Perspectives and Experiences of Self-monitoring of Blood Pressure Among Patients With Hypertension: A Systematic Review of Qualitative Studies

doi:10.1093/ajh/hpad021

. 2023 Jun 15;36(7):372-384.

doi: 10.1093/ajh/hpad021.

Perspectives and Experiences of Self-monitoring of Blood Pressure Among Patients With Hypertension: A Systematic Review of Qualitative Studies

Patrizia Natale^{1

2

3}, Jia Yi Ni^{1

4}, David Martinez-Martin^{5

4}, Ayano Kelly^{6

7

8

9}, Clara K Chow^{10

11}, Aravinda Thiagalingam^{10

11

12}, Corinne Caillaud^{5

13

14}, Benjamin Eggleton⁵, Nicole Scholes-Robertson^{1

6}, Jonathan C Craig¹⁵, Giovanni F M Strippoli^{1

2}, Allison Jaure^{1

6}

Affiliations

¹ Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
² Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy.
³ Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
⁴ School of Biomedical Engineering, The University of Sydney, Sydney, NSW, Australia.
⁵ The University of Sydney Nano Institute (Sydney Nano), The University of Sydney, Sydney, NSW, Australia.
⁶ Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.
⁷ South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.
⁸ Department of Rheumatology, Liverpool Hospital, Sydney, NSW, Australia.
⁹ Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
¹⁰ Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
¹¹ Westmead Applied Research Centre, Westmead Hospital, SydneyAustralia.
¹² Westmead Clinical School, Westmead Hospital, Sydney, NSW, Australia.
¹³ School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia.
¹⁴ Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
¹⁵ College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.

PMID: 36840919
PMCID: PMC10267641
DOI: 10.1093/ajh/hpad021

Perspectives and Experiences of Self-monitoring of Blood Pressure Among Patients With Hypertension: A Systematic Review of Qualitative Studies

Patrizia Natale et al. Am J Hypertens. 2023.

. 2023 Jun 15;36(7):372-384.

doi: 10.1093/ajh/hpad021.

Authors

Affiliations

¹ Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
² Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy.
³ Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
⁴ School of Biomedical Engineering, The University of Sydney, Sydney, NSW, Australia.
⁵ The University of Sydney Nano Institute (Sydney Nano), The University of Sydney, Sydney, NSW, Australia.
⁶ Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.
⁷ South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.
⁸ Department of Rheumatology, Liverpool Hospital, Sydney, NSW, Australia.
⁹ Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
¹⁰ Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
¹¹ Westmead Applied Research Centre, Westmead Hospital, SydneyAustralia.
¹² Westmead Clinical School, Westmead Hospital, Sydney, NSW, Australia.
¹³ School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia.
¹⁴ Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
¹⁵ College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.

PMID: 36840919
PMCID: PMC10267641
DOI: 10.1093/ajh/hpad021

Abstract

Background: Self-monitoring of blood pressure is a key strategy in managing hypertension but may be challenging and burdensome for patients. The aim of the study was to describe the perspectives and experiences of self-monitoring of blood pressure in patients with hypertension.

Methods: MEDLINE, Embase, PsycINFO, and CINAHL were searched from database inception to March 2022. We used thematic synthesis to analyze the data.

Results: Thirty-five studies involving 872 patients aged 18-95 years were included. Four themes were identified: enabling autonomy and empowerment of own health (allowing access to comprehensive and accurate data, bolstering motivation for lifestyle changes, encouraging diligence in medication taking, gaining interest in self-management, and increasing awareness of health status); providing reassurance and convenience (instilling a sense of security, readiness for troubleshooting, and reducing the frequency of clinical appointments); triggering confusion and stress (anxiety and panic over "bad" numbers, constant reminder of illness identity, disregarded by clinicians, lack of confidence in interpreting and responding to results, redundancy of continuous monitoring, and uncertainties around targets and frequency of measures, concerns of unreliability); financial and operational burden of device (vulnerability preventing use, or unsustainable cost).

Conclusions: Inadequate knowledge about the benefits of lowering blood pressure, home blood pressure monitoring, blood pressure goals, and interpretation of blood pressure values, limited access to home blood pressure monitoring devices, and psychological burden with home blood pressure monitoring limit home blood pressure monitoring.

Keywords: blood pressure; hypertension; patient perspective; self-monitoring blood pressure.

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Figures

None — This graphical abstract is also available at Tidbit https://www.editorialmanager.com/ajh/EMDetails.aspx?docid=13418&ms_num=AJH-D-22-00286&sectionID=1#:~:text=https%3A//tidbitapp.io/tidbits/perspectives%2Dand%2Dexperiences%2Dof%2Dself%2Dmonitoring%2Dof%2Dblood%2Dpressure%2Damong%2Dpatients%2Dwith%2Dhypertension%2Da%2Dsystematic%2Dreview%2Dof%2Dqualitative%2Dstudies

**Figure 2.**
Thematic schema. Abbreviation: SMBP, self-monitoring of blood pressure.

See this image and copyright information in PMC

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References

1. World Health Organization (WHO). Hypertension. https://www.who.int/news-room/fact-sheets/detail/hypertension. Accessed 08 March 2023.
1. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021; 398:957–980. - PMC - PubMed
1. Shimbo D, Artinian NT, Basile JN, Krakoff LR, Margolis KL, Rakotz MK, Wozniak G; American Heart Association and the American Medical Association. Self-measured blood pressure monitoring at home: a joint policy statement from the American Heart Association and American Medical Association. Circulation 2020; 142:e42–e63. - PubMed
1. Williams BM, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I; ESC Scientific Document Group. ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021–3104. - PubMed
1. Cohen JB, Lotito MJ, Trivedi UK, Denker MG, Cohen DL, Townsend RR.. Cardiovascular events and mortality in white coat hypertension: a systematic review and meta-analysis. Ann Intern Med 2019; 170:853–862. - PMC - PubMed

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[1] World Health Organization (WHO). Hypertension. https://www.who.int/news-room/fact-sheets/detail/hypertension. Accessed 08 March 2023.

[2] World Health Organization (WHO). Hypertension. https://www.who.int/news-room/fact-sheets/detail/hypertension. Accessed 08 March 2023.

[3] NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021; 398:957–980. - PMC - PubMed

[4] NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021; 398:957–980. - PMC - PubMed

[5] Shimbo D, Artinian NT, Basile JN, Krakoff LR, Margolis KL, Rakotz MK, Wozniak G; American Heart Association and the American Medical Association. Self-measured blood pressure monitoring at home: a joint policy statement from the American Heart Association and American Medical Association. Circulation 2020; 142:e42–e63. - PubMed

[6] Shimbo D, Artinian NT, Basile JN, Krakoff LR, Margolis KL, Rakotz MK, Wozniak G; American Heart Association and the American Medical Association. Self-measured blood pressure monitoring at home: a joint policy statement from the American Heart Association and American Medical Association. Circulation 2020; 142:e42–e63. - PubMed

[7] Williams BM, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I; ESC Scientific Document Group. ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021–3104. - PubMed

[8] Williams BM, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I; ESC Scientific Document Group. ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021–3104. - PubMed

[9] Cohen JB, Lotito MJ, Trivedi UK, Denker MG, Cohen DL, Townsend RR.. Cardiovascular events and mortality in white coat hypertension: a systematic review and meta-analysis. Ann Intern Med 2019; 170:853–862. - PMC - PubMed

[10] Cohen JB, Lotito MJ, Trivedi UK, Denker MG, Cohen DL, Townsend RR.. Cardiovascular events and mortality in white coat hypertension: a systematic review and meta-analysis. Ann Intern Med 2019; 170:853–862. - PMC - PubMed

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Perspectives and Experiences of Self-monitoring of Blood Pressure Among Patients With Hypertension: A Systematic Review of Qualitative Studies

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Perspectives and Experiences of Self-monitoring of Blood Pressure Among Patients With Hypertension: A Systematic Review of Qualitative Studies

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