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Evidence-Based Healthcare & Public Health (2005) 9, 121–122

KEYWORDBlood presHome monHypertensi

1744-2249/$ - sdoi:10.1016/j.e

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www.elsevier.com/locate/ebhph

EVIDENCE-BASED HEALTHCARE MANAGEMENT

Home blood pressure monitoring improves bloodpressure control$

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from: Cappuccio FP, Kls. BMJ 2004; 329:145.

Question: Does home monitoring improve blood pressure control in people withhypertension?Study design: Systematic review with meta-analysis.Main results: Eighteen randomised controlled trials met inclusion criteria (13reported systolic blood pressure; 16 reported diastolic blood pressure; threereported mean arterial pressure; and six reported blood pressure above target).Blood pressure self-monitoring at home, or monitoring by a family membersignificantly reduced blood pressure compared with usual monitoring in healthcaresettings (see results table). Adjusting for publication bias reduced this difference(mean difference in systolic pressure: 2.2mmHg, 95%CI �0.9 to 5.3; mean differencein diastolic pressure: 1.9mmHg, 95%CI 0.6 to 3.2). At 1 year, the relative risk ofhaving blood pressure above the target was lower in people who were monitoringthemselves at home compared with people monitored in the healthcare system (RR0.9, 95%CI 0.8 to 1.0).Authors’ conclusions: Home blood pressure monitoring improves blood pressuremore than monitoring in the healthcare system in people with hypertension.& 2005 Elsevier Ltd. All rights reserved.

Further details

Search strategy

Studies were identified using MEDLINE (1966 to January 2003), EMBASE (1980 to January 2003), CochraneDatabase of Systematic Reviews, Database of Abstracts of Clinical Effectiveness, Health TechnologyAssessment Database, NHS Economic Evaluation Database and TRIP database. The websites for the Centrefor Reviews and Dissemination, and the Agency for Healthcare Research and Quality, were also searched.Reference lists were searched by hand.

Inclusion/exclusion criteria

Eligible studies were randomised controlled trials comparing home self blood pressure monitoring (ormonitoring by a family member) with healthcare system monitoring in people with hypertension.Exclusions: studies that used ambulatory blood pressure monitoring.

Elsevier Ltd. All rights reserved.

erry SM, Forbes L, Donald A. Blood pressure control by home monitoring: meta-analysis of

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Results table

Effect of home monitoring on blood pressure in people with hypertension.

Outcome Home monitoring n healthcare system monitoringMean difference (mmHg) 95% CI

Systolic blood pressure 4.2 1.5 to 6.9Diastolic blood pressure 2.4 1.2 to 3.5Mean arterial blood pressure 4.4 2.0 to 6.8

EVIDENCE-BASED HEALTHCARE MANAGEMENT122

Data analysis

Data were extracted on the change in systolic, diastolic and mean arterial blood pressure between peoplewho were monitoring blood pressure at home and people who were being monitored in the healthcaresystem. Information was also extracted on the number of people above the target blood pressure. Meta-analysis was carried out using a random effects model and publication bias was examined using funnel plotanalysis.

Main outcomes

Change in blood pressure; change in proportion of people with blood pressure above target.

Notes

Authors note that effects of home monitoring may be underestimated due to heterogeneity in the design ofthe eligible studies.

Sources of funding: Bristol-Myers Squibb, UK.

Abstract provided by Bazian Ltd, London