Blood pressure control by home monitoring: meta-analysis of randomised trials

doi:10.1136/bmj.38121.684410.AE

BMJ 2004;329:145 (17 July), doi:10.1136/bmj.38121.684410.AE (published 11 June 2004)

Primary care

Blood pressure control by home monitoring: meta-analysis of randomised trials

Francesco P Cappuccio, professor of clinical epidemiology and primary care¹, Sally M Kerry, senior lecturer in medical statistics¹, Lindsay Forbes, public health consultant², Anna Donald, managing director²

¹ Department of Community Health Sciences, St George's Hospital Medical School, London SW17 0RE, ² Bazian Ltd, London N1 1QP

Correspondence to: F P Cappuccio f.cappuccio{at}sghms.ac.uk

Objective To determine the effect of home blood pressure monitoringon blood pressure levels and proportion of people with essentialhypertension achieving targets.

Design Meta-analysis of 18 randomised controlled trials.

Participants 1359 people with essential hypertension allocatedto home blood pressure monitoring and 1355 allocated to the"control" group seen in the healthcare system for 2-36 months.

Main outcome measures Differences in systolic (13 studies),diastolic (16 studies), or mean (3 studies) blood pressures,and proportion of patients achieving targets (6 studies), betweenintervention and control groups.

Results Systolic blood pressure was lower in people with hypertensionwho had home blood pressure monitoring than in those who hadstandard blood pressure monitoring in the healthcare system(standardised mean difference 4.2 (95% confidence interval 1.5to 6.9) mm Hg), diastolic blood pressure was lower by 2.4 (1.2to 3.5) mm Hg, and mean blood pressure was lower by 4.4 (2.0to 6.8) mm Hg. The relative risk of blood pressure above predeterminedtargets was lower in people with home blood pressure monitoring(risk ratio 0.90, 0.80 to 1.00). When publication bias was allowedfor, the differences were attenuated: 2.2 (-0.9 to 5.3) mm Hgfor systolic blood pressure and 1.9 (0.6 to 3.2) mm Hg for diastolicblood pressure.

Conclusions Blood pressure control in people with hypertension(assessed in the clinic) and the proportion achieving targetsare increased when home blood pressure monitoring is used ratherthan standard blood pressure monitoring in the healthcare system.The reasons for this are not clear. The difference in bloodpressure control between the two methods is small but likelyto contribute to an important reduction in vascular complicationsin the hypertensive population.

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Self monitoring of high blood pressure: J Carel Bakx, Mark C van der Wel, and Chris van Weel
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BMJ 2005 331: 493. [Abstract] [Full Text] [PDF]

Home control of blood pressure is beneficial
BMJ 2004 329: 0. [Full Text]

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Rapid Responses:

Read all Rapid Responses

Overall effect, of home monitoring on BP readings, is much greater in practice: Julian D Povey
bmj.com, 17 Jul 2004 [Full text]
Mercury in the domestic environment � a reflection of doctor behaviour?: Phillip J. Colquitt
bmj.com, 17 Jul 2004 [Full text]
Could it be concordance: Andrew J Leigh
bmj.com, 19 Jul 2004 [Full text]
Patients help to explain the benefits of home monitoring: Andrew Herxheimer, et al.
bmj.com, 19 Jul 2004 [Full text]
Re: Patients help to explain the benefits of home monitoring: Frankie E Campling
bmj.com, 20 Jul 2004 [Full text]
Inconsequential meta-anaytical research: David Barnes
bmj.com, 21 Jul 2004 [Full text]
Home monitoring of Blood Pressure: Mervyn S. Gotsman
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Systematic review guidelines� acronym is QUOROM not QUORUM: Willem J. Assendelft
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Meta-analysis does not allow appraisal of complex interventions: Ingrid M�hlhauser
bmj.com, 5 Aug 2004 [Full text]
Validity of conclusions: Nick J Field
bmj.com, 10 Aug 2004 [Full text]
Home monitoring of blood pressures could be useful for relevant few hypertensives: Nasir Shariff
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