Antihypertensive drug treatment: A comparison of usual care with self blood pressure measurement

Bailey, Benoît; Carney, Shane; Gillies, Alastair J.; Smith, Anthony J.

doi:10.1038/sj.jhh.1000758

Cited by 29 publications

(30 citation statements)

References 6 publications

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“…The table shows the characteristics of the analysed trials. Six were based in hospital outpatient clinics,14 19 21 22 25 31 eight in communities and general practices,16 18 23 24 26–29 and four in mixed settings 15 17 20 30. Treatment in the “control” group was mainly “usual” or “standard” care,15–19 21 22 24–29 31 but some trials had nurse clinics,14 30 educational interventions,20 or flagged medical records 23.…”

Section: Resultsmentioning

confidence: 99%

Blood pressure control by home monitoring: meta-analysis of randomised trials

Cappuccio

Kerry

Forbes³

et al. 2004

BMJ

439

254

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Objective To determine the effect of home blood pressure monitoring on blood pressure levels and proportion of people with essential hypertension achieving targets. Design Meta-analysis of 18 randomised controlled trials. Participants 1359 people with essential hypertension allocated to home blood pressure monitoring and 1355 allocated to the "control" group seen in the healthcare system for 2-36 months. Main outcome measures Differences in systolic (13 studies), diastolic (16 studies), or mean (3 studies) blood pressures, and proportion of patients achieving targets (6 studies), between intervention and control groups. Results Systolic blood pressure was lower in people with hypertension who had home blood pressure monitoring than in those who had standard blood pressure monitoring in the healthcare system (standardised mean difference 4.2 (95% confidence interval 1.5 to 6.9) mm Hg), diastolic blood pressure was lower by 2.4 (1.2 to 3.5) mm Hg, and mean blood pressure was lower by 4.4 (2.0 to 6.8) mm Hg. The relative risk of blood pressure above predetermined targets was lower in people with home blood pressure monitoring (risk ratio 0.90, 0.80 to 1.00). When publication bias was allowed for, the differences were attenuated: 2.2 ( − 0.9 to 5.3) mm Hg for systolic blood pressure and 1.9 (0.6 to 3.2) mm Hg for diastolic blood pressure. Conclusions Blood pressure control in people with hypertension (assessed in the clinic) and the proportion achieving targets are increased when home blood pressure monitoring is used rather than standard blood pressure monitoring in the healthcare system. The reasons for this are not clear. The difference in blood pressure control between the two methods is small but likely to contribute to an important reduction in vascular complications in the hypertensive population.

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Section: Resultsmentioning

confidence: 99%

Blood pressure control by home monitoring: meta-analysis of randomised trials

Cappuccio

Kerry

Forbes³

et al. 2004

BMJ

439

254

View full text Add to dashboard Cite

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“…We included 2 articles in which home BPs were measured only in the morning 31, 36 (the morning home BPs were used as the average home BPs in these studies) and one article where BP was measured in the morning, at noon, and in the evening. 16 We included some articles in which the method of clinic BP measurements was not clearly described, 15, 19, 24, 30, 31, 33, 35-37 and/or in which clinic BP was measured only once per clinic visit, 31 but we repeated our analyses excluding these articles. Rater differences in the selection of articles were discussed, and the last author (TGP) resolved any remaining discrepancies concerning article eligibility.…”

Section: Methodsmentioning

confidence: 99%

Changes in Home Versus Clinic Blood Pressure With Antihypertensive Treatments

et al. 2008

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Home blood pressure (HBP) monitoring is recommended for assessing the effects of antihypertensive treatment, but it is not clear how the treatment-induced changes in HBP compare with the changes in clinic BP (CBP). We searched PubMed using the terms “home or self-measured blood pressure,” and selected articles in which the changes in CBP and HBP (using the upper arm oscillometric method) induced by antihypertensive drugs were presented. We performed a systematic review of 30 articles published before March 2008 that included a total of 6794 subjects. As there was significant heterogeneity in most of the outcomes, a random effects model was used for the meta-analyses. The mean changes (± standard error) in CBP and HBP (systolic/diastolic) were -15.2±0.03/-10.3±0.03 mmHg and -12.2±0.04/-8.0±0.04 mmHg respectively, although there were wide varieties of differences in the reduction between HBP and CBP. The reductions in CBP were correlated with those of HBP (systolic BP; r=0.66, B=0.48, diastolic BP; r=0.71, B=0.52, P<0.001). In 7 studies that also included 24-hour BP monitoring, the reduction of HBP was greater than that of 24-hr BP in systolic (HBP; -12.6±0.06 mmHg, 24-hr BP; -11.9±0.04 mmHg, P<0.001). In 5 studies that included daytime and nighttime systolic BP separately, HBP decreased 15% more than daytime ambulatory BP and 30% more than nighttime ambulatory BP. In conclusion, HBP falls about 20% less than CBP with antihypertensive treatments. Daytime systolic BP falls 15% less and nighttime systolic BP falls 30% less than home systolic BP.

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“…However, when the intervention effects were categorized on the basis of the type of medication adherence measure employed in each of the individual trials, all 3 studies that employed objective electronic monitoring of medication adherence reported positive intervention effects, 123,125,126 and 3 of 5 trials that utilized pill counts reported significant improvement in medication adherence, 120,122,127 whereas all the studies that utilized self-report measures or pharmacy refill data reported negative find-ings. 118,119,121,124,128 The authors concluded that the data on the effects of HBPM on patients' medication-taking behavior are mixed and that HBPM should be considered a useful adherence-enhancing strategy, especially when used in combination with other approaches such as patient counseling, patient reminders, and use of nurse case managers. Not included in this systematic review was a Spanish study that tested the effect of HBPM compared with usual care in improving medication adherence assessed with electronic monitoring.…”

Section: Effects On Medication Adherencementioning

confidence: 99%

Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring

Pickering¹,

Miller

Ogedegbe³

et al. 2008

Hypertension

481

235

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Abstract-Home blood pressure monitoring (HBPM) overcomes many of the limitations of traditional office blood pressure (BP) measurement and is both cheaper and easier to perform than ambulatory BP monitoring. Monitors that use the oscillometric method are currently available that are accurate, reliable, easy to use, and relatively inexpensive. An increasing number of patients are using them regularly to check their BP at home, but although this has been endorsed by national and international guidelines, detailed recommendations for their use have been lacking. There is a rapidly growing literature showing that measurements taken by patients at home are often lower than readings taken in the office and closer to the average BP recorded by 24-hour ambulatory monitors, which is the BP that best predicts cardiovascular risk. Because of the larger numbers of readings that can be taken by HBPM than in the office and the elimination of the white-coat effect (the increase of BP during an office visit), home readings are more reproducible than office readings and show better correlations with measures of target organ damage. In addition, prospective studies that have used multiple home readings to express the true BP have found that home BP predicts risk better than office BP (Class IIa; Level of Evidence A). This call-to-action article makes the following recommendations: (1) It is recommended that HBPM should become a routine component of BP measurement in the majority of patients with known or suspected hypertension; (2) Patients should be advised to purchase oscillometric monitors that measure BP on the upper arm with an appropriate cuff size and that have been shown to be accurate according to standard international protocols. They should be shown how to use them by their healthcare providers; (3) Two to 3 readings should be taken while the subject is resting in the seated position, both in the morning and at night, over a period of 1 week. A total of Ն12 readings are recommended for making clinical decisions; (4) HBPM is indicated in patients with newly diagnosed or suspected hypertension, in whom it may distinguish between white-coat and sustained hypertension. If the results are equivocal, ambulatory BP monitoring may help to establish the diagnosis; (5) In patients with prehypertension, HBPM may be useful for detecting masked hypertension; (6) HBPM is recommended for evaluating the response to any type of antihypertensive treatment and may improve adherence; (7) The target HBPM goal for treatment is Ͻ135/85 mm Hg or Ͻ130/80 mm Hg in high-risk patients; (8) HBPM is useful in the elderly, in whom both BP variability and the white-coat effect are increased; (9) HBPM is of value in patients with diabetes, in whom tight BP control is of paramount importance; (10) Other populations in whom HBPM may be beneficial include pregnant women, children, and patients with kidney disease; and (11) HBPM has the potential to improve the quality of care while reducing costs and should be reimbursed. (Hypertension. 2008;52:10-29.)

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Antihypertensive drug treatment: A comparison of usual care with self blood pressure measurement

Cited by 29 publications

References 6 publications

Blood pressure control by home monitoring: meta-analysis of randomised trials

Blood pressure control by home monitoring: meta-analysis of randomised trials

Changes in Home Versus Clinic Blood Pressure With Antihypertensive Treatments

Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring

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