Self-monitoring of blood pressure in patients with hypertension related multi-morbidity: Systematic review and individual patient data meta-analysis

J P Sheppard, K L Tucker, W J Davison, R Stevens, W Aekplakorn, H B Bosworth, A Bove, K Earle, M Godwin, B B Green, P Hebert, C Heneghan, N Hill, F D R Hobbs, I Kantola, S M Kerry, A Leiva, D J Magid, J Mant, K L MargolisB McKinstry, M A McLaughlin, K McNamara, S Omboni, O Ogedegbe, G Parati, J Varis, W J Verberk, B J Wakefield, R J McManus

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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.

Original languageEnglish
Pages (from-to)243–251
Number of pages9
JournalAmerican Journal of Hypertension
Volume33
Issue number3
Early online date15 Nov 2019
DOIs
Publication statusPublished - Mar 2020

Keywords

  • CLINICAL INERTIA
  • CONTROLLED-TRIAL
  • DISEASE
  • INTERVENTION
  • MANAGEMENT
  • MULTIMORBIDITY
  • PREVALENCE
  • PRIMARY-CARE
  • TELEMEDICINE
  • URBAN
  • blood pressure
  • coronary heart disease
  • diabetes
  • hypertension
  • obesity
  • randomized controlled trial
  • stroke

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