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

Autor: Hayden B. Bosworth, FD Richard Hobbs, Olugbenga Ogedegbe, Karen L. Margolis, Richard Stevens, Jonathan Mant, Alfonso Leiva, Johnson George, Bahman P. Tabaei, Beverly B. Green, Juha Varis, Brian McKinstry, Katherine L. Tucker, Bonnie J. Wakefield, Willem J. Verberk, Sally Kerry, Emma P Bray, Alfred A. Bove, Nashat Qamar, James P Sheppard, Richard J McManus, Paul L. Hebert, Ilkka Kantola, David J. Magid, Kenneth A. Earle, Gianfranco Parati, Mary Ann McLaughlin, Marshall Godwin, Stefano Omboni
Přispěvatelé: RS: CARIM - R3.02 - Hypertension and target organ damage, Interne Geneeskunde, Tucker, K, Sheppard, J, Stevens, R, Bosworth, H, Bove, A, Bray, E, Earle, K, George, J, Godwin, M, Green, B, Hebert, P, Hobbs, F, Kantola, I, Kerry, S, Leiva, A, Magid, D, Mant, J, Margolis, K, Mckinstry, B, Mclaughlin, M, Omboni, S, Ogedegbe, O, Parati, G, Qamar, N, Tabaei, B, Varis, J, Verberk, W, Wakefield, B, Mcmanus, R, Tucker, Katherine L [0000-0001-6544-8066], Sheppard, James P [0000-0002-4461-8756], Stevens, Richard [0000-0002-9258-4060], George, Johnson [0000-0002-0326-0495], Hobbs, FD Richard [0000-0001-7976-7172], Kerry, Sally M [0000-0002-7181-9107], Magid, David J [0000-0001-9288-0532], McKinstry, Brian [0000-0001-9581-0468], Omboni, Stefano [0000-0002-7124-2096], Parati, Gianfranco [0000-0001-9402-7439], Tabaei, Bahman P [0000-0001-6779-1044], Wakefield, Bonnie J [0000-0001-8154-0065], McManus, Richard J [0000-0003-3638-028X], Apollo - University of Cambridge Repository, Rahimi, Kazem
Jazyk: angličtina
Rok vydání: 2017
Předmět:
humanos
Blood Pressure
030204 cardiovascular system & hematology
Cochrane Library
COST-EFFECTIVENESS
0302 clinical medicine
MASKED HYPERTENSION
Medicine
030212 general & internal medicine
10. No inequality
Randomized Controlled Trials as Topic
AFRICAN-AMERICANS
ensayos clínicos controlados aleatorizados como asunto
PRIMARY-CARE
General Medicine
Blood Pressure Monitoring
Ambulatory
RANDOMIZED CONTROLLED-TRIAL
3. Good health
Antihypertensive Agent
estilo de vida
Meta-analysis
Hypertension
Ambulatory
INTERVENTION
Human
presión sanguínea
medicine.medical_specialty
MEDLINE
URBAN
CLINICAL-TRIAL
03 medical and health sciences
Patient Education as Topic
Internal medicine
Diabetes mellitus
MANAGEMENT
Humans
Life Style
Antihypertensive Agents
business.industry
medicine.disease
Blood pressure
HEALTH-CARE
antihipertensivos
Physical therapy
Self-monitoring
hipertensión
educación de pacientes como asunto
business
Body mass index
Zdroj: PLoS Medicine, 14(9):1002389. Public Library of Science
PLoS Medicine, Vol 14, Iss 9, p e1002389 (2017)
Tucker, K L, Sheppard, J P, Stevens, R, Bosworth, H B, Bove, A, Bray, E P, Earle, K, George, J, Godwin, M, Green, B B, Hebert, P, Hobbs, F D R, Kantola, I, Kerry, S M, Leiva, A, Magid, D J, Mant, J, Margolis, K L, Mckinstry, B, Mclaughlin, M A, Omboni, S, Ogedegbe, O, Parati, G, Qamar, N, Tabaei, B P, Varis, J, Verberk, W J, Wakefield, B J & Mcmanus, R J 2017, ' Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis ', PLoS Medicine, vol. 14, no. 9, pp. e1002389 . https://doi.org/10.1371/journal.pmed.1002389
ISSN: 1549-1277
1549-1676
Popis: 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 (9June 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 (97,138/8,292 [86%] of randomised participants). Overall, self-monitoring was associated with reduced clinic systolic blood pressure (9sBP) 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 (91,478 patients), which assessed selfmonitoring with little or no co-intervention. There was no association between self-monitoring and either lower clinic or ambulatory sBP in this group (9clinic -0.2 mmHg [-2.2, 1.8]; ambulatory 1.1 mmHg [-0.3, 2.5]). Results for diastolic blood pressure (9dBP) 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 (9including 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.
This research was funded by the Institute for Health Research School for Primary Care Research (NIHR SPCR number 112) and via an NIHR Professorship for RM (NIHR-RP-02-12-015). JS holds a Medical Research Council (MRC) Strategic Skills Postdoctoral Fellowship (MR/K022032/1). FDRH is part funded as Director of the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR), Theme Leader of the NIHR Oxford Biomedical Research Centre (BRC), and Director of the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Databáze: OpenAIRE
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