Self-monitoring of blood pressure (SMBP) leads to reduced blood pressure in patients with hypertension

Fletcher BR, Hartmann-Boyce J, Hinton L, et al.  The effect of self-monitoring of blood pressure on medication adherence and lifestyle factors: A systematic review and meta-analysis  American Journal of Hypertension. February 2015; hpv008

Review question

Does self-monitoring of blood pressure (SMBP) lead to reduced blood pressure in patients with hypertension?

Background

Previous evidence has shown that SMBP leads to reduced blood pressure in people with hypertension, but how exactly this happens is unknown.

SMBP could motivate patients to continue taking their medication regularly, may make physicians more likely to correctly prescribe medication, or may inspire patients to make positive lifestyle changes such as dietary improvements and increased physical activity.

Understanding how exactly SMBP reduces blood pressure can help identify ways to make future interventions more effective and efficient.

How the review was done

A detailed search of a number of electronic databases for studies published from inception to February 2014 was conducted. Studies that focused on self-monitoring of blood pressure for patients with hypertension in ambulatory/outpatient settings were included in the review.

A total of 7,109 studies were identified in searches, and 34 were included in the review after assessments for eligibility.

This review was funded by Omron and Lloyds Pharmacies.

What the researchers found

SMBP interventions were shown to improve medication adherence in hypertensive patients. Effect sizes were small but significant.

Several interventions involved patients’ family physicians receiving self-measured blood pressure results from their patients, or being informed when patients exceeded target blood pressure. Physicians were then able to act accordingly by changing prescription dosage or recommending other interventions.

There was scarce evidence indicating that SMBP influences changes in lifestyle factors such as diet and exercise.

Conclusion

This review found that SMBP likely leads to reduced blood pressure in patients with hypertension because it improves patient medication adherence, and provides healthcare professionals with personalized patient information to help them prescribe the correct dosage of medication. There was not significant evidence to indicate that SMBP changes patient diet or exercise habits. Future research should examine the extent to which medication adherence and physician prescribing practices affect blood pressure outcomes.