Department of Family and Community Medicine, University of Missouri, Columbia patilso@health.missouri.edu
The authors reported no potential conflict of interest relevant to this article.
This project was supported by grant number R01HS023328 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
More than half of the studies included in the meta-analysis were of low quality, and none of the studies recruited patients based on differences in clinic BP and home BP patterns, but rather on controlled or uncontrolled hypertension status. The studies included in this meta-analysis measured final BP outcomes by measuring ambulatory BP or clinic BP.
Another systematic review of 19 studies and 7100 participants looking at how HBPM compared with ABPM as a measurement standard for BP control and patient outcomes found insufficient data to determine the benefit of using HBPM as a measurement standard for BP control.19
HBPM + added support. There was high-quality evidence from the meta-analysis that HBPM plus additional support vs usual care led to a reduction in BP and a higher proportion of patients achieving target BP.18 However, the additional support interventions in the studies were heterogeneous.
4. Should HBPM be used to detect a change in BP associated with medication alterations?
Yes (SOR B).
A 2008 meta-analysis20 and several other studies21,22 showed that HBPM has greater accuracy than office BP for identifying drug-induced BP changes. The 2008 meta-analysis looked at changes in office and home BP measurements produced by various antihypertensive drugs. In 7 studies that compared office BP measurements with home and ambulatory BP measurements, the 24-hour ambulatory BP measurements and home BP measurements showed less dramatic BP reductions with medications than clinic BP measurements.20 This meta-analysis included 30 studies with 6794 participants and showed that home BP readings fell 20% less than office BP readings; the difference was statistically significant. These findings suggest that treatment-attributable changes in home BP and clinic BP measurements are linearly related, with the treatment effect on home BP measurements being around 80% of the effect on clinic BP measurements.
5. Do home BP measurements correlate with clinical outcomes?
Yes, and better than office BP measurements do; however, most studies comparing home BP measurements with usual care while looking at clinical outcomes are observational or quasi-experimental (SOR B).
For example, a 2015 systematic review looking at associations between BP measurement type (office, home, and ambulatory) and patient mortality found 5 observational studies that showed that adding home or ambulatory BP information improved cardiovascular risk prediction models. Moreover, all-cause mortality was associated with home BP and ambulatory BP levels only and not with office BP levels.19 The number of participants in these 5 studies varied between 210 and 2051 with study duration between 2.4 and 12.3 years. Of note, every study had a distinct population, affecting the generalizability of the results.
