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Self-Measured Blood Pressure Monitoring

Slide: 17 of 27

Comparative Effectiveness of SMBP Monitoring Plus Additional Support Versus Usual Care (1 of 2)

There is high strength of evidence that SMBP plus additional support improved BP control when compared with usual care. Eleven trials, including six trials that were rated as being high in quality, reported statistically significant reductions in systolic BP or diastolic BP in the SMBP group. The additional support examined in these 11 trials were telecounseling; Web training with pharmacist counseling; self-titration plus provider alert; education; medication monitoring with provider alert; personalized Web site plus videoconference counseling; pharmacist counseling; and combined medication-behavioral management (as needed whenever there was inadequate BP control).

For a follow-up period of upto12 months, there was a significant mean net reduction in in-clinic systolic BP ranging from 1.6 to 8.5 mmHg and a significant mean net reduction in diastolic BP ranging from 1.9 to 4.4 mmHg—both favoring SMBP plus additional support. Meta-analyses of the studies was not possible because of the high level of heterogeneity in the types of additional support interventions used.

There was no difference between SMBP monitoring with some form of additional support and usual care for intermediate and surrogate outcomes, including medication number and dosage, medication adherence, quality of life, and adverse drug reactions. Inconsistency in findings and heterogeneity in definitions resulted in the strength of evidence being rated low for this finding.