Self-Measured Blood Pressure Monitoring in the Management of Hypertension: A Systematic Review and Meta-Analysis
The following are 10 key points from a meta-analysis of 52 prospective comparative studies of self-monitored blood pressure (SMBP) monitoring with or without additional support (educational materials, letters to patients and providers on treatment recommendations, Web resources, phone monitoring, etc.) versus usual care or an alternative SMBP monitoring intervention:
1. Although the American Heart Association recommends SMBP measurements for evaluation of most patients with known or suspected hypertension, it is unclear whether such monitoring confers benefit or should be combined with other support (e.g., telemedicine).
2. For SMBP monitoring alone versus usual care (26 comparisons), there is moderate-strength evidence that supports a lower blood pressure with SMBP monitoring at 6 months (summary net difference, -3.9 mm Hg and -2.4 mm Hg for systolic BP and diastolic BP, respectively). Differences were not significant at 12 months.
3. For SMBP monitoring plus additional support versus usual care (25 comparisons), high-strength evidence supports a lower BP with use of SMBP monitoring, 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.
4. For SMBP monitoring plus additional support versus SMBP monitoring alone or with less intense additional support (13 comparisons), low-strength evidence fails to support a difference.
5. There is insufficient evidence of the effect of SMBP on clinical outcomes.
6. There is heterogeneity in the type of additional support interventions that were reported in the literature. No two studies used the same method of additional support.
7. On a population level, the observed magnitude of BP reduction by SMBP monitoring with or without additional support would be clinically relevant.
8. The BP effect of SMBP beyond 12 months and long-term benefits remain uncertain, and future research to clarify these issues is warranted.
9. Additional possible benefits of SMBP monitoring include patient empowerment, increased adherence to lifestyle modifications, and avoidance of under- and overtreatment.
10. SMBP monitoring with or without additional support lowers BP compared with usual care at 6 months, but the sustainability and clinical effectiveness of such monitoring remains uncertain.
Keywords: Telemedicine, Blood Pressure Monitoring, Ambulatory, Cardiovascular Diseases, Hypertension, United States
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