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IMPROVING PATIENT CARE

Self-Measured Blood Pressure Monitoring in the Management of Hypertension: A Systematic Review and Meta-analysis

Katrin Uhlig, MD, MS; Kamal Patel, MPH, MBA; Stanley Ip, MD; Georgios D. Kitsios, MD, MS, PhD; and Ethan M. Balk, MD, MPH
[+] Article and Author Information

From the Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, and Lahey Hospital and Medical Center, Burlington, Massachusetts.

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.


Ann Intern Med. 2013;159(3):185-194. doi:10.7326/0003-4819-159-3-201308060-00008
Text Size: A A A

Background: Clinical guidelines recommend that adults with hypertension self-monitor their blood pressure (BP).

Purpose: To summarize evidence about the effectiveness of self-measured blood pressure (SMBP) monitoring in adults with hypertension.

Data Sources: MEDLINE (inception to 8 February 2013) and Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (fourth quarter 2012).

Study Selection: 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 Extraction: Data on population, interventions, BP, other outcomes, and study method were extracted. Random-effects model meta-analyses were done.

Data Synthesis: 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.

Limitation: 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.

Conclusion: 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.

Primary Funding Source: Agency for Healthcare Research and Quality.

Figures

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Appendix Figure.

Summary of evidence search and selection.

SMBP = self-measured blood pressure.

* Several studies include multiple comparisons of interest.

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Figure 1.

SMBP monitoring versus usual care for continuous clinic BP.

Net change of systolic (black circles) and diastolic (white circles) BP, with separate meta-analyses and P values and I2 estimates, at different follow-ups. BP = blood pressure; ND = no data; NS = not significant; SMBP = self-measured blood pressure.

* Study provided data at multiple time points.

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Figure 2.

SMBP monitoring plus additional support versus usual care for continuous clinic BP at 3- and 6-month follow-up.

Net change of systolic (black circles) and diastolic (white circles) BP at different follow-ups. See Appendix Table 2 for full descriptions of letters in square brackets: C (counseling), E (education), W (Web-based), and M (miscellaneous). BP = blood pressure; counsel = counseling; mgt = management; monitor = monitoring; ND = no data; Rx = medication; SMBP = self-measured blood pressure; tele = telemedicine.

* Study provided data at multiple time points.

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Figure 3.

SMBP monitoring plus additional support versus usual care for continuous clinic BP at 12- to 60-month follow-up.

Net change of systolic (black circles) and diastolic (white circles) BP at different follow-ups. See Appendix Table 2 for full descriptions of letters in square brackets: C (counseling), E (education), W (Web-based), and M (miscellaneous). BP = blood pressure; counsel = counseling; mgt = management; monitor = monitoring; Rx = medication; SMBP = self-measured blood pressure.

* Study provided data at multiple time points. † References (52) and (54) are the same trial at different time points.

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Figure 4.

SMBP monitoring plus additional support versus a less intense SMBP monitoring intervention for continuous clinic BP.

Net change of systolic (black circles) and diastolic (white circles) BP. See Appendix Table 2 for full descriptions of letters in square brackets: C (counseling), E (education), W (Web-based), and M (miscellaneous). AS = additional support; BP = blood pressure; counsel = counseling; mgt = management; monitor = monitoring; ND = no data; Rx = medication; SMBP = self-measured blood pressure.

* Study provided data at multiple time points.

† Comparison is SMBP monitoring plus medication management vs. SMBP monitoring plus behavioral management.

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