Does home blood pressure monitoring improve patient outcomes? A systematic review comparing home and ambulatory blood pressure monitoring on blood pressure control and patient outcomes

Abstract

ObjectiveOur objective was to compare the clinical effectiveness of home blood pressure monitoring (HBPM) and 24-hour ambulatory blood pressure monitoring (ABPM) on blood pressure (BP) control and patient outcomes.DesignA systematic review was conducted. We also appraised the methodological quality of studies.Data sourcesPubMed, Scopus, CINAHL, and the Cochrane Central Register of Control Trials (CENTRAL).Inclusion criteriaRandomized control trials, prospective and retrospective cohort studies, observational studies, and case-control studies published in English from any year to present that describe HBPM and 24-hour ABPM and report on systolic and/or diastolic BP and/or heart attack, stroke, kidney failure and/or all-cause mortality for adult patients. Due to the nature of the question, studies with only untreated patients were not considered.ResultsOf 1,742 titles and abstractions independently reviewed by two reviewers, 137 studies met predetermined criteria for evaluation. Nineteen studies were identified as relevant and included in the paper. The common themes were that HBPM and ABPM correlated with cardiovascular events and mortality, and targeting HBPM or ABPM resulted in similar outcomes. Associations between BP measurement type and mortality differed by study population. Both the low sensitivity of office blood pressure monitoring (OBPM) to detect optimal BP control by ABPM and the added association of HBPM with cardiovascular mortality supported the routine use of HBPM in clinical practice. There was insufficient data to determine the benefit of using HBPM as a measurement standard for BP control.ConclusionHBPM encourages patient-centered care and improves BP control and patient outcomes. Given the limited number of studies with both HBPM and ABPM, these measurement types should be incorporated into the design of randomized clinical trials within hypertensive populations.

Ambulatory and home blood pressure monitoring: gaps between clinical guidelines and clinical practice in Singapore

“…However, some believe that HBPM should be the monitoring tool of choice and that this should take the leading role in hypertension management 13. The findings of a meta-analysis looking at the association between BP determined using HBPM or ABPM and mortality support guideline recommendations to include HBPM for clinical practice management of patients with hypertension 15. In addition, HBPM has been shown to improve BP control16 and adherence to antihypertensive medication 17.…”

The use of ambulatory blood pressure monitoring to confirm a diagnosis of high blood pressure by primary-care physicians in Oregon

“…Home blood pressure monitoring could be incorporated into the diagnosis and management of hypertension [42] in the absence of ambulatory blood pressure monitoring.…”

Recommendations for home blood pressure monitoring in Latin American countries: A Latin American Society of Hypertension position paper

“…Moreover, in patients with chronic kidney disease followed over a mean of 3.5 years, HBP was a stronger predictor of end‐stage renal disease or death compared with BP values obtained in the clinic . The predictive value of HBPM on outcome has also been compared to that of ABPM in a systematic review summarizing available studies . Conclusion of this analysis was that HBPM and ABPM correlated similarly with cardiovascular events and mortality.…”