Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis

Abstract BACKGROUND Studies have shown that self-monitoring of blood pressure (BP) is effective when combined with co-interventions, but its efficacy varies in the presence of some co-morbidities. This study examined whether self-monitoring can reduce clinic BP in patients with hypertension-related...

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Published in:American journal of hypertension Vol. 33; no. 3; pp. 243 - 251
Main Authors: Sheppard, J P, Tucker, K L, Davison, W J, Stevens, R, Aekplakorn, W, Bosworth, H B, Bove, A, Earle, K, Godwin, M, Green, B B, Hebert, P, Heneghan, C, Hill, N, Hobbs, F D R, Kantola, I, Kerry, S M, Leiva, A, Magid, D J, Mant, J, Margolis, K L, McKinstry, B, McLaughlin, M A, McNamara, K, Omboni, S, Ogedegbe, O, Parati, G, Varis, J, Verberk, W J, Wakefield, B J, McManus, R J
Format: Journal Article
Language:English
Published: US Oxford University Press 13.03.2020
Subjects:
Aged
Aged, 80 and over
Blood Pressure
Blood Pressure Monitoring, Ambulatory
Female
Humans
Hypertension - diagnosis
Hypertension - epidemiology
Hypertension - physiopathology
Hypertension - therapy
Male
Middle Aged
Multimorbidity
Predictive Value of Tests
Prognosis
Randomized Controlled Trials as Topic
Risk Factors
Self Care
Time Factors
blood pressure
coronary heart disease
diabetes
hypertension
stroke
obesity
randomized controlled trial
ISSN:0895-7061, 1941-7225, 1941-7225
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Summary:Abstract BACKGROUND Studies have shown that self-monitoring of blood pressure (BP) is effective when combined with co-interventions, but its efficacy varies in the presence of some co-morbidities. This study examined whether self-monitoring can reduce clinic BP in patients with hypertension-related co-morbidity. METHODS A systematic review was conducted of articles published in Medline, Embase, and the Cochrane Library up to January 2018. Randomized controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorized by whether they examined a low/high-intensity co-intervention. Change in BP and likelihood of uncontrolled BP at 12 months were examined according to number and type of hypertension-related co-morbidity in a one-stage IPD meta-analysis. RESULTS A total of 22 trials were eligible, 16 of which were able to provide IPD for the primary outcome, including 6,522 (89%) participants with follow-up data. Self-monitoring was associated with reduced clinic systolic BP compared to usual care at 12-month follow-up, regardless of the number of hypertension-related co-morbidities (−3.12 mm Hg, [95% confidence intervals −4.78, −1.46 mm Hg]; P value for interaction with number of morbidities = 0.260). Intense interventions were more effective than low-intensity interventions in patients with obesity (P < 0.001 for all outcomes), and possibly stroke (P < 0.004 for BP control outcome only), but this effect was not observed in patients with coronary heart disease, diabetes, or chronic kidney disease. CONCLUSIONS Self-monitoring lowers BP regardless of the number of hypertension-related co-morbidities, but may only be effective in conditions such obesity or stroke when combined with high-intensity co-interventions.
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ISSN:0895-7061
1941-7225
1941-7225
DOI:10.1093/ajh/hpz182