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 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.

Home blood pressure monitoring in France: Device possession rate and associated determinants, the Esteban study

“…37 In previous studies, HBPM had a marginal effect on BP when used in the absence of other interventions such as patient education, counseling by nurses or pharmacists, and telecounseling. 33,38,39 Finally, interventional studies showed that HBPM was not associated with improved BP control in patients with frequent medical visits. 40 Home blood pressure monitoring is already considered a better predictor of cardiovascular risk than clinical measurements.…”

Evidence and Recommendations on the Use of Telemedicine for the Management of Arterial Hypertension

“…However, these studies did not provide any significant evidence to support the superiority of telemedicine for BP management in these patients. A recently published metaanalysis [50] investigated whether the effectiveness of self-monitoring of BP combined with a cointervention, including telemonitoring, varied by co-morbidity. Self-monitoring of BP combined with intense co-interventions was more effective than low-intensity self-monitoring in patients with obesity and possibly stroke, but not in patients with coronary artery disease, diabetes, or CKD.…”

The Telehealth Ten: A Guide for a Patient-Assisted Virtual Physical Examination

“…While some patients omit writing down the heart rate, it is essential in determining whether a significant postural decrease in BP is associated with a compensatory increase in heart rate or not, which can be an early clue to autonomic causes of orthostatic hypotension. 5 , 6 Temperature checks and pulse oximeter readings are especially useful in identifying patients in whom COVID-19 might be suspected. The patient can be guided through these measurements by a medical assistant or nurse prior to the virtual visit.…”