Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis

• Main Authors: J. P. Sheppard, K. L. Tucker, W. J. Davison, R. Stevens, W. Aekplakorn, H. B. Bosworth, A. Bove, K. Earle, M. Godwin, B. B. Green, P. Hebert, C. Heneghan, N. Hill, F. D.R. Hobbs, I. Kantola, S. M. Kerry, A. Leiva, D. J. Magid, J. Mant, K. L. Margolis, B. McKinstry, M. A. McLaughlin, K. McNamara, S. Omboni, O. Ogedegbe, G. Parati, J. Varis, W. J. Verberk, B. J. Wakefield, R. J. McManus
• Other Authors: Cardiovascular Research Institute Maastricht
• Format: Article
• Published: 2020
• Subjects: Medicine
• Online Access: https://repository.li.mahidol.ac.th/handle/123456789/53724
• Institution: Mahidol University

© The Author(s) 2019. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. 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.