Document Detail


Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analysis.
MedLine Citation:
PMID:  21115879     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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. The search yielded 37 randomized controlled trials with 9446 participants that contributed data for this meta-analysis. Compared with clinic-based measurements (control group), systolic BP improved with home-based BP monitoring (-2.63 mm Hg; 95% CI, -4.24, -1.02); diastolic BP also showed improvement (-1.68 mm Hg; 95% CI, -2.58, -0.79). Reductions in home BP monitoring-based therapy were greater when telemonitoring was used. Home BP monitoring led to more frequent antihypertensive medication reductions (relative risk, 2.02 [95% CI, 1.32 to 3.11]) and was associated with less therapeutic inertia defined as unchanged medication despite elevated BP (relative risk for unchanged medication, 0.82 [95% CI, 0.68 to 0.99]). Compared with clinic BP monitoring alone, home BP monitoring has the potential to overcome therapeutic inertia and lead to a small but significant reduction in systolic and diastolic BP. Hypertension control with home BP monitoring can be enhanced further when accompanied by plans to monitor and treat elevated BP such as through telemonitoring.
Authors:
Rajiv Agarwal; Jennifer E Bills; Tyler J W Hecht; Robert P Light
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, U.S. Gov't, Non-P.H.S.; Review     Date:  2010-11-29
Journal Detail:
Title:  Hypertension     Volume:  57     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-16     Completed Date:  2011-01-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  29-38     Citation Subset:  IM    
Affiliation:
Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Ind 46202, USA. ragarwal@iupui.edu
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MeSH Terms
Descriptor/Qualifier:
Antihypertensive Agents / therapeutic use*
Blood Pressure / drug effects
Blood Pressure Monitoring, Ambulatory*
Female
Humans
Hypertension / diagnosis*,  drug therapy*
Male
Randomized Controlled Trials as Topic
Risk
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antihypertensive Agents
Comments/Corrections
Comment In:
Hypertension. 2011 Jan;57(1):21-3   [PMID:  21115877 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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