicine, Maastricht University, Maastricht, the Netherlands.
25
Department of Veterans (VA) Health Services Research and Development Centre for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Centre, University of Iowa, Iowa, United States of America.

Abstract

BACKGROUND:

Self-monitoring of blood pressure (BP) appears to reduce BP in hypertension but important questions remain regarding effective implementation and which groups may benefit most. This individual patient data (IPD) meta-analysis was performed to better understand the effectiveness of BP self-monitoring to lower BP and control hypertension.

METHODS AND FINDINGS:

Medline, Embase, and the Cochrane Library were searched for randomised trials comparing self-monitoring to no self-monitoring in hypertensive patients (June 2016). Two reviewers independently assessed articles for eligibility and the authors of eligible trials were approached requesting IPD. Of 2,846 articles in the initial search, 36 were eligible. IPD were provided from 25 trials, including 1 unpublished study. Data for the primary outcomes-change in mean clinic or ambulatory BP and proportion controlled below target at 12 months-were available from 15/19 possible studies (7,138/8,292 [86%] of randomised participants). Overall, self-monitoring was associated with reduced clinic systolic blood pressure (sBP) compared to usual care at 12 months (-3.2 mmHg, [95% CI -4.9, -1.6 mmHg]). However, this effect was strongly influenced by the intensity of co-intervention ranging from no effect with self-monitoring alone (-1.0 mmHg [-3.3, 1.2]), to a 6.1 mmHg (-9.0, -3.2) reduction when monitoring was combined with intensive support. Self-monitoring was most effective in those with fewer antihypertensive medications and higher baseline sBP up to 170 mmHg. No differences in efficacy were seen by sex or by most comorbidities. Ambulatory BP data at 12 months were available from 4 trials (1,478 patients), which assessed self-monitoring with little or no co-intervention. There was no association between self-monitoring and either lower clinic or ambulatory sBP in this group (clinic -0.2 mmHg [-2.2, 1.8]; ambulatory 1.1 mmHg [-0.3, 2.5]). Results for diastolic blood pressure (dBP) were similar. The main limitation of this work was that significant heterogeneity remained. This was at least in part due to different inclusion criteria, self-monitoring regimes, and target BPs in included studies.

CONCLUSIONS:

Self-monitoring alone is not associated with lower BP or better control, but in conjunction with co-interventions (including systematic medication titration by doctors, pharmacists, or patients; education; or lifestyle counselling) leads to clinically significant BP reduction which persists for at least 12 months. The implementation of self-monitoring in hypertension should be accompanied by such co-interventions.

PMID:
28926573
PMCID:
PMC5604965
DOI:
10.1371/journal.pmed.1002389
[Indexed for MEDLINE]
Free PMC Article

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