Abstract
Background: The effectiveness of home blood pressure monitoring (HBPM) in diagnosing and controlling hypertension is well stablished. HBPM is known to reduce blood pressure (BP) levels among patients with uncontrolled hypertension. However, it is unknown whether the BP lowering effects of HBPM are sustained over time. Methods: We performed a meta-analysis study to assess the effect of HBPM on systolic and diastolic BP reduction over multiple periods of time. 53 randomized control trials published between 1975 and 2014, and representing 13,290 participants were included in this meta-analysis. A multiple-outcome, random-effect model was used to estimate the effect size of HBPM at 0 to 3, 4 to 6, 7 to 12 and more than 12 months compared to baseline. Results: BP (systolic, diastolic) was improved with HBPM at 0-3 months (-0.574 mmHg, -0.582 mmHg) and at 4-6 months (-0.269 mmHg, -0.263 mmHg). However, BP reduction was not statistically significant for either diastolic BP at 7-12 months, or for systolic and diastolic BP beyond 12 months. Moreover, average BP reductions became progressively smaller over time (see Figure 1 for average diastolic and systolic average BP reduction and 95% confidence interval). Conclusions: Our analysis is consistent with previous studies reporting small but statistically significant effects of HBPM on systolic and diastolic BP reductions. Here we show in addition that the BP lowering effects of HBPM occur primarily in the first 3 to 6 months, with non-significant lowering of BP after 6 months. Our results suggests a “honeymoon effect” in the clinical benefit of HBPM when applied to uncontrolled hypertensive patients. Interventions intended to produce longer-term control of hypertension will require strategies specifically designed to prolong the benefits of HBPM, possibly by providing periodic educational reinforcement sessions or by incorporating regular positive feedback to patients.
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