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Meta-Analysis
. 2017 Sep 19;14(9):e1002389.
doi: 10.1371/journal.pmed.1002389. eCollection 2017 Sep.

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

Katherine L Tucker  1 , James P Sheppard  1 , Richard Stevens  1 , Hayden B Bosworth  2 , Alfred Bove  3 , Emma P Bray  4 , Kenneth Earle  5 , Johnson George  6 , Marshall Godwin  7 , Beverly B Green  8 , Paul Hebert  9 , F D Richard Hobbs  1 , Ilkka Kantola  10 , Sally M Kerry  11 , Alfonso Leiva  12 , David J Magid  13 , Jonathan Mant  14 , Karen L Margolis  15 , Brian McKinstry  16 , Mary Ann McLaughlin  17 , Stefano Omboni  18 , Olugbenga Ogedegbe  19 , Gianfranco Parati  20   21 , Nashat Qamar  22 , Bahman P Tabaei  23 , Juha Varis  10 , Willem J Verberk  24 , Bonnie J Wakefield  25 , Richard J McManus  1
Affiliations
Meta-Analysis

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

Katherine L Tucker et al. PLoS Med. .

Abstract

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 IPD were provided from 25 trials, including 1 unpublished study.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.

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Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: RJM has received research funding in terms of blood pressure monitors from Omron and Lloyds Healthcare; has received expenses and an honorarium from the Japanese Society of Hypertension and American Society of Nephrology. WJV is now employed by Microlife but was not at the time that the data contributed were collected. FDRH has in the past received limited free or subsidised BP measuring devices from Microlife and Omron to support hypertension research where there was no input from the companies to the design, funding, delivery, analysis, or interpretation of that research. SO is a consultant of Biotechmed Ltd. (provider of blood pressure telemonitoring services). SK has received research funding in terms of blood pressure monitors from Omron. HBB has received grant funding to Duke University from Sanofi, Johnson and Johnson, Takeda, WestMeadVaco, and Improved patient Outcome; has received an honorarium from Walgreens, Genentech, Sanofi; and has received funds for consulting for Sanofi. JPS received an MRC Strategic Skills Postdoctoral Fellowship (2013-2016) and now receives funding from the NIHR Oxford Collaborations for Leadership in Applied Health Research and Care. AB owns stocks in Insight Telehealth Systems LLC. MG received a research grant from the Heart and Stroke Foundation of Ontario prior to this work to conduct a study on self-monitoring of blood pressure, data from which are included in this meta-analysis. JG has held unrestricted investigator initiated grants from Pfizer and Boehringer-Ingelheim (BI) for unrelated research; is a member of the Lung Foundation Australia's (LFA) COPD-X guidelines committee. Pfizer, BI, or LFA did not have any role in my decision to participate in the work submitted by Tucker et al. IK has received travel grants and honoraria for speaking or participation at meetings from Sanofi-Genzyme and Shire concerning Fabry disease; has participated in clinical studies concerning diabetic nephropathy and hyperlipidemia sponsored by Bayer, Boehringer-Ingelheim, Merck Sharp and Dome and Pfizer.

Figures

Fig 1
Fig 1. Impact of self-monitoring of BP on clinic sBP according to level of co-intervention support at 12 months (15 studies).
Change in sBP adjusted for age, sex, baseline clinic BP, and history of diabetes. The trials are grouped into the 4 levels of intervention, and I2 and P values are shown for each level of intervention and for the overall analysis. Effect of self-monitoring on clinic sBP at 6 and 18 months are shown in S3 and S6 Figs, respectively. Wakefield’s study participants self-monitored for 6 months; follow-up continued to 12 months. Abbreviations: BP, blood pressure; sBP, systolic blood pressure.
Fig 2
Fig 2. Impact of self-monitoring of BP on clinic dBP according to level of co-intervention support at 12 months (15 studies).
Change in dBP adjusted for age, sex, baseline clinic BP, and history of diabetes. The trials are grouped into the 4 levels of intervention, and I2 and P values are shown for each level of intervention and for the overall analysis. Effect of self-monitoring on clinic dBP at 6 and 18 months are shown in S4 and S7 Figs, respectively. Wakefield’s participants self-monitored for 6 months; follow-up continued to 12 months. Abbreviations: BP, blood pressure; dBP, diastolic blood pressure.
Fig 3
Fig 3. Impact of self-monitoring of BP on the RR of uncontrolled BP at 12 months according to level of co-intervention support (15 studies).
RR of uncontrolled BP adjusted for age, sex, baseline clinic BP, and history of diabetes. The trials are grouped into the 4 levels of intervention, and I2 and P values are shown for each level of intervention and for the overall analysis. The effect of self-monitoring on the RR of BP at 6 and 18 months are displayed in S5 and S8 Figs, respectively. Wakefield study participants self-monitored for 6 months; follow-up continued to 12 months. Abbreviations: BP, blood pressure; RR, relative risk.
Fig 4
Fig 4. Impact of self-monitoring of BP on clinic and ambulatory sBP at 12 months (4 studies).
These 4 studies used both clinic and ambulatory BP as endpoints and so are presented in addition to the overall results in Fig 1, which are for clinic BP alone (including these studies). Change in sBP adjusted for age, sex, baseline clinic BP, history of diabetes, and level of intervention. Effect of self-monitoring on systolic clinic and ambulatory BP at 6 months is in S9 Fig. Abbreviations: BP, blood pressure; sBP, systolic blood pressure.
Fig 5
Fig 5. Impact of self-monitoring of BP on clinic and ambulatory dBP at 12 months (4 studies).
These 4 studies used both clinic and ambulatory BP as endpoints and so are presented in addition to the overall results in Fig 1, which are for clinic BP alone (including these studies). Change in dBP adjusted for age, sex, baseline clinic BP, history of diabetes, and level of intervention. Effect of self-monitoring on diastolic clinic and ambulatory BP at 6 months is in S10 Fig. Abbreviations: BP, blood pressure; dBP, diastolic blood pressure.
Fig 6
Fig 6. Impact of self-monitoring of BP on clinic sBP at 12 months according to prespecified subgroups (15 studies).
Obesity defined as BMI ≥ 30 kg/m2. Change in sBP at 12 months adjusted for age, sex, baseline clinic BP, level of intervention, and studies contributing patient data. Abbreviations: BMI, body mass index; BP, blood pressure; CKD, chronic kidney disease; MI, myocardial infarction; sBP, systolic blood pressure.
Fig 7
Fig 7. Impact of self-monitoring of BP on clinic dBP at 12 months according to prespecified subgroups (15 studies).
Obesity defined as BMI ≥ 30 kg/m2. Change in dBP at 12 months adjusted for age, sex, baseline clinic BP, level of intervention, and studies contributing patient data. Abbreviations: BMI, body mass index; BP, blood pressure; CKD, chronic kidney disease; dBP, diastolic blood pressure; MI, myocardial infarction.
Fig 8
Fig 8. Impact of self-monitoring of BP on the RR of uncontrolled BP at 12 months according to prespecified subgroups (15 studies).
Obesity defined as BMI ≥ 30 kg/m2. RR of uncontrolled BP at 12 months adjusted for age, sex, baseline clinic BP, level of intervention, and studies contributing patient data. Abbreviations: BMI, body mass index; BP, blood pressure; CKD, chronic kidney disease; MI, myocardial infarction; RR, risk ratio; sBP, systolic blood pressure.
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References

    1. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338: b1665 doi: 10.1136/bmj.b1665 - DOI - PMC - PubMed
    1. Collins R, Peto R, MacMahon S, Hebert P, Fiebach NH, Eberlein KA, et al. Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet. 1990;335: 827–38. - PubMed
    1. Wolf-Maier K, Cooper RS, Kramer H, Banegas JR, Giampaoli S, Joffres MR, et al. Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension. 2004;43: 10–17. Epub 2003/11/26. doi: 10.1161/01.HYP.0000103630.72812.10 - DOI - PubMed
    1. 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: 185–94. Epub 2013/08/08. doi: 10.7326/0003-4819-159-3-201308060-00008 - DOI - PubMed
    1. Little P, Barnett J, Barnsley L, Marjoram J, Fitzgerald-Barron A, Mant D. Comparison of acceptability of and preferences for different methods of measuring blood pressure in primary care. BMJ. 2002;325: 258–9. Epub 2002/08/03. - PMC - PubMed

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