Primary Care

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

BMJ 2004; 329 doi: http://dx.doi.org/10.1136/bmj.38121.684410.AE (Published 15 July 2004) Cite this as: BMJ 2004;329:145
  1. Francesco P Cappuccio (f.cappuccio{at}sghms.ac.uk), professor of clinical epidemiology and primary care1,
  2. Sally M Kerry, senior lecturer in medical statistics1,
  3. Lindsay Forbes, public health consultant2,
  4. Anna Donald, managing director2
  1. 1 Department of Community Health Sciences, St George's Hospital Medical School, London SW17 0RE
  2. 2 Bazian Ltd, London N1 1QP
  1. Correspondence to: F P Cappuccio
  • Accepted 1 February 2004

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.

Footnotes

  • Embedded Image Appendices A-D are on bmj.com

    FPC is a member of the St George's Cardiovascular Research Group.

  • Contributors FPC, LF, and AD conceived the idea, set the objectives, and contributed to design and interpretation. LF ran the searches. SMK and LF abstracted the data, consulting FPC when necessary. SMK did the statistical analysis. FPC drafted the paper, and all authors reviewed it. FPC is the guarantor.

  • Funding Bazian Ltd was supported, in part, by an educational grant from Bristol-Myers Squibb.

  • Competing interests Bazian Ltd is an independent company that specialises in evidence based reviews and training. It has a policy of strict scientific integrity and does not accept contracts that threaten impartiality when assessing and reviewing research. Bazian Ltd provides managing editorship to publications of the BMJ Publishing Group.

  • Ethical approval Not needed.

  • Accepted 1 February 2004
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