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Heart Disease and Stroke Prevention: Self-Measured Blood Pressure Monitoring Interventions for Improved Blood Pressure Control – When Used Alone

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What the CPSTF Found

About The Systematic Review

The Task Force finding is based on evidence from a systematic review published in 2013 (Uhlig et al., 52 studies, search period through February 2013). Twenty-six (28 study arms) of the included studies evaluated the effectiveness of self-measured blood pressure monitoring interventions when used alone to manage high blood pressure.

Context

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Summary of Results

Information about data variability is available in the Task Force Finding and Rationale Statement [PDF - 311 KB].

The systematic review included 26 studies with 28 study arms.

  • Blood Pressure Outcomes
    • Proportion of patients with blood pressure at goal: median increase of 6.9 percentage points (median duration: 6 months; 13 study arms)
    • Change in mean systolic blood pressure: median reduction of 3.2 mmHg (median duration: 9 months; 18 study arms)
    • Change in diastolic blood pressure: median reduction of 1.3 mmHg (median duration: 6 months; 21 study arms)
    • Results were statistically significant at 6 months and continued to be favorable at 12 months, although they were smaller in magnitude and not statistically significant.
  • Other Outcomes
    • No studies reported sickness or death outcomes.
    • Findings were inconsistent for medication adherence, health-related quality-of-life, and patient satisfaction outcomes.

Summary of Economic Evidence

Information about data variability is available in the Task Force Finding and Rationale Statement [PDF - 311 KB].

The economic review included 8 studies (search period through March 2015). Monetary values are reported in 2014 U.S. dollars.

  • There was not enough evidence to determine cost-effectiveness of the interventions when used alone. However, the averted cost of medication and outpatient visits exceeded the intervention cost.
  • No studies reported the effect of the intervention on worksite productivity or provided a full assessment for cost-benefit analysis.
  • Intervention Cost
    • Intervention cost included the cost of blood pressure monitoring devices, the cost of communicating blood pressure readings to healthcare providers, and the labor cost associated with training patients and reviewing records.
    • The median intervention cost was $60 per person (7 studies).
  • Intervention Cost and Healthcare Cost
    • The intervention cost plus the change in healthcare cost equals the total cost of the intervention.
      • Healthcare cost is defined as the cost for medication, outpatient visits, hospital inpatient stays, and emergency room visits.
      • When the estimated total cost is positive, the intervention is cost-increasing; when it is negative, the intervention is cost-saving.
    • Five of six total cost estimates were negative (median: -$72 per person) over a median follow-up period of 12 months, indicating the intervention is cost-saving.
  • Cost-Effectiveness
    • Two methods from the literature (Mason et al., 2005; McEwan et al., 2006) were used to translate reductions in systolic blood pressure to quality adjusted life year (QALY) saved. An intervention is considered cost-effective if cost per QALY saved is less than $50,000.
    • Cost per QALY estimates were inconsistent across five studies.
      • Two studies indicated cost savings and QALY saved.
      • Two studies reported cost savings, but systolic blood pressure increased.
      • One study indicated the intervention was not cost-effective ($100,000 and $144,000 per QALY saved, based on two methods).

Applicability

Based on results for interventions in different settings and populations, findings are applicable to the following:

  • Adults with high blood pressure
  • Women and men
  • Outpatient, general practice, and primary care settings

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base.

  • The effectiveness of blood pressure monitoring interventions that require patients to provide their own blood pressure monitoring devices. In all of the included studies, blood pressure monitoring devices were provided to patients.
  • How often patients should measure their blood pressure, and how often clinicians should monitor patients' self-measured blood pressure readings.
  • The role of telemedicine in self-measured blood pressure monitoring interventions, and how it affects patient-provider interaction and medication management.
  • The effectiveness of self-measured blood pressure monitoring interventions among various subgroups including racial/ethnic minorities, low-income populations, patients with comorbidities, and children.
  • Long-term benefits of self-measured blood pressure monitoring interventions that last longer than 12 months, including effects on rates of sickness and death.
  • The effectiveness of self-measured blood pressure monitoring interventions in community and worksite settings, and whether they strengthen community-clinical linkages.
  • The intervention cost when the cost of devices and software used in self-measured blood pressure monitoring interventions are distributed over the duration of their use.
  • Returns on investment in self-measured blood pressure monitoring interventions, based on the monetized value of benefits including reduced mortality and averted productivity losses.

Study Characteristics

  • Studies were done in the United States (10 studies), Western Europe (9 studies), Canada (3 studies), Australia (2 studies), and Brazil (2 studies).
  • In 23 studies, interventions were delivered in outpatient, general practice, or primary care settings.
  • Included studies represented both men (median: 44.0%; 24 studies) and women (median: 55.0%; 24 studies).
  • Study populations included adults ages 18 years and older (median: 56.6 years; 23 studies).
  • Six studies reported race/ethnicity with study populations mainly identifying as white. One study included a study population with more than 75% identifying as African American.
  • All 26 evaluated interventions provided patients with blood pressure monitors and training, with patients measuring their blood pressure at home.
  • Twenty interventions provided patients with fully automated blood pressure monitor devices.
  • Patients' blood pressure readings were delivered to healthcare providers during medical visits as self-recorded readings (16 studies), through electronic transmissions sent directly from blood pressure devices to central databases that providers could access (2 studies), or by mail (3 studies).

Publications

Jacob V, Chattopadhyay SK, Proia KK, et al. Economics of Self-Measured Blood Pressure Monitoring: A Community Guide Systematic Review. American Journal of Preventive Medicine. 2017;53(3):e105–13.
Community Preventive Services Task Force. Self-Measured Blood Pressure Monitoring Improves Outcomes: Recommendation of the Community Preventive Services Task Force. American Journal of Preventive Medicine. 2017;53(3):e115–8.
Chattopadhyay SK, Jacob V, Mercer SL, Hopkins DP, Elder RW, Jones CD, Community Preventive Services Task Force. Community Guide Cardiovascular Disease Economic Reviews: Tailoring Methods to Ensure Utility of Findings. American Journal of Preventive Medicine. 2017;53(6S2):S155–63. Available at: http://www.sciencedirect.com/science/article/pii/S0749379717303227?via%3Dihub.
Shantharam SS, Mahalingam M, Rasool A, et al. Systematic Review of Self-Measured Blood Pressure Monitoring With Support: Intervention Effectiveness and Cost. American Journal of Preventive Medicine. 2021.

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