Impact of self-monitoring of blood pressure on processes of hypertension care and long-term blood pressure control
<p><strong>Background:</strong> Self-monitoring of blood pressure (SMBP) improves blood pressure (BP) outcomes at 12-months, but information is lacking on how SMBP affects hypertension care processes and longer-term BP outcomes.</p> <p><strong>Methods and Results...
| Main Authors: | , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
American Heart Association
2020
|
| _version_ | 1797071354319601664 |
|---|---|
| author | Bryant, K Sheppard, J Ruiz-Negrón, N Kronish, IM McManus, R |
| author_facet | Bryant, K Sheppard, J Ruiz-Negrón, N Kronish, IM McManus, R |
| author_sort | Bryant, K |
| collection | OXFORD |
| description | <p><strong>Background:</strong> Self-monitoring of blood pressure (SMBP) improves blood pressure (BP) outcomes at 12-months, but information is lacking on how SMBP affects hypertension care processes and longer-term BP outcomes.</p>
<p><strong>Methods and Results:</strong> We pooled individual participant data from four randomized clinical trials of SMBP in the United Kingdom (combined n=2590) with varying intensities of support. Multivariable random effects regression was used to estimate the probability of antihypertensive intensification at 12 months for usual care versus SMBP. Using these data, we simulated 5-year BP control rates using a validated mathematical model. Trial participants were mostly older adults (mean age 66.6 years, standard deviation 9.5), male (53.9%), and predominately white (95.6%); mean baseline BP was 151.8/85.0 mmHg. Compared to usual care, the likelihood of antihypertensive intensification increased with both SMBP with feedback to patient or provider alone (odds ratio 1.8, 95% confidence interval 1.2-2.6) and with telemonitoring or self-management (3.3, 2.5-4.2). Over 5 years, we estimated 33.4% BP control (<140/90 mmHg) with usual care (95% uncertainty interval 27.7%-39.4%). One year of SMBP with feedback to patient or provider alone achieved 33.9% (28.3%-40.3%) BP control and SMBP with telemonitoring or self-management 39.0% (33.1%-45.2%) over 5 years. If SMBP interventions and associated BP control processes were extended to five years, BP control increased to 52.4% (45.4%-59.8 %) and 72.1% (66.5%-77.6%), respectively.</p>
<p><strong>Conclusions:</strong> One year of SMBP plus telemonitoring or self-management increases the likelihood of antihypertensive intensification and could improve BP control rates at five years; continuing SMBP for five years could further improve BP control.</p> |
| first_indexed | 2024-03-06T22:52:00Z |
| format | Journal article |
| id | oxford-uuid:5f1989fc-4f08-45d1-9ab5-61ebb9125494 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T22:52:00Z |
| publishDate | 2020 |
| publisher | American Heart Association |
| record_format | dspace |
| spelling | oxford-uuid:5f1989fc-4f08-45d1-9ab5-61ebb91254942022-03-26T17:44:52ZImpact of self-monitoring of blood pressure on processes of hypertension care and long-term blood pressure controlJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:5f1989fc-4f08-45d1-9ab5-61ebb9125494EnglishSymplectic ElementsAmerican Heart Association2020Bryant, KSheppard, JRuiz-Negrón, NKronish, IMMcManus, R<p><strong>Background:</strong> Self-monitoring of blood pressure (SMBP) improves blood pressure (BP) outcomes at 12-months, but information is lacking on how SMBP affects hypertension care processes and longer-term BP outcomes.</p> <p><strong>Methods and Results:</strong> We pooled individual participant data from four randomized clinical trials of SMBP in the United Kingdom (combined n=2590) with varying intensities of support. Multivariable random effects regression was used to estimate the probability of antihypertensive intensification at 12 months for usual care versus SMBP. Using these data, we simulated 5-year BP control rates using a validated mathematical model. Trial participants were mostly older adults (mean age 66.6 years, standard deviation 9.5), male (53.9%), and predominately white (95.6%); mean baseline BP was 151.8/85.0 mmHg. Compared to usual care, the likelihood of antihypertensive intensification increased with both SMBP with feedback to patient or provider alone (odds ratio 1.8, 95% confidence interval 1.2-2.6) and with telemonitoring or self-management (3.3, 2.5-4.2). Over 5 years, we estimated 33.4% BP control (<140/90 mmHg) with usual care (95% uncertainty interval 27.7%-39.4%). One year of SMBP with feedback to patient or provider alone achieved 33.9% (28.3%-40.3%) BP control and SMBP with telemonitoring or self-management 39.0% (33.1%-45.2%) over 5 years. If SMBP interventions and associated BP control processes were extended to five years, BP control increased to 52.4% (45.4%-59.8 %) and 72.1% (66.5%-77.6%), respectively.</p> <p><strong>Conclusions:</strong> One year of SMBP plus telemonitoring or self-management increases the likelihood of antihypertensive intensification and could improve BP control rates at five years; continuing SMBP for five years could further improve BP control.</p> |
| spellingShingle | Bryant, K Sheppard, J Ruiz-Negrón, N Kronish, IM McManus, R Impact of self-monitoring of blood pressure on processes of hypertension care and long-term blood pressure control |
| title | Impact of self-monitoring of blood pressure on processes of hypertension care and long-term blood pressure control |
| title_full | Impact of self-monitoring of blood pressure on processes of hypertension care and long-term blood pressure control |
| title_fullStr | Impact of self-monitoring of blood pressure on processes of hypertension care and long-term blood pressure control |
| title_full_unstemmed | Impact of self-monitoring of blood pressure on processes of hypertension care and long-term blood pressure control |
| title_short | Impact of self-monitoring of blood pressure on processes of hypertension care and long-term blood pressure control |
| title_sort | impact of self monitoring of blood pressure on processes of hypertension care and long term blood pressure control |
| work_keys_str_mv | AT bryantk impactofselfmonitoringofbloodpressureonprocessesofhypertensioncareandlongtermbloodpressurecontrol AT sheppardj impactofselfmonitoringofbloodpressureonprocessesofhypertensioncareandlongtermbloodpressurecontrol AT ruiznegronn impactofselfmonitoringofbloodpressureonprocessesofhypertensioncareandlongtermbloodpressurecontrol AT kronishim impactofselfmonitoringofbloodpressureonprocessesofhypertensioncareandlongtermbloodpressurecontrol AT mcmanusr impactofselfmonitoringofbloodpressureonprocessesofhypertensioncareandlongtermbloodpressurecontrol |