Home BP monitoring significantly lowers pressure
Simulation model suggests active surveillance offers greatest quality-adjusted life expectancy
Home monitoring lowers blood pressure significantly more than clinic care alone, according to a new meta-analysis of home monitoring trials.
More than 300 randomized controlled trials with over 9,000 participants were included in the analysis. All studies randomized patients to home-based or office-based blood pressure measurements and reported on either changes in blood pressure or percentage of patients achieving a pre-established goal of therapy. Overall, home-based monitoring lowered blood pressure by 2.63 mm Hg systolic and 1.68 mm Hg diastolic compared to clinic-based monitoring. Home monitoring also resulted in 11% more patients meeting their goal blood pressures, but the difference was not statistically significant. The analysis was published online by Hypertension on Nov. 29.
Some of the included trials used telemonitoring as part of the home measurement intervention, and even greater reductions in blood pressure were seen in those trials. Hemodialysis patients also appeared to benefit even more from the intervention than those not on dialysis. Another result of the home monitoring was that it overcame some therapeutic inertia—the home treatment arms showed more frequent antihypertensive medication reductions and fewer cases in which medication went unchanged despite elevated blood pressure.
Study authors concluded that home blood pressure monitoring is associated with a small but significant improvement in blood pressure control. However, they noted that the monitoring is of little value unless patients and their physicians act on the results, by titration of antihypertensive drugs, for example. The authors called for larger studies of home monitoring for hemodialysis patients, since the intervention appeared to be particularly beneficial to them. Future studies should also research the impact of factors such as patient motivation, physician commitment, frequency of visits and the need for quick treatment adjustment on the effectiveness of home monitoring, an accompanying editorial suggested.