Role of Home Blood Pressure Monitoring in Overcoming Therapeutic Inertia and Improving Hypertension Control A Systematic Review and Meta-Analysis
Role of Home Blood Pressure Monitoring in Overcoming Therapeutic Inertia and Improving Hypertension Control A Systematic Review and Meta-Analysis
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DOI：
10.1161/hypertensionaha.110.160911
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发表时间：
2011-01-01
期刊：
影响因子：
8.3
通讯作者：
Light, Robert P.
中科院分区：
文献类型：
--
作者：
Agarwal, Rajiv;Bills, Jennifer E.;Light, Robert P.
高血压仍然是最常见的可改变的心血管危险因素，但高血压控制率仍然令人沮丧。家庭血压（BP）监测有可能改善高血压控制。本综述的目的是量化家庭血压监测对血压降低的益处的程度和机制。使用结构化审查，如果研究报告了使用基于家庭和基于办公室的BP测量的随机分组之间BP或达到预先设定的BP目标的参与者百分比的变化，则选择研究。随机效应模型用于估计获益和相对风险的大小。检索得到37项随机对照试验，9446名参与者为本荟萃分析提供了数据。与基于诊所的测量（对照组）相比，基于家庭的血压监测改善了收缩压（-2.63 mmHg; 95% CI，-4.24，-1.02）;舒张压也显示出改善（-1.68 mmHg; 95% CI，-2.58，-0.79）。当使用远程监测时，基于家庭BP监测的治疗的减少更大。家庭血压监测导致更频繁的降压药物减量（相对风险，2.02 [95%CI，1.32 - 3.11]），并与较少的治疗惰性相关，治疗惰性定义为尽管血压升高但仍使用未改变的药物（未改变药物的相对风险，0.82 [95%CI，0.68 - 0.99]）。与单独的诊所血压监测相比，家庭血压监测有可能克服治疗惰性，并导致收缩压和舒张压的小幅但显著的降低。通过家庭血压监测控制高血压，可以进一步加强，同时制定计划，监测和治疗血压升高，如通过远程监测。（高血压。2011; 57：29-38.）
Hypertension remains the most common modifiable cardiovascular risk factor, yet hypertension control rates remain dismal. Home blood pressure (BP) monitoring has the potential to improve hypertension control. The purpose of this review was to quantify both the magnitude and mechanisms of benefit of home BP monitoring on BP reduction. Using a structured review, studies were selected if they reported either changes in BP or percentage of participants achieving a pre-established BP goal between randomized groups using home-based and office-based BP measurements. A random-effects model was used to estimate the magnitude of benefit and relative risk. The search yielded 37 randomized controlled trials with 9446 participants that contributed data for this meta-analysis. Compared with clinic-based measurements (control group), systolic BP improved with home-based BP monitoring (-2.63 mm Hg; 95% CI, -4.24, -1.02); diastolic BP also showed improvement (-1.68 mm Hg; 95% CI, -2.58, -0.79). Reductions in home BP monitoring-based therapy were greater when telemonitoring was used. Home BP monitoring led to more frequent antihypertensive medication reductions (relative risk, 2.02 [95% CI, 1.32 to 3.11]) and was associated with less therapeutic inertia defined as unchanged medication despite elevated BP (relative risk for unchanged medication, 0.82 [95% CI, 0.68 to 0.99]). Compared with clinic BP monitoring alone, home BP monitoring has the potential to overcome therapeutic inertia and lead to a small but significant reduction in systolic and diastolic BP. Hypertension control with home BP monitoring can be enhanced further when accompanied by plans to monitor and treat elevated BP such as through telemonitoring. (Hypertension. 2011; 57:29-38.)