Leicester Diabetes Centre, University of Leicester, Leicester, UK.
NIHR Applied Research Collaboration East Midlands, Leicester, UK.
J Clin Hypertens (Greenwich). 2024 Apr;26(4):314-329. doi: 10.1111/jch.14795. Epub 2024 Mar 25.
High blood pressure is an important risk factor for cardiovascular disease and disease progression in chronic kidney disease (CKD). Evidence on the effects of home blood pressure monitoring (HBPM) is limited. This review aimed to determine the effect of HBPM on systolic (SBP) and diastolic blood pressure (DBP) in patients with CKD. We searched medical literature databases for eligible studies presenting pre- and post-data for interventions utilizing HBPM. Study quality was assessed using the NHLBI tools for quality assessment. Heterogeneity prohibited a meta-analysis so estimates of effects were calculated along a sign test to examine the probability of observing the given pattern of positive effect direction. Eighteen studies were included (n = 1187 participants, mean age 56.7 [± 7.7] years). In 15 studies, HBPM was conducted within the context of additional high-level tailored support. Overall, the quality of n = 7/18 studies was rated as "good"; n = 6/18 were "fair," and n = 5/18 were rated as "poor." Interventions utilizing HBPM had a significant effect on SBP, with 14/16 studies favoring the intervention (88% [95% CI: 62%-98%], P = .002). Favorable effects were also seen on DBP (73% [95% CI: 45%-92%], P = .059). HBPM had a favorable effect on blood pressure goal attainment (86% [95% CI: 42%-100%], P = .062). HBPM in patients with CKD as part of a multicomponent intervention may lead to clinically significant reductions in blood pressure; however, research is needed to support the validity of this claim due to the high heterogeneity across the studies included.
高血压是心血管疾病和慢性肾脏病（CKD）疾病进展的重要危险因素。有关家庭血压监测（HBPM）效果的证据有限。本综述旨在确定 HBPM 对 CKD 患者收缩压（SBP）和舒张压（DBP）的影响。我们搜索了医学文献数据库，以获取呈现干预措施使用 HBPM 的预-后数据的合格研究。使用 NHLBI 工具评估研究质量以进行质量评估。由于存在异质性，因此无法进行荟萃分析，因此使用符号检验计算效应估计值，以检查观察到给定阳性效应方向的可能性。共纳入 18 项研究（n=1187 名参与者，平均年龄 56.7[±7.7]岁）。在 15 项研究中，HBPM 是在额外的高水平定制支持的背景下进行的。总体而言，n=7/18 项研究的质量被评为“良好”；n=6/18 项研究被评为“中等”，n=5/18 项研究被评为“差”。使用 HBPM 的干预措施对 SBP 有显著影响，16 项研究中有 14 项（88%[95%CI：62%-98%]，P=0.002）支持干预措施。DBP 也显示出有利的影响（73%[95%CI：45%-92%]，P=0.059）。HBPM 对血压达标有有利影响（86%[95%CI：42%-100%]，P=0.062）。HBPM 作为多组分干预的一部分在 CKD 患者中可能会导致血压显著降低；然而，由于纳入的研究存在高度异质性，因此需要进一步的研究来支持这一说法的有效性。
