Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Ind 46202, USA.
Hypertension. 2011 Jan;57(1):29-38. doi: 10.1161/HYPERTENSIONAHA.110.160911. Epub 2010 Nov 29.
Hypertension remains the most common modifiable cardiovascular risk factor, yet hypertension control rates remain dismal. Home blood pressure (BP) monitoring has the potential to improve hypertension control. The purpose of this review was to quantify both the magnitude and mechanisms of benefit of home BP monitoring on BP reduction. Using a structured review, studies were selected if they reported either changes in BP or percentage of participants achieving a pre-established BP goal between randomized groups using home-based and office-based BP measurements. A random-effects model was used to estimate the magnitude of benefit and relative risk. The search yielded 37 randomized controlled trials with 9446 participants that contributed data for this meta-analysis. Compared with clinic-based measurements (control group), systolic BP improved with home-based BP monitoring (-2.63 mm Hg; 95% CI, -4.24, -1.02); diastolic BP also showed improvement (-1.68 mm Hg; 95% CI, -2.58, -0.79). Reductions in home BP monitoring-based therapy were greater when telemonitoring was used. Home BP monitoring led to more frequent antihypertensive medication reductions (relative risk, 2.02 [95% CI, 1.32 to 3.11]) and was associated with less therapeutic inertia defined as unchanged medication despite elevated BP (relative risk for unchanged medication, 0.82 [95% CI, 0.68 to 0.99]). Compared with clinic BP monitoring alone, home BP monitoring has the potential to overcome therapeutic inertia and lead to a small but significant reduction in systolic and diastolic BP. Hypertension control with home BP monitoring can be enhanced further when accompanied by plans to monitor and treat elevated BP such as through telemonitoring.
高血压仍然是最常见的可改变心血管风险因素，但高血压控制率仍然不容乐观。家庭血压（BP）监测有可能改善高血压控制。本综述的目的是量化家庭 BP 监测对降低血压的幅度和机制。使用结构化综述，如果报告了随机组之间使用基于家庭和基于诊所的 BP 测量的 BP 变化或达到预先设定的 BP 目标的参与者百分比，则选择研究。使用随机效应模型估计获益幅度和相对风险。该搜索产生了 37 项随机对照试验，共有 9446 名参与者提供了本荟萃分析的数据。与基于诊所的测量（对照组）相比，家庭 BP 监测可改善收缩压（-2.63mmHg；95%CI，-4.24，-1.02）；舒张压也有所改善（-1.68mmHg；95%CI，-2.58，-0.79）。当使用远程监测时，基于家庭 BP 监测的治疗减少幅度更大。家庭 BP 监测导致更频繁地减少降压药物（相对风险，2.02 [95%CI，1.32 至 3.11]），并且与治疗惰性相关，定义为尽管血压升高但药物不变（不变药物的相对风险，0.82 [95%CI，0.68 至 0.99]）。与单独的诊所 BP 监测相比，家庭 BP 监测有可能克服治疗惰性，并导致收缩压和舒张压的微小但显著降低。当与监测和治疗升高的 BP 的计划（例如通过远程监测）一起使用时，家庭 BP 监测可以进一步提高高血压控制。
