The role of home BP monitoring: Answers to 10 common questions
How does home BP monitoring stack up against clinic and ambulatory measurements for the Dx and management of hypertension? Find out in this review.
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
One quasi-experimental study with 450 participants showed that home BP measurements were at least as good as ambulatory BP measurements at predicting end organ damage related to hypertension when organ damage was measured by cardiac echocardiography, detection of microalbuminuria, and carotid echocardiography.23 Similarly, a systematic review of 14 studies and 2485 participants comparing home, ambulatory, and office BP readings showed that home BP measurements’ association with left ventricular mass index is as good as that of ambulatory BP measurements, and superior to clinic BP readings.24
6. Does HBPM help improve medication adherence?
The jury is still out on this one (SOR B).
A 2006 systematic review of randomized controlled trials (RCTs) incorporating HBPM and evaluating medication adherence outcomes found that in 6 of the 11 studies identified, there was some improvement in medication adherence with HBPM.25 However, only 1 of the 6 studies in this review involved HBPM as the sole intervention; the remaining 5 studies employed additional adherence-enhancing strategies.
Another systematic review looking at HBPM vs usual care included 8 studies (3 of moderate quality and 5 of low quality) that measured medication adherence (using varying measures of adherence) of which only 3 studies showed some improvement in medication adherence with HBPM.18
7. Does HBPM reduce therapeutic inertia?
Yes (SOR B).
A meta-analysis of 15 studies showed that therapeutic inertia was less common with HBPM than with office BP monitoring alone; the relative risk for unchanged medication was 0.82 (95% CI, 0.68 to 0.99) with HBPM.26 However, 10 of the 15 studies were of low quality with a Jadad score ≤3.
8. Does HBPM, along with titration of treatment, improve BP outcomes?
Yes (SOR B).
Two RCTs that looked at self-monitoring of BP and self-titration of hypertensive medications showed significant reductions in BP levels.27,28 In a cluster RCT of home BP telemonitoring, in which the pharmacist adjusted antihypertensives based on transmitted BP measurements, hypertension control was significantly better in the intervention group than in the usual care group (57.2% vs 30%).29
Continue to: What are the recommended techniques for HBPM?
