Schedules for Self-monitoring Blood Pressure: A Systematic Review

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Hodgkinson, James A 
Stevens, Richard 
Grant, Sabrina 
Mant, Jonathan William 
Bray, Emma P 

BACKGROUND Self-monitoring of blood pressure better predicts prognosis than clinic measurement, is popular with patients, and endorsed in hypertension guidelines. However, there is uncertainty over the optimal selfmonitoring schedule. We therefore aimed to determine the optimum schedule to predict future cardiovascular events and determine “true” underlying blood pressure.

METHODS Six electronic databases were searched from November 2009 (updating a National Institute for Health and Care Excellence [NICE] systematic review) to April 2017. Studies that compared aspects of self-monitoring schedules to either prognosis or reliability/reproducibility in hypertensive adults were included. Data on study and population characteristics, self-monitoring regime, and outcomes were extracted by 2 reviewers independently.

RESULTS From 5,164 unique articles identified, 25 met the inclusion criteria. Twelve studies were included from the original NICE review, making a total of 37 studies. Increasing the number of days of measurement improved prognostic power: 72%–91% of the theoretical maximum predictive value (asymptotic maximum hazard ratio) was reached by 3 days and 86%–96% by 7 days. Increasing beyond 3 days of measurement did not result in better correlation with ambulatory monitoring. There was no convincing evidence that the timing or number of readings per day had an effect, or that ignoring the first day’s measurement was necessary.

CONCLUSIONS Home blood pressure should be measured for 3 days, increased to 7 only when mean blood pressure is close to a diagnostic or treatment threshold. Other aspects of a monitoring schedule can be flexible to facilitate patient uptake of and adherence with self-monitoring.

blood pressure, blood pressure monitoring, hypertension, regression dilution, schedule, self-monitoring, systematic review, Blood Pressure, Blood Pressure Monitoring, Ambulatory, Humans, Hypertension, Patient Compliance
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American Journal of Hypertension
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Oxford University Press (OUP)
We thank Siobhan Milner, Nashat Qamar, and Sally Fillingham for their support in screening studies. This article presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (RP-PG-1209–10051). R.J.M. was funded by an NIHR Professorship (NIHR-RP-R2-12–015). R.J.M. and F.D.R.H. receive support from the NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) Oxford. The guideline development work undertaken by R.O.M., R.J.M, and B.W. received funding from the National Institute for Health and Care Excellence. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health, or the National Institute for Health and Care Excellence.