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

Abstract

BackgroundSelf-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 findingsMedline, 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 IPD were provided from 25 trials, including 1 unpublished study.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.ConclusionsSelf-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.

Home blood pressure telemonitoring in the 21st century

“…In the various studies included in the meta‐analyses, the effect of BPT in conjunction with cointervention (including for instance medication titration by a case manager, education or lifestyle counseling) led to significantly larger and persistent (up to 12 months) BP reductions than self–BP monitoring alone without transmission of BP data and counseling, suggesting a possible additional effect of the BPT approach beyond self–BP monitoring …”

Development and Preliminary Feasibility of an Automated Hypertension Self-Management System

“…Blood pressure self-monitoring may increase patient’s daily awareness of his or her BP and provide feedback that improves adherence to BP-lowering health behaviors and overall hypertension management 9,22,23 . Current trials using web/mobile technologies to support blood pressure self-monitoring are identifying design features that may increase blood pressure reduction achieved by blood pressure self-monitoring 24 .…”

Attitudes towards telemedicine in pregnancy monitoring: A questionnaire survey among health care professionals in Germany (Preprint)

“…The willingness of expectant mothers to engage in these forms of pregnancy monitoring is well established [22]. At the same time, self-monitoring of blood pressure in hypertension reduces blood pressure significantly in conjunction with co-interventions [39]. Equally, self-care of heart failure via telemonitoring improves quality of life [40].…”