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Title: Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis
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
Cardiovascular Research Institute Maastricht
University of Cambridge
University of Edinburgh
University of Oxford
Turun Yliopistollinen Keskussairaala
NYU Grossman School of Medicine
Queen Mary, University of London
Monash University
Memorial University of Newfoundland
Deakin University
Kaiser Permanente
Faculty of Medicine, Ramathibodi Hospital, Mahidol University
University of Washington, Seattle
VA Medical Center
Lewis Katz School of Medicine
Icahn School of Medicine at Mount Sinai
University of Milano - Bicocca
University of East Anglia, Faculty of Medicine and Health Sciences
St George's Hospital, London
University of Colorado at Denver
Sechenov First Moscow State Medical University
Duke University
IRCCS Istituto Auxologico Italiano
Primary Care Research Unit of Mallorca
Italian Institute of Telemedicine
Keywords: Medicine
Issue Date: 13-Mar-2020
Citation: American journal of hypertension. Vol.33, No.3 (2020), 243-251
Abstract: © 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.
ISSN: 19417225
Appears in Collections:Scopus 2020

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