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Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension

Clinician Summary – Feb. 22, 2012

Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension

Formats

Table of Contents

Focus of Research for Clinicians

To review the role of self-measured blood pressure (SMBP) monitoring with or without additional support (interventions such as telemonitoring, counseling, education, Web support, behavioral interventions, home visits, etc.) in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence predictors of SMBP monitoring. The review addressed SMBP monitoring performed by the patient or the patient’s companion at home; it did not include monitoring done at the doctor’s office, clinic, pharmacy, or health unit at work, nor did it include blood pressure (BP) monitoring done at home by nurses or other health care professionals. The full report, listing all studies, is available at www.effectivehealthcare.ahrq.gov/selfmeasuredbp.cfm. This summary is provided to assist in clinical decisionmaking along with consideration of a patient’s values and preferences. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines.

Background

High BP or hypertension (BP ≥140/90 mmHg) is a common, ongoing health condition, affecting 1 in 3 adults in the United States aged 20 or older. Hypertension has been identified as a major risk factor for cardiovascular disease and an important modifiable risk factor for acute myocardial infarction, stroke, congestive heart failure, and chronic kidney disease. Key strategies for managing hypertension include lifestyle and behavior modifications (such as dietary modification, weight loss, and regular exercise), usually combined with medication. Estimates indicate that a decrease of 5 mmHg in systolic BP can significantly reduce morbidity and mortality. However, long-term adherence to lifestyle modifications and medication remains a significant challenge in managing this condition.

While SMBP monitoring may improve patient participation in chronic disease management, the effects of this strategy on BP, clinical outcomes, and health care utilization remain uncertain.

Conclusions

In the management of hypertension, SMBP alone versus usual care yielded a modest reduction in clinic systolic BP (SBP) and diastolic BP (DBP) at 6 months (SBP/DBP -3.1/-2.0 mmHg) and 12 months (SBP/DBP -1.2/-0.8 mmHg). Meta-analyses showed that the net reduction in SBP and DBP was statistically significant at 6 months but not at 12 months. Combining additional support with SMBP monitoring led to greater BP reduction when compared to usual care at up to 12 months of followup based on consistent findings in six high-quality studies. However, the evidence was too limited to determine the superiority of any one form of clinical support, as modalities varied widely across studies. The evidence is weak or insufficient to determine if SMBP with or without additional support has an impact on other outcomes (including mortality, quality of life, number of medications used, medication adherence, and health care encounters). Additional research is needed to determine the effect of SMBP on BP control beyond 12 months and to determine long-term clinical consequences of SMBP.

Clinical Bottom Line

SMBP alone versus usual care

BP Control

Other Clinical, Surrogate, and Intermediate Outcomes2

SMBP plus additional support versus usual care

BP Control

Other Clinical, Surrogate, and Intermediate Outcomes

SMBP plus additional support versus SMBP without additional support or with less-intense additional support

BP Control

Other Clinical, Surrogate, and Intermediate Outcomes

evidence low

Predictors of SMBP adherence

1 Usual care is the standard-of-care management of hypertension in outpatient and general practice settings.
2 Other outcomes assessed included clinical outcomes (quality of life, patient satisfaction with care), surrogate outcomes (left ventricular hypertrophy, left ventricular mass index), and intermediate outcomes (number and dosage of medications, medication adherence, number of health care encounters).
3 Additional support varied across trials and included telemonitoring, counseling, education, Web support, behavioral interventions, home visits, et cetera.

Strength of Evidence Scale

High: evidence high
There are consistent results from good-quality studies. Further research is very unlikely to change the conclusions.

Moderate: evidence medium
Findings are supported, but further research could change the conclusions.

Low: evidence low
There are very few studies, or existing studies are flawed.

Insufficient: evidence insufficient
Research is either unavailable or does not permit estimation of a treatment effect.

Gaps in Knowledge

What To Discuss With Your Patients

  • The importance of effectively controlling high BP.
  • The link between measuring BP and controlling high BP.
  • Adherence to strategies aimed at managing hypertension such as lifestyle and dietary modifications and medication.
  • How SMBP allows patients to participate more actively in managing their BP.
  • The types of SMBP devices available and how to operate the device selected for the patient.

Resource for Patients

Measuring Your Blood Pressure at Home, A Review of the Research for Adults is a companion to this clinician research summary. It can help adults with hypertension talk to their health care professional about how to perform SMBP monitoring to help manage their condition.

Ordering Information

To order free print copies, call the AHRQ Publications Clearinghouse at 800-358-9295.

Source

The information in this summary is based on Self-Measured Blood Pressure Monitoring: Comparative Effectiveness, Comparative Effectiveness Review No. 45, prepared by the Tufts Medical Center Evidence-based Practice Center under Contract No. HHSA 290-2007-10055-I for the Agency for Healthcare Research and Quality, January 2012.

This summary was prepared by the John M. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine, Houston, TX. It was written by Geetha Achanta, Ph.D., Amelia Williamson Smith, M.S., Thomas Workman, Ph.D., Sarah Michel, M.P.H., James Pool, M.D., and Michael Fordis, M.D.

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