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Home Blood Pressure Monitoring, Treatment Adherence and Hypertension Control

  • Alejandro de la SierraEmail author
  • Anastasia Mihailidou
  • Ji-Guang Wang
  • Daichi Shimbo
  • Richard J. McManus
Chapter
Part of the Updates in Hypertension and Cardiovascular Protection book series (UHCP)

Abstract

Home blood pressure monitoring (HBPM) is superior to clinic BP in predicting cardiovascular events in hypertension and helps diagnostic and therapeutic decisions by identifying different hypertension phenotypes, such as white-coat and masked hypertension. In addition to these main advantages of HBPM, several studies have evaluated its impact on long-term management, especially on medication adherence and on BP reduction and control.

In randomized studies versus usual care (decisions based on office BP readings), HBPM has been associated with significant modest improvements in medication adherence, an effect that is usually more evident when HBPM has been a part of other interventions, such as lifestyle counselling and/or adherence reminders. Concerning the effect on BP, again the results of clinical trials and meta-analyses have shown a significant effect on BP reduction when HBPM is added to management. Mean effect on systolic BP at 12 months has been quantified in approximately 3 mmHg, although again positive studies usually combine other interventions, while the isolated use of HBPM has a considerably smaller effect. Intervention studies have also examined the effect of self-management (modifications of antihypertensive treatment by the patient according to a protocol based on HBP measures) and telemonitoring (tele-transmission of data to the physician or to the pharmacist and treatment modifications by health care providers). Results indicate that self-management combined with HBPM has an important impact in reducing BP, provided there is specific training and with the proviso that not all patients will be suitable. Studies with telemonitoring are more controversial. Under strict experimental conditions, it does not seem to improve the effect of HBPM alone. However, even though the marginal benefits of telemonitoring on daily practice compared to manual methods are difficult to measure, they may bring significant improvements, easing integration of self-monitored blood pressure into clinical records. Therefore, it presents an opportunity for an improvement in long-term BP management.

Keywords

Home blood pressure monitoring Hypertension Antihypertensive treatment Treatment adherence Hypertension control 

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Copyright information

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG, part of Springer Nature 2020

Authors and Affiliations

  • Alejandro de la Sierra
    • 1
    Email author
  • Anastasia Mihailidou
    • 2
    • 3
  • Ji-Guang Wang
    • 4
  • Daichi Shimbo
    • 5
  • Richard J. McManus
    • 6
  1. 1.Department of Internal MedicineHospital Mutua Terrassa, University of BarcelonaBarcelonaSpain
  2. 2.Cardiovascular & Hormonal Research Laboratory, Department of Cardiology and Kolling InstituteRoyal North Shore HospitalSydneyAustralia
  3. 3.Macquarie UniversitySydneyAustralia
  4. 4.The Shanghai Institute of HypertensionRuijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
  5. 5.Department of MedicineColumbia University Medical CenterNew YorkUSA
  6. 6.Nuffield Department of Primary Care Health SciencesUniversity of Oxford, Radcliffe Observatory QuarterOxfordUK

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