Effectiveness Of Home Blood Pressure Monitoring Research Articles

Home Blood Pressure Monitoring and Its Association With Blood Pressure Control Among Hypertensive Patients With High Cardiovascular Risk in China.

Home blood pressure monitoring (HBPM) is viewed as a facilitating factor in the initial diagnosis and long-term management of treated hypertension. However, evidence remains scarce about the effectiveness of HBPM use in the real world. This study aimed to examine the associations of HBPM use with blood pressure (BP) control and medication adherence. This prospective cohort study included hypertensive patients with high cardiovascular risk who were aged ≥50 years. At baseline, information about types of BP monitor, frequency of HBPM, perception of anti-hypertensive treatment, and measured office BP were collected. During the 1-year follow-up (visits at 1, 2, 3, 6, and 12 months), information on medication adherence was collected at each visit. The 2 major outcomes were BP control at baseline and medication adherence during the 1-year follow-up. A log-binomial regression model was used to examine the association between frequency of HBPM and outcomes, stratified by the perceptions of anti-hypertensive treatment. A total of 5,363 hypertensive patients were included in the analysis. The age was (64.6 ± 7.2) years, and 41.2% (2,208) were female. Of the total patients, 85.9% (4,606) had a home BP monitor and 47.8% (2,564) had an incorrect perception of anti-hypertensive treatment. Overall, 24.2% (1,299) of patients monitored their BP daily, 37.6% (2,015) weekly, 17.3% (926) monthly, and 20.9% (1,123) less than monthly. At baseline, the systolic BP and diastolic BP were (146.6 ± 10.8) mmHg and (81.9 ± 10.6) mmHg, respectively, and 28.5% (1,527) of patients had their BP controlled. Regardless of whether the patients had correct or incorrect perceptions of anti-hypertensive treatment, there is no significant association between HBPM frequency and BP control at baseline. During the 1-year follow-up, 23.9% (1,280) of patients had non-adherence to medications at least once. In patients with an incorrect perception of anti-hypertensive treatment, those monitoring BP most frequently (daily) had the highest non-adherence rate (29.9%, 175/585). Compared with those monitoring their BP less than monthly, patients who monitored their BP daily were more likely not to adhere to anti-hypertensive medications (adjusted relative risk = 1.38, 95% confidence interval: 1.11-1.72, P = 0.004). HBPM performance among hypertensive patients in China is, in general, sub-optimal. No association was observed between using HBPM alone and hypertension control, indicating that the effects of HBPM could be conditional. Patients' misconceptions about anti-hypertensive treatment may impair the role of BP monitoring in achieving medication adherence. Fully incorporating the correct perception of hypertension into the management of hypertensive patients is needed.

Effects of Remote Monitoring of Blood Pressure in Management of Urban Hypertensive Patients: A Systematic Review and Meta-Analysis

Background Remote home blood pressure monitoring (HBPM) has been shown as effective in managing hypertension in underserved areas. Effects on urban patients, who are more easily provided with high-quality medical services, are still unclear. We systematically review previously published randomized controlled trials on the effect of HBPM for urban hypertensive patients. Methods We searched electronic databases for studies published in English up to October 2018. Studies comparing the use of HBPM to face-to-face care were included. Outcome measures were changes in office blood pressure (BP) and the rate of BP control. Results We identified 1,433 potential references for screening, of which 27 were eligible for review. Substantial heterogeneity was evident for the investigated variables. A significant standardized mean difference (SMD) was observed for HBPM for SBP, but the effect size was small compared to face-to-face care and was clinically irrelevant in avoiding cardiovascular events (0.212: 95% confidence interval, 0.148 to 0.275; P < 0.001). For diastolic BP, the SMD between the two groups was small (0.170, P < 0.001) and the effect of HBPM was irrelevant in preventing cardiovascular events. The effect on the rate of BP control was significantly high for the intervention group (relative risk: 1.136; P = 0.018). Conclusion This review demonstrates that HBPM performed on urban hypertensive patients has limited value and seems not to be superior to ordinary care in avoidance of cardiovascular events. Further studies are needed to provide more reliable information about the effectiveness of HBPM in preventing hypertensive cardiovascular complications.

Abstract 143: A Meta-analysis of the Short and Long Term Effects of Home Blood Pressure Monitoring

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.

Home blood pressure for the management of hypertension: will it become the new standard of practice?

Accurate identification of hypertension is crucial for the prevention of cardiovascular disease. Home blood pressure monitoring (HBPM) provides superior prediction of cardiovascular disease, compared with clinic pressures. HBPM can be a valuable resource for the effective treatment of hypertension, when combined with other modalities used to improve patient education, lifestyle enhancement, adherence to medication and reduction of unnecessary clinic visits. In some developed nations, more than half of households with a hypertensive patient have a device for HBPM. The use of HBPM by patients and the acceptance of HBPM measurements by providers is increasing. The long-term effectiveness of HBPM, combined with telemetry for disease prevention, is promising. More research is still needed to establish its full value. It is predicted that HBPM has definite potential for more effective strategies to control hypertension and reduce the need for on-site clinical care.

A Systematic Review of the Effects of Home Blood Pressure Monitoring on Medication Adherence

Home blood pressure monitoring (HBPM) improves blood pressure control, but little is known about its effects on medication adherence. The authors conducted a systematic review of the published literature on the effects of HBPM on medication adherence. Of 440 abstracts and citations reviewed, 11 randomized control trials met predefined criteria. Six of the 11 randomized controlled trials reported statistically significant improvement in medication adherence; 84% of these were complex interventions involving the use of HBPM in combination with other adherence-enhancing strategies such as patient counseling by nurses, pharmacists, or a telephone-linked system; patient education; and the use of timed medication reminders. Interventions conducted in primary care settings were not effective compared with those that occurred in hospital-based clinics or nonclinical settings. The data on the effects of HBPM on patients' medication-taking behavior are mixed. Future studies should investigate the independent effects of HBPM in primary care practices where the majority of hypertensive patients receive their care.