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 A. Bove,Emma P Bray,Kenneth A. Earle,Johnson George,Marshall Godwin,Beverly B. Green,Paul L. Hebert,FD Richard Hobbs,Ilkka Kantola,Sally Kerry,Alfonso Leiva,David J. Magid,Jonathan Mant,Karen L. Margolis,Brian McKinstry,Mary Ann McLaughlin,Stefano Omboni,Olugbenga Ogedegbe,Gianfranco Parati,Nashat Qamar,Bahman P. Tabaei,Juha Varis,Willem J. Verberk,Bonnie J. Wakefield,Richard J McManus +28 more
TLDR
Self-monitoring alone is not associated with lower BP or better control, but in conjunction with co-interventions leads to clinically significant BP reduction which persists for at least 12 months.Abstract:
© 2017 Tucker et al. 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 IPD were provided from 25 trials, including 1 unpublished study.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.read more
Citations
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2018 ESC/ESH Guidelines for the management of arterial hypertension.
B. Williams,G. Mancia,Wilko Spiering,Agabiti Rosei E,M. Azizi,Michel Burnier,Denis Clement,A. Coca,de Simone G,A Dominiczak,T. Kahan,Felix Mahfoud,Josep Redon,L.M. Ruilope,Alberto Zanchetti,Mary Kerins,S.E. Kjeldsen,Reinhold Kreutz,S. Laurent,Lip Gyh.,Richard J McManus,Krzysztof Narkiewicz,Frank Ruschitzka,R.E. Schmieder,Evgeny Shlyakhto,Constantinos Tsioufis,Aboyans,Ileana Desormais +27 more
Journal ArticleDOI
2018 ESC/ESH Guidelines for the management of arterial hypertension : The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension
Bryan Williams,Giuseppe Mancia,Wilko Spiering,Enrico Agabiti Rosei,Michel Azizi,Michel Burnier,Denis Clement,Antonio Coca,Giovanni de Simone,Anna F. Dominiczak,Thomas Kahan,Felix Mahfoud,Josep Redon,Luis M. Ruilope,Alberto Zanchetti,Mary Kerins,Sverre E. Kjeldsen,Reinhold Kreutz,Stéphane Laurent,Gregory Y.H. Lip,Richard J McManus,Krzysztof Narkiewicz,Frank Ruschitzka,Roland E. Schmieder,Evgeny Shlyakhto,Costas Tsioufis,Victor Aboyans,Ileana Desormais +27 more
TL;DR: De Backer et al. as mentioned in this paper developed the ESC Guidelines for the ESC Review Co-ordinator, which are used for the evaluation of the ESC review process and the review process.
Journal ArticleDOI
Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association.
Paul Muntner,Daichi Shimbo,Robert M. Carey,Jeanne Charleston,Trudy Gaillard,Sanjay Misra,Martin G. Myers,Gbenga Ogedegbe,Joseph E. Schwartz,Raymond R. Townsend,Elaine M. Urbina,Anthony J. Viera,William B. White,Jackson T. Wright +13 more
TL;DR: Both oscillometric and auscultatory methods are considered acceptable for measuring BP in children and adolescents and initial and ongoing training of technicians and healthcare providers and the use of validated and calibrated devices are critical for obtaining accurate BP measurements.
Journal ArticleDOI
Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial
Richard J McManus,Jonathan Mant,Marloes Franssen,Alecia Nickless,Claire Schwartz,James Hodgkinson,Peter Bradburn,Andrew Farmer,Sabrina Grant,Sheila Greenfield,Carl Heneghan,Sue Jowett,Una Martin,Siobhan Milner,Mark Monahan,Sam Mort,Emma Ogburn,Rafael Perera-Salazar,Syed Ahmar Shah,Ly-Mee Yu,Lionel Tarassenko,FD Richard Hobbs,Brendan Bradley,Chris Lovekin,David Judge,Luis Castello,Maureen Dawson,Rebecca Brice,Bethany Dunbabin,Sophie Maslen,Heather Rutter,Mary Norris,Lauren French,Michael Loynd,Pippa Whitbread,Luisa Saldana Ortaga,Irene Noel,Karen Madronal,Julie Timmins,Lucy Hughes,Beth Hinks,S Bailey,Sue Read,Andrea Weston,Somi Spannuth,Sue Maiden,Makiko Chermahini,Ann McDonald,Shelina Rajan,Susan Allen,Brenda Deboys,Kim Fell,Jenny Johnson,Helen Jung,Rachel Lister,Ruth Osborne,Amy Secker,Irene Qasim,Kirsty William,Abi Harris,Susan Zhao,Elaine Butcher,Pauline Darbyshire,Sarah Joshi,Jon Davies,Claire Talbot,Eleanor Hoverd,Linda Field,Tracey Adcock,Julia Rooney,Nina Cooter,Aaron Butler,Naomi E. Allen,Maria Abdul-Wahab,Kathryn McNicholas,Lara Peniket,Kate Dodd,Julie Mugurza,Richard L. Baskerville,Rakshan Syed,Clare Bailey,Jill Adams,Paul Uglow,Neil Townsend,Alison MacLeod,Charlotte Hawkins,Suparna Behura,Jonathan Crawshaw,Robin Fox,Waleed Doski,Martin Aylward,Christine A'Court,David Rapley,Jo Walsh,Paul Batra,Ana Seoane,Sluti Mukherjee,Jonathan Dixon,Peter Arthur,Karen Sutcliffe,Costas Paschallides,Richard Woof,Peter Winfrey,Matthew Clark,Roya Kamali,Paul S. Thomas,David Ebbs,Liz Mather,Andre Beattie,Karim Ladha,Larisa Smondulak,Surinder Jemahl,Peter Hickson,Liam Stevens,Tony Crockett,David Shukla,Ian Binnian,Paul Vinson,Nigel DeKare-Silver,Ramila Patel,Ivor Singh,Louise Lumley,Glennis Williams,Mark J. Webb,Jack Bambrough,Neetul Shah,Hergeven Dosanjh,Frank Spannuth,Carolyn Paul,Jude Ganesegaram,Laurie Pike,Vijaysundari Maheswaran,Farah Paruk,Stephen Ford,Vineeta Verma,Kate Milne,Farhana Lockhat,Jennifer Ferguson,Anne-Marie Quirk,Hugo Wilson,David Copping,Sam Bajallan,Simria Tanvir,Faheem Khan,Tom Alderson,Amar Ali,Richard Young,Umesh Chauhan,Lindsey Crockett,Louise McGovern,Claire Cubitt,Simon Weatherill,Abdul Tabassum,Philip Saunders,Naresh Chauhan,Samantha Johnson,Inderjit Marok,Rajiv Sharma,William Lumb,John Tweedale,Ian E. Smith,Lawrence Miller,Tanveer Ahmed,Mark Sanderson,Claire Jones,Peter Stokell,Matthew J Edwards,Andrew Askey,Jason Spencer,Kathryn Morgan,Kyle Knox,Robert Baker,Crispin Fisher,Rachel Halstead,Neil Modha,David I Buckley,Catherine Stokell,John Gerald McCabe,Jennifer A. Taylor,Helen Nutbeam,Richard Smith,Christopher MacGregor,Sam Davies,Mark Lindsey,Simon Cartwright,Jonathan Whittle,Julie Colclough,Alison Crumbie,Nicholas Stuart Tudor Thomas,Vattakkatt Premchand,Rafia Hamid,Zishan Ali,John W. Ward,Philip Pinney,Stephen Thurston,Tina Banerjee +195 more
TL;DR: Self- Monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings.
Journal ArticleDOI
Evidence and Recommendations on the Use of Telemedicine for the Management of Arterial Hypertension: An International Expert Position Paper.
Stefano Omboni,Richard J McManus,Hayden B. Bosworth,Lucy C Chappell,Beverly B. Green,Kazuomi Kario,Alexander G. Logan,David J. Magid,Brian McKinstry,Karen L. Margolis,Gianfranco Parati,Bonnie J. Wakefield +11 more
TL;DR: The best proposed healthcare model for telemedicine in hypertension management should include remote monitoring and transmission of vital signs and medication adherence plus education on lifestyle and risk factors, with video consultation as an option.
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