OBJECTIVE: To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? METHODS: Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. RESULTS: Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of <130 mm Hg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure, and major cardiovascular events. No class of medications (i.e., angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, or beta blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome.
OBJECTIVE: To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? METHODS: Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. RESULTS: Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of <130 mm Hg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure, and major cardiovascular events. No class of medications (i.e., angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, or beta blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome.
Authors: Samuel Cykert; Thomas C Keyserling; Michael Pignone; Darren DeWalt; Bryan J Weiner; Justin G Trogdon; Thomas Wroth; Jacqueline Halladay; Monique Mackey; Jason Fine; Jung In Kim; Crystal Cene Journal: Health Serv Res Date: 2020-10-13 Impact factor: 3.402
Authors: HwaJung Choi; Andrew Steptoe; Michele Heisler; Philippa Clarke; Robert F Schoeni; Stephen Jivraj; Tsai-Chin Cho; Kenneth M Langa Journal: JAMA Intern Med Date: 2020-07-13 Impact factor: 21.873
Authors: Ambarish Pandey; Kershaw V Patel; Wanpen Vongpatanasin; Colby Ayers; Jarett D Berry; Robert J Mentz; Michael J Blaha; John W McEvoy; Paul Muntner; Muthiah Vaduganathan; Adolfo Correa; Javed Butler; Daichi Shimbo; Vijay Nambi; Christopher deFilippi; Stephen L Seliger; Christie M Ballantyne; Elizabeth Selvin; James A de Lemos; Parag H Joshi Journal: Circulation Date: 2019-11-11 Impact factor: 29.690
Authors: Karen L Margolis; Steven P Dehmer; JoAnn Sperl-Hillen; Patrick J O'Connor; Stephen E Asche; Anna R Bergdall; Beverly B Green; Rachel A Nyboer; Pamala A Pawloski; Nicole K Trower; Michael V Maciosek Journal: Hypertension Date: 2020-08-31 Impact factor: 10.190
Authors: Byron C Jaeger; D Edmund Anstey; Adam P Bress; John N Booth; Mark Butler; Donald Clark; George Howard; Jolaade Kalinowski; D Leann Long; Gbenga Ogedegbe; Timothy B Plante; Daichi Shimbo; Mario Sims; Mark A Supiano; Paul K Whelton; Paul Muntner Journal: Hypertension Date: 2019-02 Impact factor: 10.190