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

Abstract

Objective: To determine the effect of home blood pressure monitoring on blood pressure levels and proportion of people with essential hypertension achieving targets.

Design: Meta-analysis of 18 randomised controlled trials.

Participants: 1359 people with essential hypertension allocated to 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), between intervention and control groups.

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

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

Fig 1

QUORUM statement flow diagram. RTC=randomised controlled trial

Fig 2

Standardised mean differences (95% confidence interval) in systolic (top), diastolic (middle), and mean (bottom) blood pressures achieved in people monitoring blood pressure at home compared with people whose blood pressure was monitored by health professionals in clinical settings

Fig 3

Funnel plots for systolic and diastolic blood pressure

Fig 4

Standardised relative risk of blood pressure above target in people monitoring blood pressure at home compared with people whose blood pressure was monitored by health professionals in clinical settings