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Schedules for Self-monitoring Blood Pressure: A Systematic Review

Hodgkinson, J.A., Stevens, R., Grant, Sabrina ORCID: https://orcid.org/0000-0003-0148-9103, Mant, J., Bray, E.P., Hobbs, F.D.R., Martin, U., Schwartz, C., McCartney, D., O’Mahony, R., Perera-Salazar, R., Roberts, N., Stevens, S., Williams, B. and McManus, R.J. (2019) Schedules for Self-monitoring Blood Pressure: A Systematic Review. American Journal of Hypertension, 32 (4). pp. 350-364. ISSN Print: 0895-7061, Online: 1524-4563

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Abstract

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 self-monitoring schedule. We therefore aimed to determine the optimum schedule to predict future cardiovascular events and determine “true” underlying blood pressure.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.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.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.

Item Type: Article
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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
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The full-text of the online published article can be accessed via the official URL.

Uncontrolled Keywords: blood pressure, blood pressure monitoring, hypertension, regression, dilution, schedule, self-monitoring, systematic review
Divisions: Divisions (2019 onwards) > College of Health, Life and Environmental Sciences > School of Nursing and Midwifery
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Copyright Info: Open access article
Depositing User: Dr Sabrina Grant
Date Deposited: 17 Oct 2019 14:39
Last Modified: 17 Oct 2019 14:39
URI: https://eprints.worc.ac.uk/id/eprint/8761

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