Key result
Lower BP targets cut major CV events by ~19% versus standard targets in hypertensive adults.
Why the study?
To systematically evaluate evidence on self-measured BP versus office BP, optimal BP-lowering targets, and comparative benefits and harms of first-line antihypertensive drug classes.
Does self-measured blood pressure without other augmentation improve systolic blood pressure control in adults with hypertension compared to office-measured blood pressure?
Meta-Analysis
Does self-measured blood pressure without other augmentation improve systolic blood pressure control in adults with hypertension compared to office-measured blood pressure?
Effect estimate: RR 0.81 (95% CI 0.70-0.94)
Self-measured blood pressure without additional support provides a modest, short-term improvement in systolic BP at 6 months compared to routine office care, but this benefit is not sustained at 12 months.
Self-measured BP yields modest systolic reductions at 6 months but not 12; reinforces targeting <130 mm Hg to lower MI and stroke risk.
OBJECTIVE To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? METHODS Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. RESULTS Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of <130 mm Hg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure, and major cardiovascular events. No class of medications (i.e., angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, or beta blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome.
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Reboussin et al. (2017) conducted a meta-analysis in Hypertension. Lower blood pressure target vs. Standard or higher blood pressure target was evaluated on Major cardiovascular events (RR 0.81, 95% CI 0.70-0.94). A lower blood pressure target significantly reduced the risk of major cardiovascular events by 19% compared to a standard or higher blood pressure target in adults with hypertension.
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