Blood pressure control by home monitoring: meta-analysis of randomised trials

Abstract

Objective To determine the effect of home blood pressure monitoring on blood pressure levels and proportion of people with essential hypertension achieving targets. Design Meta-analysis of 18 randomised controlled trials. Participants 1359 people with essential hypertension allocated to home blood pressure monitoring and 1355 allocated to the "control" group seen in the healthcare system for 2-36 months. Main outcome measures Differences in systolic (13 studies), diastolic (16 studies), or mean (3 studies) blood pressures, and proportion of patients achieving targets (6 studies), between intervention and control groups. Results Systolic blood pressure was lower in people with hypertension who had home blood pressure monitoring than in those who had standard blood pressure monitoring in the healthcare system (standardised mean difference 4.2 (95% confidence interval 1.5 to 6.9) mm Hg), diastolic blood pressure was lower by 2.4 (1.2 to 3.5) mm Hg, and mean blood pressure was lower by 4.4 (2.0 to 6.8) mm Hg. The relative risk of blood pressure above predetermined targets was lower in people with home blood pressure monitoring (risk ratio 0.90, 0.80 to 1.00). When publication bias was allowed for, the differences were attenuated: 2.2 ( − 0.9 to 5.3) mm Hg for systolic blood pressure and 1.9 (0.6 to 3.2) mm Hg for diastolic blood pressure. Conclusions Blood pressure control in people with hypertension (assessed in the clinic) and the proportion achieving targets are increased when home blood pressure monitoring is used rather than standard blood pressure monitoring in the healthcare system. The reasons for this are not clear. The difference in blood pressure control between the two methods is small but likely to contribute to an important reduction in vascular complications in the hypertensive population.

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

“…146 There was some evidence that involving hypertensive patients in monitoring promoted empowerment, resulting in the 'activated patient' and improved blood pressure control. 147 Visible self-monitoring of blood pressure was shown to improve blood pressure control, 69,[148][149][150] particularly when combined with remote monitoring by HCPs at a distance. 148,151 The visibility created by monitoring has been shown to enable reinforcement of information 118,120,121 and of symptom and self-management 106,109,114 and behaviour changes.…”

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

“…Thus, certain possibly relevant reviews, such as Capuccio et al's review of self-monitoring of BP, 178 were excluded as they did not fit this ethos. Where unidimensional interventions, such as drug reminders, were presented as part of mixed reviews, we did include them for further analysis as the focus of the overall review was multifaceted.…”

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“…5 The availability of validated electronic blood pressure monitors allows patients to self-monitor at home, and this has been associated with improved blood pressure control. 6,7 However, no studies of selfmonitoring have been performed specifically in stroke patients, who may have practical difficulties through disability, but who also may have high motivation to control their blood pressure to avoid another stroke.…”