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Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis
BACKGROUND: Studies have shown that self-monitoring of blood pressure (BP) is effective when combined with co-interventions, but its efficacy varies in the presence of some co-morbidities. This study examined whether self-monitoring can reduce clinic BP in patients with hypertension-related co-morbi...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162426/ https://www.ncbi.nlm.nih.gov/pubmed/31730171 http://dx.doi.org/10.1093/ajh/hpz182 |
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author | Sheppard, J P Tucker, K L Davison, W J Stevens, R Aekplakorn, W Bosworth, H B Bove, A Earle, K Godwin, M Green, B B Hebert, P Heneghan, C Hill, N Hobbs, F D R Kantola, I Kerry, S M Leiva, A Magid, D J Mant, J Margolis, K L McKinstry, B McLaughlin, M A McNamara, K Omboni, S Ogedegbe, O Parati, G Varis, J Verberk, W J Wakefield, B J McManus, R J |
author_facet | Sheppard, J P Tucker, K L Davison, W J Stevens, R Aekplakorn, W Bosworth, H B Bove, A Earle, K Godwin, M Green, B B Hebert, P Heneghan, C Hill, N Hobbs, F D R Kantola, I Kerry, S M Leiva, A Magid, D J Mant, J Margolis, K L McKinstry, B McLaughlin, M A McNamara, K Omboni, S Ogedegbe, O Parati, G Varis, J Verberk, W J Wakefield, B J McManus, R J |
author_sort | Sheppard, J P |
collection | PubMed |
description | BACKGROUND: Studies have shown that self-monitoring of blood pressure (BP) is effective when combined with co-interventions, but its efficacy varies in the presence of some co-morbidities. This study examined whether self-monitoring can reduce clinic BP in patients with hypertension-related co-morbidity. METHODS: A systematic review was conducted of articles published in Medline, Embase, and the Cochrane Library up to January 2018. Randomized controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorized by whether they examined a low/high-intensity co-intervention. Change in BP and likelihood of uncontrolled BP at 12 months were examined according to number and type of hypertension-related co-morbidity in a one-stage IPD meta-analysis. RESULTS: A total of 22 trials were eligible, 16 of which were able to provide IPD for the primary outcome, including 6,522 (89%) participants with follow-up data. Self-monitoring was associated with reduced clinic systolic BP compared to usual care at 12-month follow-up, regardless of the number of hypertension-related co-morbidities (−3.12 mm Hg, [95% confidence intervals −4.78, −1.46 mm Hg]; P value for interaction with number of morbidities = 0.260). Intense interventions were more effective than low-intensity interventions in patients with obesity (P < 0.001 for all outcomes), and possibly stroke (P < 0.004 for BP control outcome only), but this effect was not observed in patients with coronary heart disease, diabetes, or chronic kidney disease. CONCLUSIONS: Self-monitoring lowers BP regardless of the number of hypertension-related co-morbidities, but may only be effective in conditions such obesity or stroke when combined with high-intensity co-interventions. |
format | Online Article Text |
id | pubmed-7162426 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-71624262020-04-22 Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis Sheppard, J P Tucker, K L Davison, W J Stevens, R Aekplakorn, W Bosworth, H B Bove, A Earle, K Godwin, M Green, B B Hebert, P Heneghan, C Hill, N Hobbs, F D R Kantola, I Kerry, S M Leiva, A Magid, D J Mant, J Margolis, K L McKinstry, B McLaughlin, M A McNamara, K Omboni, S Ogedegbe, O Parati, G Varis, J Verberk, W J Wakefield, B J McManus, R J Am J Hypertens Original Contributions BACKGROUND: Studies have shown that self-monitoring of blood pressure (BP) is effective when combined with co-interventions, but its efficacy varies in the presence of some co-morbidities. This study examined whether self-monitoring can reduce clinic BP in patients with hypertension-related co-morbidity. METHODS: A systematic review was conducted of articles published in Medline, Embase, and the Cochrane Library up to January 2018. Randomized controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorized by whether they examined a low/high-intensity co-intervention. Change in BP and likelihood of uncontrolled BP at 12 months were examined according to number and type of hypertension-related co-morbidity in a one-stage IPD meta-analysis. RESULTS: A total of 22 trials were eligible, 16 of which were able to provide IPD for the primary outcome, including 6,522 (89%) participants with follow-up data. Self-monitoring was associated with reduced clinic systolic BP compared to usual care at 12-month follow-up, regardless of the number of hypertension-related co-morbidities (−3.12 mm Hg, [95% confidence intervals −4.78, −1.46 mm Hg]; P value for interaction with number of morbidities = 0.260). Intense interventions were more effective than low-intensity interventions in patients with obesity (P < 0.001 for all outcomes), and possibly stroke (P < 0.004 for BP control outcome only), but this effect was not observed in patients with coronary heart disease, diabetes, or chronic kidney disease. CONCLUSIONS: Self-monitoring lowers BP regardless of the number of hypertension-related co-morbidities, but may only be effective in conditions such obesity or stroke when combined with high-intensity co-interventions. Oxford University Press 2020-03 2019-11-15 /pmc/articles/PMC7162426/ /pubmed/31730171 http://dx.doi.org/10.1093/ajh/hpz182 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Contributions Sheppard, J P Tucker, K L Davison, W J Stevens, R Aekplakorn, W Bosworth, H B Bove, A Earle, K Godwin, M Green, B B Hebert, P Heneghan, C Hill, N Hobbs, F D R Kantola, I Kerry, S M Leiva, A Magid, D J Mant, J Margolis, K L McKinstry, B McLaughlin, M A McNamara, K Omboni, S Ogedegbe, O Parati, G Varis, J Verberk, W J Wakefield, B J McManus, R J Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis |
title | Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis |
title_full | Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis |
title_fullStr | Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis |
title_full_unstemmed | Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis |
title_short | Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis |
title_sort | self-monitoring of blood pressure in patients with hypertension-related multi-morbidity: systematic review and individual patient data meta-analysis |
topic | Original Contributions |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162426/ https://www.ncbi.nlm.nih.gov/pubmed/31730171 http://dx.doi.org/10.1093/ajh/hpz182 |
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