Home Blood Pressure Monitoring, Treatment Adherence and Hypertension Control
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.
KeywordsHome blood pressure monitoring Hypertension Antihypertensive treatment Treatment adherence Hypertension control
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