Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis

J. P. Sheppard, K. L. Tucker*, W. J. Davison, R. Stevens, W. Aekplakorn, H. B. Bosworth, A. Bove, K. Earle, M. Godwin, B. B. Green, P. Hebert, C. Heneghan, N. Hill, F. D. R. Hobbs, I. Kantola, S. M. Kerry, A. Leiva, D. J. Magid, J. Mant, K. L. MargolisB. McKinstry, M. A. McLaughlin, K. McNamara, S. Omboni, O. Ogedegbe, G. Parati, J. Varis, W. J. Verberk, B. J. Wakefield, R. J. McManus

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

34 Citations (Web of Science)



Studies have shown that self-monitoring of blood pressure (BP) is effective when combined with co-interventions, but its efficacy varies in the presence of some co-morbidities. This study examined whether self- monitoring can reduce clinic BP in patients with hyper tension-related co-morbidity.


A systematic review was conducted of articles published in Medline, Embase, and the Cochrane Library up to January 2018. Randomized controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorized by whether they examined a low/ high-intensity co-intervention. Change in BP and likelihood of uncontrolled BP at 12 months were examined according to number and type of hypertension-related co-morbidity in a one-stage IPD meta-analysis.


A total of 22 trials were eligible, 16 of which were able to provide IPD for the primary outcome, including 6,522 (89%) participants with fol low-up data. Self-monitoring was associated with reduced clinic systollc BP compared to usual care at 12-month follow-up, regardless of the number of hypertension-related co-morbidities (-3.12 mm Hg, [95% confidence intervals -4.78, -1.46 mm Hg]; P value for interaction with number of morbidities = 0.260). Intense interventions were more effective than low-intensity interventions in patients with obesity (P <0,001 for ail outcomes), and possibly stroke (P <0,004 for BP control outcome only), but this effect was not observed in patients with coronary heart disease, diabetes, or chronic kidney disease.


Self-monitoring lower BP regardless of the number of hypertensic related co-morbidities, but may only be effective in conditions such obesity or stroke when combined with high-intensity co-interventions.

Original languageEnglish
Pages (from-to)243-251
Number of pages9
JournalAmerican Journal of Hypertension
Issue number3
Publication statusPublished - Mar 2020


  • blood pressure
  • coronary heart disease
  • diabetes
  • hypertension
  • obesity
  • randomized controlled trial
  • stroke

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