Role of Home Blood Pressure Monitoring in Overcoming Therapeutic Inertia and Improving Hypertension Control

Abstract

Abstract-Hypertension remains the most common modifiable cardiovascular risk factor, yet hypertension control rates remain dismal. Home blood pressure (BP) monitoring has the potential to improve hypertension control. The purpose of this review was to quantify both the magnitude and mechanisms of benefit of home BP monitoring on BP reduction. Using a structured review, studies were selected if they reported either changes in BP or percentage of participants achieving a pre-established BP goal between randomized groups using home-based and office-based BP measurements.A random-effects model was used to estimate the magnitude of benefit and relative risk. Key Words: home blood pressure Ⅲ meta analysis Ⅲ hypertension Ⅲ blood pressure Ⅲ ambulatory blood pressure monitoring A lthough clinic blood pressure (BP) measurement still remains the cornerstone hypertension management, the broad availability of electronic BP measurement devices has led to their widespread adoption. Home BP monitoring is now uniformly advocated for the evaluation and management of hypertension. 1,2 This is so because BP control among treated hypertensives remains poor, and it is believed that home BP monitoring can improve hypertension control. 1,2 This improvement may be attributable to both better adherence with antihypertensive therapy and detection and treatment of masked hypertension. Further, in contrast to clinic BP measurement, which is associated with a white coat effect, home BP monitoring may reduce white coat effect and may obviate unnecessary therapy. In addition to improving hypertension control, home BP is superior to clinic BP in predicting cardiovascular prognosis 3 and end-stage renal disease. 4 A previous meta-analysis reported that home BP monitoring may improve hypertension control by only a small amount; 5 however, even this small reduction was considered to be of public health importance. Since the publication of that metaanalysis, several trials have been published that provide important information on how home BP monitoring may improve BP control. The purpose of this systematic review and meta-analysis is to update the magnitude of benefit in BP reduction with home BP monitoring. Further, and more important, it is to discover factors that may lead to improvement in BP control with this simple measurement technique. Methods Identification and Selection of TrialsTo identify randomized controlled trials that evaluated home BP monitoring to clinic BP measurements, we performed a structured Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz.

Similaridade entre os valores da pressão arterial aferida pelo método auscultatório com aparelho de coluna de mercúrio e o método oscilométrico automático com aparelho digital

“…2,23 A systematic review, followed by a recent meta-analysis, has shown that HBPM counters clinical inertia, leading the physician to more strictly seek the therapeutic goal, resulting in better BP control. 24 Another meta-analysis of 18 randomized, controlled trials observed that in hypertensive patients followed up at health units, the use of HBPM, compared with casual BP measurements, resulted in better BP control and higher likelihood of reaching adequate BP targets, strengthening the applicability of the method to the management of hypertension. 23 Prospective studies have shown that HBPM values were better correlated to cardiovascular and renal complications when compared to ambulatory measurements.…”

Automedida da pressão arterial para o controle das cifras tensionais e para a adesão ao tratamento

“…Moreover, the difference may be due to increased adherence to drug treatment. We should point out that some studies have shown even better results when allowed and directed the patient to do self-adjustment on doses of drugs, according to SMBP 5,9 .…”

“…In addition, hypertensive patients accompanied with the SMBP have better blood pressure control compared to those followed by the casual measurement. This improvement is slight, but significant, and it can still be implemented in the use of methodologies that allow the self-adjustment of the medication by the patient, monitored remotely by health professionals 5,9 . It is interesting to notice that, even with a few measures, the SMBP has better predictive value for stroke (CVA) of the casual measurement, however, the greater the number of measures, the better the risk prediction 10 .…”

“…The superiority of this methodology, as compared to casual measurement of blood pressure (BP), both the diagnosis and prognosis of hypertensive patients, already being demonstrated in some studies 3,4 have an impact on better BP control, due to greater adherence to treatment in reducing the inertia of the health care professional to increased 5 blood pressure levels and reduce the unnecessary use of antihypertensive drugs, due to the identification of carriers of the white coat 6 effect.…”

Expert panel consensus recommendations for home blood pressure monitoring in Asia: the Hope Asia Network

“…The number needed to treat to avoid one case of noncompliance was 5.6 patients. Moreover, a systematic review and meta-analysis that included 9446 participants randomised to home or clinic BP monitoring concluded that the former is associated with less therapeutic inertia [27]. The investigators additionally reported that compared with clinic BP measurement, both systolic and diastolic BP improved with home-based BP monitoring.…”