Self-monitoring of blood pressure in patients with hypertension related multi-morbidity: Systematic review and individual patient data meta-analysis

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

doi:10.1093/ajh/hpz182

Self-monitoring of blood pressure in patients with hypertension related multi-morbidity: Systematic review and individual patient data meta-analysis

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 MargolisB McKinstry, M A McLaughlin, K McNamara, S Omboni, O Ogedegbe, G Parati, J Varis, W J Verberk, B J Wakefield, R J McManus

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Abstract / Description of output

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. Randomised controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorised 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 mmHg, [95%CI -4.78, -1.46 mmHg]; 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.

Original language	English
Journal	American Journal of Hypertension
Early online date	15 Nov 2019
DOIs	https://doi.org/10.1093/ajh/hpz182
Publication status	E-pub ahead of print - 15 Nov 2019

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AAM - Self-monitoring of blood pressure in patients with hypertension...
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.
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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., ... McManus, R. J. (2019). Self-monitoring of blood pressure in patients with hypertension related multi-morbidity: Systematic review and individual patient data meta-analysis. American Journal of Hypertension. Advance online publication. https://doi.org/10.1093/ajh/hpz182

@article{ccfbd9baf9e2420489984af1c2cdbcd7,

title = "Self-monitoring of blood pressure in patients with hypertension related multi-morbidity: Systematic review and individual patient data meta-analysis",

abstract = "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. Randomised controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorised 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 mmHg, [95%CI -4.78, -1.46 mmHg]; 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.",

author = "Sheppard, {J P} and Tucker, {K L} and Davison, {W J} and R Stevens and W Aekplakorn and Bosworth, {H B} and A Bove and K Earle and M Godwin and Green, {B B} and P Hebert and C Heneghan and N Hill and Hobbs, {F D R} and I Kantola and Kerry, {S M} and A Leiva and Magid, {D J} and J Mant and Margolis, {K L} and B McKinstry and McLaughlin, {M A} and K McNamara and S Omboni and O Ogedegbe and G Parati and J Varis and Verberk, {W J} and Wakefield, {B J} and McManus, {R J}",

note = "{\textcopyright} The Author(s) 2019. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd.",

year = "2019",

month = nov,

day = "15",

doi = "10.1093/ajh/hpz182",

language = "English",

journal = "American Journal of Hypertension",

issn = "0895-7061",

publisher = "Springer Nature",

}

Sheppard, JP, Tucker, KL, Davison, WJ, Stevens, R, Aekplakorn, W, Bosworth, HB, Bove, A, Earle, K, Godwin, M, Green, BB, Hebert, P, Heneghan, C, Hill, N, Hobbs, FDR, Kantola, I, Kerry, SM, Leiva, A, Magid, DJ, Mant, J, Margolis, KL, McKinstry, B, McLaughlin, MA, McNamara, K, Omboni, S, Ogedegbe, O, Parati, G, Varis, J, Verberk, WJ, Wakefield, BJ & McManus, RJ 2019, 'Self-monitoring of blood pressure in patients with hypertension related multi-morbidity: Systematic review and individual patient data meta-analysis', American Journal of Hypertension. https://doi.org/10.1093/ajh/hpz182

TY - JOUR

T1 - Self-monitoring of blood pressure in patients with hypertension related multi-morbidity

T2 - Systematic review and individual patient data meta-analysis

AU - Sheppard, J P

AU - Tucker, K L

AU - Davison, W J

AU - Stevens, R

AU - Aekplakorn, W

AU - Bosworth, H B

AU - Bove, A

AU - Earle, K

AU - Godwin, M

AU - Green, B B

AU - Hebert, P

AU - Heneghan, C

AU - Hill, N

AU - Hobbs, F D R

AU - Kantola, I

AU - Kerry, S M

AU - Leiva, A

AU - Magid, D J

AU - Mant, J

AU - Margolis, K L

AU - McKinstry, B

AU - McLaughlin, M A

AU - McNamara, K

AU - Omboni, S

AU - Ogedegbe, O

AU - Parati, G

AU - Varis, J

AU - Verberk, W J

AU - Wakefield, B J

AU - McManus, R J

PY - 2019/11/15

Y1 - 2019/11/15

N2 - 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. Randomised controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorised 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 mmHg, [95%CI -4.78, -1.46 mmHg]; 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.

AB - 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. Randomised controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorised 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 mmHg, [95%CI -4.78, -1.46 mmHg]; 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.

U2 - 10.1093/ajh/hpz182

DO - 10.1093/ajh/hpz182

M3 - Article

C2 - 31730171

SN - 0895-7061

JO - American Journal of Hypertension

JF - American Journal of Hypertension

ER -

Self-monitoring of blood pressure in patients with hypertension related multi-morbidity: Systematic review and individual patient data meta-analysis

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