Home monitoring improves BP control

Home monitoring improves BP control
Home monitoring improves BP control

HealthDay News -- Home BP monitoring helped patients with hypertension control their BP in the short term, results from a meta-analysis indicate.

Patients who self-measured BP had readings 3.9/2.4 mm Hg lower on average at six months compared with those who underwent in-clinic monitoring alone, Katrin Uhlig, MD, from Tufts Medical Center in Boston, and colleagues reported in Annals of Internal Medicine.

If these reductions were sustained over time, they would be clinically relevant at the population level, the researchers explained.

"For example, a decrease of 2 or 5 mm Hg in systolic BP in the population has been estimated to result in mortality reductions of 6% or 14% due to stroke, 4% or 9% due to chronic heart disease, and 3% or 7% due to all causes," they wrote.

In this analysis, the beneficial affects of home monitoring waned by 12 months to a nonsignificant 1.5/0.8 mm Hg reduction. However, adding additional support, such as education and counseling prolonged the benefits.

Uhlig and colleagues reviewed the literature and identified 52 prospective comparative studies of self-measured BP monitoring with or without additional support versus usual care, or an alternative self-measured BP monitoring intervention, in persons with hypertension.

About half of the studies used additional support with self-monitoring, ranging from educational materials to telecounseling, phone monitoring with electronic transmission of BP data, or nurse or pharmacist visits.

For self-measured BP monitoring alone versus usual care (26 comparisons), moderate-strength evidence supported a lower BP at six months, but not at 12 months.

Compared with usual care, self-measured BP monitoring plus additional support (25 comparisons) showed high-strength evidence with BP reductions ranging from 3.4 to 8.9 mm Hg for systolic BP and from 1.9 to 4.4 mm Hg for diastolic BP at 12 months in good-quality studies.

Low-strength evidence failed to demonstrate a difference between self-measured BP monitoring plus additional support versus self-measured BP monitoring alone or with less intense additional support (13 comparisons). Evidence was insufficient to demonstrate clinical outcomes across all comparisons.

Differences between surrogate or intermediate outcomes such as medication use, quality of life, adherence and healthcare visits, were not apparent based on low-strength evidence.

"Self-measured BP monitoring with or without additional support lowers BP compared with usual care, but the BP effect beyond 12 months and long-term benefits remain uncertain," the researchers wrote.

Study limitations include different protocols for BP monitoring, additional support, BP targets and management among the studies included in the analysis, as well as the relatively short follow-up period of one year or less in many of the studies.

The researchers cautioned the findings likely only apply to patients with uncomplicated hypertension without recent acute illness.


References

  1. Uhlig K et al. Ann Intern Med 2013; 159(3):184 - 194.
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