Hypertension affects more than 76 million Americans and is the cause of seven million deaths annually. The AHRQ reviewed the role of self-measured blood pressure (BP) monitoring with or without additional support, such as telemonitoring, counseling, education, Internet support, behavioral interventions, home visits, etc. for managing hypertension.

A systematic review of 49 studies examined the comparative effectiveness and adherence predictors of home 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 BP monitoring done at home by nurses or other health care professionals.

Good Not Great

Effective management of BP has been shown to dramatically decrease the incidence of stroke, heart attack and heart failure.  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 hypertension. Thus an increasing focus has been placed on developing strategies that can improve adherence and result in satisfactory BP control with the goal of improving health outcomes for hypertensive patients.

One such proposed method is self-measured blood BP monitoring. While patient self-participation in chronic disease management appears promising, the sustainability and clinical impact of this strategy remain uncertain.

There are several types of home-monitoring devices including "manual" devices, "semiautomated" devices and "automated devices. Many devices are commercially available and have been validated by leading organizations such as the American Association of Medical Instrumentation, the European Society of Hypertension, and the British Hypertension Society.

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

Enter the AHRQ, who reviewed the data and found that self-monitoring versus usual care yielded a modest reduction in clinic systolic BP (SBP) and diastolic BP (DBP) at six 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 six months but not at 12 months.

Combining additional support with self-monitoring at home led to greater BP reduction when compared to usual care at up to 12 months of follow-up based on consistent findings in what AHRQ called "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 conclusion: the evidence is weak or insufficient to determine if self-monitoring of BP 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). There are consistent results from good-quality studies that self-monitoring plus some form of additional support improves BP control when compared with usual care at least up to 12 months, but additional research is needed to determine the effect of self-monitoring on BP control beyond 12 months and to determine long-term clinical consequences of such monitoring.

Reference

Uhlig K, Balk EM, Patel K, et al. AHRQ Comparative Effectiveness Review No.45. January 2012.
Available at: http://www.effectivehealthcare.ahrq.gov/selfmeasuredbp.cfm.
The full report is available here.

Keywords: Stroke, Follow-Up Studies, House Calls, Disease Management, Systole, Medication Adherence, Incidence, Quality of Life, Patient Participation, Heart Failure, Blood Pressure Determination, Diastole, Internet, Hypertension, United States

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