Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis. (15th November 2019)

• Record Type: Journal Article
• Authors: Sheppard, J P; Tucker, K L; Davison, W J; Stevens, R; Aekplakorn, W; Bosworth, H B; Bove, A; Earle, K; Godwin, M; Green, B B; Hebert, P; Heneghan, C; Hill, N; Hobbs, F D R; Kantola, I; Kerry, S M; Leiva, A; Magid, D J; Mant, J; Margolis, K L; McKinstry, B; McLaughlin, M A; McNamara, K; Omboni, S; Ogedegbe, O; Parati, G; Varis, J; Verberk, W J; Wakefield, B J; McManus, R J
• Is Part Of: American journal of hypertension. Volume 33:Number 3(2020)
• Page Start: 243
• Page End: 251
• Publication Date: 2019-11-15
• Subjects: blood pressure -- coronary heart disease -- diabetes -- hypertension -- obesity -- randomized controlled trial -- stroke; Hypertension -- Periodicals; 616.132005
• DOI: 10.1093/ajh/hpz182
• Languages: English
• ISSNs: 0895-7061

Abstract

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.