Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Hypertens Res. 2019 Jun;42(6):807-816. doi: 10.1038/s41440-019-0221-y. Epub 2019 Apr 5.
Self-measured blood pressure (BP) at home, that is, home BP, is a stronger prognosticator than office BP. However, some physicians seem to think that office BP measurement is sufficient to manage hypertension. We aimed to assess whether interventions based on using home BP affect clinical outcomes including BP levels when compared with usual care based on office BP. Using the PubMed and the Cochrane Library databases (until July 2017), we searched randomized controlled trials comparing home BP-based treatment to usual care in adults with essential hypertension aged ≥18 years in an area with an established medical system. Outcomes were (1) cardiovascular events and related deaths and (2) changes in ambulatory BP levels. For outcomes of cardiovascular events and related deaths, there were no appropriate studies for the present meta-analysis. For outcomes of BP change, the analysis based on all 12 studies found by our search showed that home BP-based treatment was significantly associated with a 1.18 mmHg larger reduction in the average ambulatory systolic BP than the control group (P = 0.04). However, a high heterogeneity was observed (I = 75%, P < 0.0001). Based on nine studies employing a lower target BP for home BP than for office BP, the differences in the averages of the ambulatory systolic/diastolic BP changes between the two groups were 3.62/2.16 mmHg, respectively (P < 0.0001). No significant heterogeneity was observed (I = 0%, P ≤ 0.59). Home BP-based treatment is strongly recommended to control BP, especially in the setting of a lower home BP target than an office BP target level.
自测血压（BP），即家庭血压，是比诊室血压更强的预后预测因子。然而，一些医生似乎认为诊室血压测量足以管理高血压。我们旨在评估基于家庭 BP 的干预措施是否会影响临床结果，包括与基于诊室 BP 的常规护理相比的 BP 水平。我们使用 PubMed 和 Cochrane Library 数据库（截至 2017 年 7 月），搜索了在有完善医疗体系的地区，比较成年原发性高血压患者中基于家庭 BP 的治疗与常规护理的随机对照试验。结果为（1）心血管事件和相关死亡，（2）动态血压水平变化。对于心血管事件和相关死亡的结果，目前的荟萃分析没有合适的研究。对于 BP 变化的结果，我们搜索到的 12 项研究的分析表明，基于家庭 BP 的治疗与对照组相比，平均动态收缩压降低 1.18mmHg（P=0.04）。然而，观察到高度异质性（I=75%，P<0.0001）。基于 9 项采用家庭 BP 目标值低于诊室 BP 目标值的研究，两组之间的动态收缩压/舒张压变化平均值差异分别为 3.62/2.16mmHg（P<0.0001）。未观察到显著的异质性（I=0%，P≤0.59）。强烈建议采用基于家庭 BP 的治疗来控制 BP，尤其是在家庭 BP 目标值低于诊室 BP 目标值的情况下。
