Abstract
Worldwide hypertension (HT) guidelines recommend use of home blood pressure monitoring (HBPM) in patients with persistent suboptimal blood pressure (BP) readings. It is not clear how patients with limited health literacy could perform HBPM to assist BP control. This study aimed at finding the association between HBPM and patients from lower socioeconomic classes, particularly on the effect of health literacy or educational level. Three electronic databases (MEDLINE, EMBASE, and PubMed) were searched for primary studies with keywords including educational level, health literacy, numeracy, home blood pressure monitoring, accuracy, and quality. The PRISMA guideline was followed. The quality of the literature was assessed by the Cochrane tool and modified Newcastle-Ottawa Scale. Nineteen interventional studies and 29 cross-sectional studies were included. Different populations used different cutoffs to report patients' educational level, whereas health literacy was rarely measured. Three studies used psychometric validated tools to assess health literacy. The quality of HBPM could be assessed by the completion of the procedures' checklist or the number of HBPM readings recorded. The association between subjects' health literacy or educational level and the quality of HBPM was variable. The interventional studies showed that increasing professional-patient contact time could improve patients' knowledge, efficacy, and quality of HBPM. Conclusion. Patients' educational level and literacy were not the limiting factors to acquire high-quality HBPM. High-quality HBPM could be achieved by the structured educational intervention. The quality and amount of evidence on this topic are limited. Therefore, further studies are warranted.
Highlights
Among hypertensive patients, 10% to 50% of their office blood pressure (BP) readings are higher than the home blood pressure readings [1]
77 studies were excluded because the studies did not assess home blood pressure monitoring (HBPM) or self-BP monitoring, or the research subjects were not hypertensive patients, nor was there any association between HBPM and patients’ educational status or health literacy. 105 studies were included for full-text assessment of eligibility
Five out of twenty-nine studies reported a negative association between patient educational level or other social factors and practice of HBPM. e BP outcomes of patients were included in 5 studies: 2 studies showed a positive association of HBPM and BP control, while 3 studies did not demonstrate any better BP control
Summary
10% to 50% of their office blood pressure (BP) readings are higher than the home blood pressure readings [1]. In patients presented with uncontrolled hypertension in our daily practice, home blood pressure monitoring (HBPM) ( known as self-blood pressure monitoring (SBPM)) is an essential monitoring option especially for patients with a suspected white coat effect or masked hypertension. It has become an important recommendation in most international hypertension management guidelines [2,3,4]. An assessment done by Ringrose et al revealed that most home BP devices were not accurate to within 5 mmHg [9]
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