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

Summary

Background Self-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 findings Medline, 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 IPD were provided from 25 trials, including 1 unpublished study.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. Conclusions Self-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.

Related articles

• History and Development of Medical Technology in the Philippines

  This document provides a comprehensive overview of the history and evolution of medical technology in the Philippines, particularly during the Spanish and American occupations. It details the establishment of hospitals, key figures in medical advancements, and the development of public health initiatives.

• Functions of Management in Medical Laboratory Settings

  This document outlines the functions of management within a medical laboratory context, detailing key management principles such as planning, organizing, directing, and controlling, along with their applications in laboratory operations.

• Inflammation and Repair

  This chapter provides an overview of inflammation, defining its features and discussing the sequential steps involved, including recognition of harmful agents, recruitment of immune cells, and the process of tissue repair. It examines both acute and chronic inflammation, including their causes, mediators, and clinical implications.

• Overview of Radiographic Imaging Techniques

  This document presents personal notes detailing the principles and techniques of radiographic imaging, including the operation of X-ray equipment, technical competencies of radiographers, and the anatomy of the X-ray tube. It aims to provide a comprehensive understanding of radiography as both an art and science.

• IMAGE PRODUCTION & FILM PROCESSING

  This document provides comprehensive guidelines for the dark room processes involved in radiography, including the environmental controls, required equipment, and procedures for efficient film processing.