Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis.
Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis.
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DOI：
10.1371/journal.pmed.1002389
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发表时间：
2017-09
期刊：
影响因子：
15.8
通讯作者：
McManus RJ
中科院分区：
文献类型：
--
作者：
Tucker KL;Sheppard JP;Stevens R;Bosworth HB;Bove A;Bray EP;Earle K;George J;Godwin M;Green BB;Hebert P;Hobbs FDR;Kantola I;Kerry SM;Leiva A;Magid DJ;Mant J;Margolis KL;McKinstry B;McLaughlin MA;Omboni S;Ogedegbe O;Parati G;Qamar N;Tabaei BP;Varis J;Verberk WJ;Wakefield BJ;McManus RJ
自我监测血压（BP）似乎可以降低高血压患者的血压，但关于有效实施以及哪些群体可能受益最多的重要问题仍然存在。进行个体患者数据 (IPD) 荟萃分析是为了更好地了解血压自我监测对降低血压和控制高血压的有效性。在 Medline、Embase 和 Cochrane 图书馆中检索了比较高血压患者自我监测与不自我监测的随机试验（2016 年 6 月）。两名审稿人独立评估文章的资格，并联系合格试验的作者请求 IPD。在初始搜索的 2,846 篇文章中，有 36 篇符合条件。 IPD 由 25 项试验提供，其中包括 1 项未发表的研究。主要结局的数据——平均临床或动态血压的变化以及 12 个月时控制在目标以下的比例——可从 15/19 项可能的研究中获得（7,138/8,292 [86%] 的随机参与者）。总体而言，与 12 个月时的常规护理相比，自我监测与临床收缩压 (sBP) 降低相关（−3.2 mmHg，[95% CI −4.9，−1.6 mmHg]）。然而，这种效果受到共同干预强度的强烈影响，从单独自我监测没有效果（-1.0 mmHg [-3.3, 1.2]）到当监测与强化支持相结合时减少 6.1 mmHg (-9.0, -3.2)。对于抗高血压药物较少且基线收缩压高达 170 mmHg 的患者来说，自我监测最为有效。不同性别或大多数合并症的疗效没有差异。 12 个月时的动态血压数据来自 4 项试验（1,478 名患者），这些试验在很少或没有共同干预的情况下评估自我监测。在该组中，自我监测与较低的诊所或动态血压之间没有关联（诊所-0.2 mmHg [-2.2, 1.8]；动态 1.1 mmHg [-0.3, 2.5]）。舒张压 (dBP) 的结果相似。这项工作的主要局限性是仍然存在显着的异质性。这至少部分是由于纳入研究中的纳入标准、自我监测制度和目标血压不同。单独的自我监测与降低血压或更好的控制无关，但与联合干预措施（包括医生、药剂师或患者的系统药物滴定；教育；或生活方式咨询）相结合，可导致临床上显着的血压降低，并持续至少 12 个月。高血压自我监测的实施应伴随此类联合干预措施。在随机试验的个体患者数据荟萃分析中，凯瑟琳·塔克（Katherine Tucker）及其同事检查了高血压自我监测血压有效性的证据。自我监测血压似乎比常规护理更能降低高血压患者的血压。自我监测的实施一直不一致，可能是因为在如何最好地使用它以及针对哪些患者群体方面仍然存在重要的证据差距。更好地了解自我监测对降压和控制血压的效果。具体来说，是检查自我监测与各种共同干预措施相结合以及在不同患者群体中的效果。我们进行了系统的文献检索，以确定所有包括高血压患者血压自我监测的研究。对于自 2000 年以来发表的具有至少 6 个月随访数据和至少 100 名患者的研究，我们联系了作者以获取为每个患者收集的原始数据（主要结局提供数据的 15/19 研究：7,138/8,292 名随机参与者）。然后，我们使用这些数据进行 IPD 荟萃分析，以评估自我监测对血压水平和高血压控制的影响，并以 1 年随访作为主要终点。我们预先确定了共同干预的强度水平和患者亚组以供进一步分析。自我监测与自我管理、系统药物滴定或生活方式咨询等更强化的干预措施相结合时效果最佳，但其本身的效果很小或没有。对于抗高血压药物较少且基线收缩压高达 170 mmHg 的患者来说，自我监测最为有效。不同性别或大多数合并症的疗效没有差异。当与涉及个体定制支持的共同干预相结合时，可以建议自我监测来降低血压。单独的自我监测似乎并不能降低血压，但可能出于其他原因有用，包括与患者互动或减少临床医生的工作量。
Self-monitoring of blood pressure (BP) appears to reduce BP in hypertension but important questions remain regarding effective implementation and which groups may benefit most. This individual patient data (IPD) meta-analysis was performed to better understand the effectiveness of BP self-monitoring to lower BP and control hypertension. Medline, Embase, and the Cochrane Library were searched for randomised trials comparing self-monitoring to no self-monitoring in hypertensive patients (June 2016). Two reviewers independently assessed articles for eligibility and the authors of eligible trials were approached requesting IPD. Of 2,846 articles in the initial search, 36 were eligible. IPD were provided from 25 trials, including 1 unpublished study. Data for the primary outcomes—change in mean clinic or ambulatory BP and proportion controlled below target at 12 months—were available from 15/19 possible studies (7,138/8,292 [86%] of randomised participants). Overall, self-monitoring was associated with reduced clinic systolic blood pressure (sBP) compared to usual care at 12 months (−3.2 mmHg, [95% CI −4.9, −1.6 mmHg]). However, this effect was strongly influenced by the intensity of co-intervention ranging from no effect with self-monitoring alone (−1.0 mmHg [−3.3, 1.2]), to a 6.1 mmHg (−9.0, −3.2) reduction when monitoring was combined with intensive support. Self-monitoring was most effective in those with fewer antihypertensive medications and higher baseline sBP up to 170 mmHg. No differences in efficacy were seen by sex or by most comorbidities. Ambulatory BP data at 12 months were available from 4 trials (1,478 patients), which assessed self-monitoring with little or no co-intervention. There was no association between self-monitoring and either lower clinic or ambulatory sBP in this group (clinic −0.2 mmHg [−2.2, 1.8]; ambulatory 1.1 mmHg [−0.3, 2.5]). Results for diastolic blood pressure (dBP) were similar. The main limitation of this work was that significant heterogeneity remained. This was at least in part due to different inclusion criteria, self-monitoring regimes, and target BPs in included studies. Self-monitoring alone is not associated with lower BP or better control, but in conjunction with co-interventions (including systematic medication titration by doctors, pharmacists, or patients; education; or lifestyle counselling) leads to clinically significant BP reduction which persists for at least 12 months. The implementation of self-monitoring in hypertension should be accompanied by such co-interventions. In an individual patient data meta-analysis of randomized trials, Katherine Tucker and colleagues examine the evidence for the effectiveness of self-monitoring of blood pressure in hypertension. Self-monitoring of BP appears to lower BP in people with hypertension, over and above usual care. Implementation of self-monitoring has been inconsistent, perhaps because important evidence gaps remain regarding how best to use it and for which patient groups. To better understand the effect of self-monitoring on BP lowering and BP control. Specifically, to examine the effect of self-monitoring in combination with various co-interventions, and in different groups of patients. We undertook a systematic literature search to identify all studies that included self-monitoring of BP in people with high BP. For studies published since the year 2000 with at least 6 months of follow-up data and at least 100 patients, we contacted authors to gain access to the original data collected for each individual patient (15/19 studies with the primary outcome provided data: 7,138/8,292 randomised participants). We then used these data to perform IPD meta-analysis to evaluate the effect of self-monitoring on BP levels and in the control of hypertension using 1 year of follow-up as our primary end point. We predefined levels of intensity of co-intervention and subgroups of patients for further analysis. Self-monitoring worked best when combined with more intensive interventions such as self-management, systematic medication titration, or lifestyle counselling, but had little or no effect on its own. Self-monitoring was most effective in those with fewer antihypertensive medications and higher baseline sBP up to 170 mmHg. No differences in efficacy were seen by sex or by most comorbidities. Self-monitoring can be recommended to lower BP when combined with co-interventions involving individually tailored support. Self-monitoring alone does not seem to lower BP but may be useful for other reasons including engaging with patients or reducing clinician workload.
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影响因子：
39.2
作者：
Bosworth HB;Olsen MK;Grubber JM;Neary AM;Orr MM;Powers BJ;Adams MB;Svetkey LP;Reed SD;Li Y;Dolor RJ;Oddone EZ
通讯作者：
Oddone EZ
影响因子：
1.8
作者：
Madsen, Line Bille;Kirkegaard, Peder;Pedersen, Erling Bjerregaard
通讯作者：
Pedersen, Erling Bjerregaard
DOI：
10.1161/circoutcomes.112.968172
发表时间：
2013-03-01
影响因子：
6.9
作者：
Magid, David J.;Olson, Kari L.;Kroner, Beverly A.
通讯作者：
Kroner, Beverly A.
影响因子：
3.2
作者：
Kim, Kim B.;Han, Hae-Ra;Kim, Miyong T.
通讯作者：
Kim, Miyong T.
影响因子：
8.3
作者：
Agarwal, Rajiv;Bills, Jennifer E.;Light, Robert P.
通讯作者：
Light, Robert P.