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

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 and McManus, R J (2020) Self-monitoring of blood pressure in patients with hypertension related multi-morbidity:Systematic review and individual patient data meta-analysis. American Journal of Hypertension, 33 (3). 243–251. ISSN 0895-7061

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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.

Item Type: Article
Additional Information: © The Author(s) 2019. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd.
Uncontrolled 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
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 03 Dec 2019 02:13
Last Modified: 23 May 2020 00:00
URI: https://ueaeprints.uea.ac.uk/id/eprint/73243
DOI: 10.1093/ajh/hpz182

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