Methods: Six electronic databases were searched from November 2009 (updating a National Institute for Health and Care Excellence (NICE) systematic review) to April 2017. Studies which compared aspects of self-monitoring schedules to either prognosis or reliability/reproducibility in hypertensive adults were included. Data on study and population characteristics, self-monitoring regime, and outcomes were extracted by two reviewers independently.
Results: From 5,164 unique papers identified, 25 met the inclusion criteria. Twelve studies were included from the original NICE review, making a total of 37 studies. Increasing the number of days of measurement improved prognostic power: 72-91% of the theoretical maximum predictive value (asymptotic maximum hazard ratio) was reached by three days and 86-96% by seven days. Increasing beyond three days of measurement did not result in better correlation with ambulatory monitoring. There was no convincing evidence that the timing or number of readings per day had an effect, or that ignoring the first day’s measurement was necessary.
Conclusions: Home blood pressure should be measured for three days, increased to seven only when mean blood pressure is close to a diagnostic or treatment threshold. Other aspects of a monitoring schedule can be flexible to facilitate patient uptake of and adherence with self-monitoring.
- blood pressure monitoring
- systematic review
- regression dilution