Katrin Uhlig, MD, MS; Kamal Patel, MPH, MBA; Stanley Ip, MD; Georgios D. Kitsios, MD, MS, PhD; Ethan M. Balk, MD, MPH
Disclaimer: The findings and conclusions in this article are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this article should be construed as an official position of AHRQ.
Acknowledgment: The authors thank Esther Avendano, BA, for help with manuscript preparation.
Grant Support: By AHRQ (contract HHSA 290 2007 10055-I 1 to the Tufts Evidence-Based Practice Center).
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-3156.
Requests for Single Reprints: Katrin Uhlig, MD, MS, Tufts Medical Center, Box 391, 800 Washington Street, Boston, MA 02111.
Current Author Addresses: Dr. Uhlig: Tufts Medical Center, Box 391, 800 Washington Street, Boston, MA 02111.
Drs. Patel, Ip, and Balk: Tufts Medical Center, Box 63, 800 Washington Street, Boston, MA 02111.
Dr. Kitsios: Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805.
Author Contributions: Conception and design: K. Uhlig, K. Patel, S. Ip, G.D. Kitsios, E.M. Balk.
Analysis and interpretation of the data: K. Uhlig, K. Patel, S. Ip, G.D. Kitsios, E.M. Balk.
Drafting of the article: K. Uhlig, G.D. Kitsios, E.M. Balk.
Critical revision of the article for important intellectual content: K. Uhlig, S. Ip, G.D. Kitsios, E.M. Balk.
Final approval of the article: K. Uhlig, S. Ip, G.D. Kitsios, E.M. Balk.
Statistical expertise: K. Uhlig, S. Ip, G.D. Kitsios, E.M. Balk.
Obtaining of funding: K. Uhlig, E.M. Balk.
Administrative, technical, or logistic support: K. Uhlig, K. Patel.
Collection and assembly of data: K. Uhlig, K. Patel, S. Ip, G.D. Kitsios, E.M. Balk.
Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Self-Measured Blood Pressure Monitoring in the Management of Hypertension: A Systematic Review and Meta-analysis. Ann Intern Med. 2013;159:185-194. doi: 10.7326/0003-4819-159-3-201308060-00008
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Published: Ann Intern Med. 2013;159(3):185-194.
Clinical guidelines recommend that adults with hypertension self-monitor their blood pressure (BP).
To summarize evidence about the effectiveness of self-measured blood pressure (SMBP) monitoring in adults with hypertension.
MEDLINE (inception to 8 February 2013) and Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (fourth quarter 2012).
52 prospective comparative studies of SMBP monitoring with or without additional support versus usual care or an alternative SMBP monitoring intervention in persons with hypertension.
Data on population, interventions, BP, other outcomes, and study method were extracted. Random-effects model meta-analyses were done.
For SMBP monitoring alone versus usual care (26 comparisons), moderate-strength evidence supports a lower BP with SMBP monitoring at 6 months (summary net difference, −3.9 mm Hg and −2.4 mm Hg for systolic BP and diastolic BP) but not at 12 months. For SMBP monitoring plus additional support versus usual care (25 comparisons), high-strength evidence supports a lower BP with use of SMBP monitoring, ranging from −3.4 to −8.9 mm Hg for systolic BP and from −1.9 to −4.4 mm Hg for diastolic BP, at 12 months in good-quality studies. For SMBP monitoring plus additional support versus SMBP monitoring alone or with less intense additional support (13 comparisons), low-strength evidence fails to support a difference. Across all comparisons, evidence for clinical outcomes is insufficient. For other surrogate or intermediate outcomes, low-strength evidence fails to show differences.
Clinical heterogeneity in protocols for SMBP monitoring, additional support, BP targets, and management; follow-up of 1 year or less in most studies, with sparse clinical outcome data.
Self-measured BP monitoring with or without additional support lowers BP compared with usual care, but the BP effect beyond 12 months and long-term benefits remain uncertain. Additional support enhances the BP-lowering effect.
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Cardiology, Nephrology, Hypertension, Coronary Risk Factors.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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