Details:

Alternative Title:
J Am Coll Cardiol
Personal Author:
Reboussin, David M. ; Allen, Norrina B. ; Griswold, Michael E. ; Guallar, Eliseo ; Hong, Yuling ; ... More +
Reboussin, David M. ; Allen, Norrina B. ; Griswold, Michael E. ; Guallar, Eliseo ; Hong, Yuling ; Lackland, Daniel T. ; Miller, Edgar (Pete) R. ; Polonsky, Tamar ; Thompson-Paul, Angela M. ; Vupputuri, Suma ; Levine, Glenn N. ; O’Gara, Patrick T. ; Halperin, Jonathan L. ; Al-Khatib, Sana M. ; Beckman, Joshua A. ; Birtcher, Kim K. ; Bozkurt, Biykem ; Brindis, Ralph G. ; Cigarroa, Joaquin E. ; Curtis, Lesley H. ; Deswal, Anita ; Fleisher, Lee A. ; Gentile, Federico ; Gidding, Samuel ; Goldberger, Zachary D. ; Hlatky, Mark A. ; Ikonomidis, John ; Joglar, José A. ; Mauri, Laura ; Pressler, Susan J. ; Riegel, Barbara ; Wijeysundera, Duminda N. Less -
Description:
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.


Keywords:
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ACC/AHA Clinical Practice Guidelines Adult Advisory Committees American Heart Association Antihypertensive Agents Antihypertensive Drug Class Blood Pressure Cardiology Cardiovascular Disease Disease Management Evidence Review Committee Home Blood Pressure Monitoring Humans Hypertension Meta-analysis Practice Guidelines As Topic Research Report Risk Reduction Targets Treatment Outcomes United States
Source:
J Am Coll Cardiol. 71(19):2176-2198
Pubmed ID:
29146534
Pubmed Central ID:
PMC8654280
Document Type:
Journal Article
Funding:
CC999999/ImCDC/Intramural CDC HHSUnited States/
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:59a09e094b3b06cbec9aafdf699a2b91bb35d8a2b424bf47a723ef3852f1ccea
Download URL:
https://stacks.cdc.gov/view/cdc/112447/cdc_112447_DS1.pdf
File Type:

Supporting Files

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  	NIHMS1001528-supplement-Data_Supplement.pdf	pdf

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