Blood pressure control when home readings guide hypertension treatment
Evidence basis: randomised trials
Home readings used to guide treatment produce a small improvement in measured blood pressure.
Population: Adults with hypertension in randomized trials of home self-monitoring or treatment guided by home measurements; the 2017 individual-participant analysis had 7,138 participants with primary outcome data.
Research details
Summary
A 2017 individual-participant meta-analysis of 25 randomized trials found that self-monitoring interventions were associated with a 3.2 mmHg lower clinic systolic pressure at 12 months (95% CI −4.9 to −1.6). An updated review of 14 randomized trials found home-BP-guided treatment lowered ambulatory systolic pressure by 2.73 mmHg versus office-guided care (95% CI −5.23 to −2.22). The interventions included treatment decisions and support around measurement, so these estimates do not isolate the effect of owning or using a monitor alone.
Why this certainty
The direction of effect is consistent across randomized syntheses, but average changes are small and arise from multi-component care. This supports Moderate rather than Strong certainty for improved BP control.
Limitations
The trials varied in how monitoring was paired with education, telemonitoring, clinician feedback, and medication adjustment. Blood pressure is an intermediate outcome, and the more recent review found no eligible trial of cardiovascular outcomes beyond ambulatory BP reduction.
Effect estimate
Clinic systolic BP difference −3.2 mmHg at 12 months (95% CI −4.9 to −1.6) in Tucker et al.; ambulatory systolic BP difference −2.73 mmHg (95% CI −5.23 to −2.22) in Maruhashi et al.