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Self–monitoring and other non–pharmacological interventions to improve the management of hypertension in primary care: a systematic review

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Show simple item record Glynn, Liam G. Murphy, Andrew W. Smith, Susan M. Schroeder, Kunt Fahey, Tom 2020-09-03T14:41:32Z 2020-09-03T14:41:32Z 2010
dc.description peer-reviewed en_US
dc.description.abstract Background Patients with high blood pressure (hypertension) in the community frequently fail to meet treatment goals: a condition labelled as ‘uncontrolled’ hypertension. The optimal way to organise and deliver care to hypertensive patients has not been clearly identified. Aim To determine the effectiveness of interventions to improve control of blood pressure in patients with hypertension. Design of study Systematic review of randomised controlled trials. Setting Primary and ambulatory care. Method Interventions were categorised as following: selfmonitoring; educational interventions directed to the patient; educational interventions directed to the health professional; health professional- (nurse or pharmacist) led care; organisational interventions that aimed to improve the delivery of care; and appointment reminder systems. Outcomes assessed were mean systolic and diastolic blood pressure, control of blood pressure and proportion of patients followed up at clinic. Results Seventy-two RCTs met the inclusion criteria. The trials showed a wide variety of methodological quality. Selfmonitoring was associated with net reductions in systolic blood pressure (weighted mean difference [WMD] –2.5mmHg, 95%CI = –3.7 to –1.3 mmHg) and diastolic blood pressure (WMD –1.8mmHg, 95%CI = –2.4 to –1.2 mmHg). An organised system of regular review allied to vigorous antihypertensive drug therapy was shown to reduce blood pressure and all-cause mortality in a single large randomised controlled trial. Conclusion Antihypertensive drug therapy should be implemented by means of a vigorous stepped care approach when patients do not reach target blood pressure levels. Selfmonitoring is a useful adjunct to care while reminder systems and nurse/pharmacist -led care require further evaluation. en_US
dc.language.iso eng en_US
dc.publisher Royal College of General Practitioners en_US
dc.relation.ispartofseries British Journal of General Practice;60 (581), e476-e488
dc.subject hypertension en_US
dc.subject prevention and control en_US
dc.subject primary care en_US
dc.subject systematic review en_US
dc.title Self–monitoring and other non–pharmacological interventions to improve the management of hypertension in primary care: a systematic review en_US
dc.type info:eu-repo/semantics/article en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US
dc.identifier.doi 10.3399/bjgp10X544113
dc.contributor.sponsor HRB en_US
dc.rights.accessrights info:eu-repo/semantics/openAccess en_US
dc.internal.rssid 2859365

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