Self-monitoring of blood pressure in hypertension

A systematic review and individual patient data meta-analysis

Katherine L. Tucker, James P. Sheppard, Richard Stevens, Hayden B. Bosworth, Alfred Bove, Emma P. Bray, Kenneth Earle, Johnson George, Marshall Godwin, Beverly B. Green, Paul Hebert, F. D.Richard Hobbs, Ilkka Kantola, Sally M. Kerry, Alfonso Leiva, David J. Magid, Jonathan Mant, Karen L. Margolis, Brian McKinstry, Mary Ann McLaughlin & 9 others Stefano Omboni, Olugbenga Ogedegbe, Gianfranco Parati, Nashat Qamar, Bahman P. Tabaei, Juha Varis, Willem J. Verberk, Bonnie J. Wakefield, Richard J. McManus

Research output: Contribution to journalArticle

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 IPD were provided from 25 trials, including 1 unpublished study.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

Original languageEnglish (US)
Article numbere1002389
JournalPLoS Medicine
Volume14
Issue number9
DOIs
StatePublished - Sep 1 2017

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Ambulatory Blood Pressure Monitoring
Meta-Analysis
Blood Pressure
Hypertension
Pharmacists
Antihypertensive Agents
Libraries
Life Style
Comorbidity
Counseling

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Tucker, K. L., Sheppard, J. P., Stevens, R., Bosworth, H. B., Bove, A., Bray, E. P., ... McManus, R. J. (2017). Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis. PLoS Medicine, 14(9), [e1002389]. https://doi.org/10.1371/journal.pmed.1002389

Self-monitoring of blood pressure in hypertension : A systematic review and individual patient data meta-analysis. / Tucker, Katherine L.; Sheppard, James P.; Stevens, Richard; Bosworth, Hayden B.; Bove, Alfred; Bray, Emma P.; Earle, Kenneth; George, Johnson; Godwin, Marshall; Green, Beverly B.; Hebert, Paul; Hobbs, F. D.Richard; Kantola, Ilkka; Kerry, Sally M.; Leiva, Alfonso; Magid, David J.; Mant, Jonathan; Margolis, Karen L.; McKinstry, Brian; McLaughlin, Mary Ann; Omboni, Stefano; Ogedegbe, Olugbenga; Parati, Gianfranco; Qamar, Nashat; Tabaei, Bahman P.; Varis, Juha; Verberk, Willem J.; Wakefield, Bonnie J.; McManus, Richard J.

In: PLoS Medicine, Vol. 14, No. 9, e1002389, 01.09.2017.

Research output: Contribution to journalArticle

Tucker, KL, Sheppard, JP, Stevens, R, Bosworth, HB, Bove, A, Bray, EP, Earle, K, George, J, Godwin, M, Green, BB, Hebert, P, Hobbs, FDR, Kantola, I, Kerry, SM, Leiva, A, Magid, DJ, Mant, J, Margolis, KL, McKinstry, B, McLaughlin, MA, Omboni, S, Ogedegbe, O, Parati, G, Qamar, N, Tabaei, BP, Varis, J, Verberk, WJ, Wakefield, BJ & McManus, RJ 2017, 'Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis', PLoS Medicine, vol. 14, no. 9, e1002389. https://doi.org/10.1371/journal.pmed.1002389
Tucker, Katherine L. ; Sheppard, James P. ; Stevens, Richard ; Bosworth, Hayden B. ; Bove, Alfred ; Bray, Emma P. ; Earle, Kenneth ; George, Johnson ; Godwin, Marshall ; Green, Beverly B. ; Hebert, Paul ; Hobbs, F. D.Richard ; Kantola, Ilkka ; Kerry, Sally M. ; Leiva, Alfonso ; Magid, David J. ; Mant, Jonathan ; Margolis, Karen L. ; McKinstry, Brian ; McLaughlin, Mary Ann ; Omboni, Stefano ; Ogedegbe, Olugbenga ; Parati, Gianfranco ; Qamar, Nashat ; Tabaei, Bahman P. ; Varis, Juha ; Verberk, Willem J. ; Wakefield, Bonnie J. ; McManus, Richard J. / Self-monitoring of blood pressure in hypertension : A systematic review and individual patient data meta-analysis. In: PLoS Medicine. 2017 ; Vol. 14, No. 9.
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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.",
author = "Tucker, {Katherine L.} and Sheppard, {James P.} and Richard Stevens and Bosworth, {Hayden B.} and Alfred Bove and Bray, {Emma P.} and Kenneth Earle and Johnson George and Marshall Godwin and Green, {Beverly B.} and Paul Hebert and Hobbs, {F. D.Richard} and Ilkka Kantola and Kerry, {Sally M.} and Alfonso Leiva and Magid, {David J.} and Jonathan Mant and Margolis, {Karen L.} and Brian McKinstry and McLaughlin, {Mary Ann} and Stefano Omboni and Olugbenga Ogedegbe and Gianfranco Parati and Nashat Qamar and Tabaei, {Bahman P.} and Juha Varis and Verberk, {Willem J.} and Wakefield, {Bonnie J.} and McManus, {Richard J.}",
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TY - JOUR

T1 - Self-monitoring of blood pressure in hypertension

T2 - A systematic review and individual patient data meta-analysis

AU - Tucker, Katherine L.

AU - Sheppard, James P.

AU - Stevens, Richard

AU - Bosworth, Hayden B.

AU - Bove, Alfred

AU - Bray, Emma P.

AU - Earle, Kenneth

AU - George, Johnson

AU - Godwin, Marshall

AU - Green, Beverly B.

AU - Hebert, Paul

AU - Hobbs, F. D.Richard

AU - Kantola, Ilkka

AU - Kerry, Sally M.

AU - Leiva, Alfonso

AU - Magid, David J.

AU - Mant, Jonathan

AU - Margolis, Karen L.

AU - McKinstry, Brian

AU - McLaughlin, Mary Ann

AU - Omboni, Stefano

AU - Ogedegbe, Olugbenga

AU - Parati, Gianfranco

AU - Qamar, Nashat

AU - Tabaei, Bahman P.

AU - Varis, Juha

AU - Verberk, Willem J.

AU - Wakefield, Bonnie J.

AU - McManus, Richard J.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - 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.

AB - 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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