Does home blood pressure monitoring improve blood pressure‐related outcomes in people living with chronic kidney disease? A systematic review

Abstract

High blood pressure is an important risk factor for cardiovascular disease and disease progression in chronic kidney disease (CKD). Evidence on the effects of home blood pressure monitoring (HBPM) is limited. This review aimed to determine the effect of HBPM on systolic (SBP) and diastolic blood pressure (DBP) in patients with CKD. We searched medical literature databases for eligible studies presenting pre‐ and post‐data for interventions utilizing HBPM. Study quality was assessed using the NHLBI tools for quality assessment. Heterogeneity prohibited a meta‐analysis so estimates of effects were calculated along a sign test to examine the probability of observing the given pattern of positive effect direction. Eighteen studies were included (n = 1187 participants, mean age 56.7 [± 7.7] years). In 15 studies, HBPM was conducted within the context of additional high‐level tailored support. Overall, the quality of n = 7/18 studies was rated as “good”; n = 6/18 were “fair,” and n = 5/18 were rated as “poor.” Interventions utilizing HBPM had a significant effect on SBP, with 14/16 studies favoring the intervention (88% [95% CI: 62%–98%], P = .002). Favorable effects were also seen on DBP (73% [95% CI: 45%–92%], P = .059). HBPM had a favorable effect on blood pressure goal attainment (86% [95% CI: 42%–100%], P = .062). HBPM in patients with CKD as part of a multicomponent intervention may lead to clinically significant reductions in blood pressure; however, research is needed to support the validity of this claim due to the high heterogeneity across the studies included.