Does self-monitoring reduce blood pressure? Meta-analysis with meta-regression of randomized controlled trials
Does self-monitoring reduce blood pressure? Meta-analysis with meta-regression of randomized controlled trials
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DOI：
10.3109/07853890.2010.489567
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发表时间：
2010-07-01
影响因子：
4.4
通讯作者：
McManus, Richard J.
中科院分区：
文献类型：
--
作者：
Bray, Emma P.;Holder, Roger;McManus, Richard J.
介绍。自我监测血压（BP）是高血压管理中越来越普遍的一部分。本系统综述的目的是评估与自我监测相关的收缩压和舒张压降低以及目标血压的实现情况。检索MEDLINE、Embase、Cochrane系统评价数据库、临床疗效摘要数据库、卫生技术评估数据库、NHS经济评估数据库和TRIP数据库，以办公室/门诊血压改变或控制血压比例为干预措施包括自我监测血压的研究。两名审稿人独立提取数据。采用随机效应模型的meta分析与meta回归相结合来调查效应量的异质性。共纳入25项符合条件的随机对照试验（RCTs）（27个比较）。与常规护理相比，自我监测组的办公室收缩压（20个rct， 21个比较，5,898例患者）和舒张压（23个rct， 25个比较，6,038例患者）显著降低(加权平均差值（WMD）收缩压-3.82 mmHg（95%可信区间-5.61至-2.03)，舒张压-1.45 mmHg(-1.95至-0.94)）。自我监测增加了达到办公室血压目标的机会（12项随机对照试验，13项比较，2,260例患者，相对风险= 1.09(1.02至1.16)）。所有三个比较的研究之间存在显著的异质性，这可能部分归因于使用了额外的联合干预措施。自我监测可以降低血压，虽然幅度不大，但效果显著。元回归只能解释部分观察到的异质性。
Introduction. Self-monitoring of blood pressure (BP) is an increasingly common part of hypertension management. The objectives of this systematic review were to evaluate the systolic and diastolic BP reduction, and achievement of target BP, associated with self-monitoring.Methods. MEDLINE, Embase, Cochrane database of systematic reviews, database of abstracts of clinical effectiveness, the health technology assessment database, the NHS economic evaluation database, and the TRIP database were searched for studies where the intervention included self-monitoring of BP and the outcome was change in office/ambulatory BP or proportion with controlled BP. Two reviewers independently extracted data. Meta-analysis using a random effects model was combined with meta-regression to investigate heterogeneity in effect sizes.Results. A total of 25 eligible randomized controlled trials (RCTs) (27 comparisons) were identified. Office systolic BP (20 RCTs, 21 comparisons, 5,898 patients) and diastolic BP (23 RCTs, 25 comparisons, 6,038 patients) were significantly reduced in those who self-monitored compared to usual care (weighted mean difference (WMD) systolic -3.82 mmHg (95% confidence interval -5.61 to -2.03), diastolic -1.45 mmHg (-1.95 to -0.94)). Self-monitoring increased the chance of meeting office BP targets (12 RCTs, 13 comparisons, 2,260 patients, relative risk = 1.09 (1.02 to 1.16)). There was significant heterogeneity between studies for all three comparisons, which could be partially accounted for by the use of additional co-interventions.Conclusion. Self-monitoring reduces blood pressure by a small but significant amount. Meta-regression could only account for part of the observed heterogeneity.