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Schedules for Self-monitoring Blood Pressure: A Systematic Review

Hodgkinson, JA; Stevens, R; Grant, S; Mant, J; Bray, EP; Hobbs, FDR; Martin, U; ... McManus, RJ; + view all (2019) Schedules for Self-monitoring Blood Pressure: A Systematic Review. American Journal of Hypertension , 32 (4) pp. 350-364. 10.1093/ajh/hpy185. Green open access

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Abstract

BACKGROUND: Self-monitoring of blood pressure better predicts prognosis than clinic measurement, is popular with patients, and endorsed in hypertension guidelines. However, there is uncertainty over the optimal self-monitoring schedule. We therefore aimed to determine the optimum schedule to predict future cardiovascular events and determine "true" underlying blood pressure. METHODS: Six electronic databases were searched from November 2009 (updating a National Institute for Health and Care Excellence [NICE] systematic review) to April 2017. Studies that compared aspects of self-monitoring schedules to either prognosis or reliability/reproducibility in hypertensive adults were included. Data on study and population characteristics, self-monitoring regime, and outcomes were extracted by 2 reviewers independently. RESULTS: From 5,164 unique articles identified, 25 met the inclusion criteria. Twelve studies were included from the original NICE review, making a total of 37 studies. Increasing the number of days of measurement improved prognostic power: 72%-91% of the theoretical maximum predictive value (asymptotic maximum hazard ratio) was reached by 3 days and 86%-96% by 7 days. Increasing beyond 3 days of measurement did not result in better correlation with ambulatory monitoring. There was no convincing evidence that the timing or number of readings per day had an effect, or that ignoring the first day's measurement was necessary. CONCLUSIONS: Home blood pressure should be measured for 3 days, increased to 7 only when mean blood pressure is close to a diagnostic or treatment threshold. Other aspects of a monitoring schedule can be flexible to facilitate patient uptake of and adherence with self-monitoring.

Type: Article
Title: Schedules for Self-monitoring Blood Pressure: A Systematic Review
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/ajh/hpy185
Publisher version: https://doi.org/10.1093/ajh/hpy185
Language: English
Additional information: © The Author(s) 2019. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).
Keywords: blood pressure, blood pressure monitoring, hypertension, regression dilution, schedule, self-monitoring, systematic review
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10067128
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