Open Access Open Access  Accesso riservato Abbonamento o quota di accesso

Efficacia del monitoraggio domiciliare della pressione arteriosa. Sinossi di revisioni sistematiche

Luca Giuseppe Re, Viviana Fusetti

Abstract

INTRODUZIONE. Il monitoraggio domiciliare della pressione arteriosa (MDPA) è sostenuto e raccomandato per la sua utilità ai fini della gestione dell’ipertensione; tuttavia permangono alcune incertezze sui benefici dell’intervento nella pratica clinica. OBIETTIVO. Valutare gli effetti del monitoraggio domiciliare della pressione arteriosa sui valori pressori.

METODI. E’ stata condotta in data 12 gennaio 2016 una ricerca sui seguenti database: The Cochrane Library, Medline, CINAHL, Embase, Web of Science. I record restituiti dalla stra- tegia di ricerca sono stati analizzati in modo indipendente e quelli che rispettavano i criteri di inclusione sono stati reperiti in versione integrale. Sono state incluse nella sinossi solo revisioni sistematiche con meta-analisi di sperimentazioni cliniche controllate che comparassero il MDPA con il monitoraggio ambulatoriale (MAPA) o ospedaliero (MOPA) della pressione arteriosa. Per la valutazione di qualità è stata impiegata la AMSTAR checklist mentre per il confronto fra meta- analisi si è proceduto all’analisi dell’indice di Higgins I2.

RISULTATI. Cinque revisioni sistematiche hanno rispettato i criteri di inclusione. La qualità meto- dologica degli studi inclusi è stata elevata. Il range di I2 è stato pari a 37%-72% (eterogeneità da moderata ad elevata). Rispetto a MAPA, MOPA e cure standard, il MDPA è risultato associato ad una modesta ma statisticamente significativa riduzione della pressione arteriosa sistolica (da - 2.50 mmHg a -4.25 mmHg) e della pressione arteriosa diastolica (da -1.45 mmHg a -2.37 mmHg).

DISCUSSIONE: Le ridotte dimensioni dell’effetto di MDPA determinano un modesto beneficio nella pratica clinica. I potenziali vantaggi sul controllo dei valori pressori dipendono dalla capa- cità del paziente nell’esecuzione e lettura dei risultati e dei professionisti sanitari nell’utilizzo dei dati registrati per introdurre o modificare la terapia farmacologica e migliorare l’aderenza comples- siva al trattamento antipertensivo.

CONCLUSIONI: Il MDPA è più efficace per ridurre la pressione sistolica e diastolica rispetto ad altri interventi ma la rilevanza clinica del suo effetto è modesta.

PAROLE CHIAVE. Efficacia, monitoraggio domiciliare della pressione arteriosa, sinossi.

ABSTRACT

INTRODUCTION: Home blood pressure monitoring (HmBPM) is as a valuable and useful tool for hypertension management; some uncertainties remain about benefits of intervention in clinical practice.

OBJECTIVE: To assess the effects of home blood pressure monitoring on blood pressure values.

METHODS: A search on the following databases The Cochrane Library, Medline, CINAHL, Embase, Web of Science was carried out on January the 12 2016 . The records retrieved were analysed independently and those which met the inclusion criteria were gathered as full text. In the synopsis were included only systematic reviews with meta-analysis of Randomised Controlled Trials comparing home blood pressure monitoring with ambulatory (ABPM) or hospital (HsBPM) blood pressure monitoring. AMSTAR checklist was used to evaluate reviews quality while for comparing meta-analysis it was proceeded to index of Higgins I2 analysis.

RESULTS: Five systematic reviews met inclusion criteria. The overall methodological quality of included studies was high. Range of I2 was equal to 37%-72% (moderate to high heterogeneity). Compared to ABPM, HsBPM or standard of care, HmBPM was associated with moderate but statistically significant reduction in systolic blood pressure (weighted mean difference from -2.50 mmHg to -4.25 mmHg) and diastolic blood pressure (weighted mean difference from -1.45 mmHg to -2.37 mmHg).

DISCUSSION: The reduced size of HmBPM effect results in a moderate benefit in clinical prac- tice. Potential advantages on blood pressure control are dependent on patient ability to perform and interpret HmBPM results as well as health professionals to use recorded data to introduce or modify drug therapy and improve the overall compliance to antihypertensive treatment. CONCLUSIONS.HmBPM is more effective in reducing systolic and diastolic blood pressure compared to other interventions but the clinical significance of its effect is moderate.

KEYWORDS. Effectiveness, blood pressure home monitoring, synopsis.

Full Text

PDF

Riferimenti bibliografici

Agarwal, R., Bills, J.E., Hecht, T.J., & Light R.P. (2011) Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analysis. Hypertension, 57 (1), 29-38.

Agena, F., da Silva, G.C., & Pierin, A.M. (2011) Home blood pressure monitoring: updates and the nurse's role. Rev Esc Enferm USP, 45 (1), 258-263.

Bailey, B., Carney, S.L., Gillies, A.A., & Smith, A.J. (1999) Antihypertensive drug treatment: a comparison of usual care with self blood pressure measurement. J Hum Hypertens, 13 (2), 147-150.

Bengtson, A., & Drevenhorn, E. (2003) The nurse's role and skills in hypertension care: a review. Clin Nurse Spec, 17 (5), 260-268.

Bonafini, S., & Fava, C. (2015) Home blood pressure measurements: advantages and disadvantages compared to office and ambulatory monitoring. Blood Press, 24 (6), 325-332.

Bray, E.P., Holder, R., Mant, J., & McManus, R.J. (2010) Does self-monitoring reduce blood pressure? Meta- analysis with meta-regression of randomized controlled trials. Ann Med, 42 (5), 371-386.

Bucher, H.C., Guyatt, G.H., Cook, D.J., Holbrook, A., & McAlister, F.A. (1999) Users’ Guide to medical literature. XIX Applying clinical trial results. A: How to use an article measuring the effect of an intervention on surrogate end points. JAMA, 282 (8), 771-778

Burnier, M. (2002) Blood pressure control and the implementation of guidelines in clinical practice: can we fill the gap ? J Hypertens, 20 (7), 1251-1253.

Calderón ,M.A., Boyle, R.J., Penagos, M., & Sheikh, A. (2011) Immunotherapy: The meta-analyses. What have we learned ? Immunol Allergy Clin North Am, 31 (2), 159-173, vii. Cappuccio, F.P., Kerry, S.M., Forbes, L., & Donald, A. (2004) Blood pressure control by home monitoring: meta-analysis of randomised trials. BMJ, 329 (7464), 145-148.

Celis H., Den Hond, E., & Staessen, J.A. (2005) Self- measurement of blood pressure at home in the management of hypertension. Clin Med Res, 3 (1), 19-26.

Chobanian, A.V. (2001) Control of hypertension - an important national priority. NEJM, 345 (7), 534-535.

Colósimo, F.C.C., Silva, S.S.B.E., & Pierin, A.M.G. (2008) Medida residencial da pressão arterial (MRPA) e programa de educação para hipertensos: ferramentas de incremento do controle. Hipertensão, 11 (2), 55-60.

Cooper, H., & Koenka, A.C. (2012) The overview of reviews: unique challenges and opportunities when research syntheses are the principal elements of new integrative scholarship. Am Psychol, 67 (6), 446-462.

Costantino, G., Montano, N., & Casazza, G. (2015) When should we change our clinical practice based on the results of a clinical study? Searching for evidence: PICOS and PubMed. Intern Emerg Med, 10 (4), 525-527.

Ebrahim, S. Detection, adherence and control of hypertension for the prevention of stroke: a systematic review. (1998) Health Technol Assess, 2 (11), i-iv, 1-78.

Epicentro. (2012) Ipertensione: i dati dell’Osservatorio epidemiologico cardiovascolare. Data accesso 2 maggio 2016, da http://www.epicentro.iss.it/approfondimenti/ 2013/whdDatiOEC.asp

Fagard, RH., Van Den Enden, M., Leeman, M., & Warling, X. (2002) Survey on treatment of hypertension and implementation of World Health Organization/ International Society of Hypertension risk stratification in primary care in Belgium. J Hypertens, 20 (7), 1297- 1302.

Fahey, T., Schroeder, K., & Ebrahim, S. (2006) Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev, (2), CD005182. (Update in: Cochrane Database Syst Rev, (1), CD005182)

Fahey, T., Schroeder K., & Ebrahim, S. (2007) Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev, (1) CD005182

Friedman, R.H., Kazis, L.E., Jette, A., Smith, M.B., Stollerman, J., Torgerson, J., et al. (1996) A telecommunications system for monitoring and counseling patients with hypertension. Impact on medication adherence and blood pressure control. Am J Hypertens, 9 (4 Pt 1), 285-292.

Gerin, W., Ogedegbe, G., Schwartz, J.E., Chaplin, W.F., Goyal, T., Clemow, L., et al. (2006) Assessment of the white-coat effect. J Hypertens, 24 (1), 67-74.

Glynn, L.G., Murphy, A.W., Smith, S.M., Schroeder, K., & Fahey, T. (2010) Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev, (3), CD005182.

Haynes, R.B., Sackett, D.L., Gibson, E.S., Taylor, D.W., Hackett, B.C., Roberts, R.S., et al. (1976) Improvement of medication compliance in uncontrolled hypertension. Lancet, 1 (7972), 1265-1268.

Higgins, J.P., Thompson, S.G., Deeks, J.J., & Altman, D.G. (2003) Measuring inconsistency in meta-analyses. BMJ, 327 (7414), 557-560.

Hyman, D.J., & Pavlik, V.N. (2001) Characteristics of patients with uncontrolled hypertension in the United States. NEJM, 345 (7), 479-486.

Kang, Y.Y., Li, Y., Huang, Q.F., Song, J., Shan, X.L., Dou, Y., et al. (2015) Accuracy of home versus ambulatory blood pressure monitoring in the diagnosis of white-coat and masked hypertension. J Hypertens, 33 (8), 1580-1587.

Landgraf, J., Wishner, S.H., & Kloner, R.A. (2010) Comparison of automated oscillometric versus auscultatory blood pressure measurement. Am J Cardiol, 106 (3), 386-388.

Laver, K., Dyer, S., Whitehead, C., Clemson, L., & Crotty, M. (2016) Interventions to delay functional decline in people with dementia: a systematic review of systematic reviews. BMJ Open, 6 (4), e010767.

Liberati, A., Altman, D.G., Tetzlaff, J., Mulrow, C., Gøtzsche, P.C.,Ioannidis,J.P.,etal.(2009)ThePRISMAstatement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med, 6 (7), e1000100.

Lipicky, R.J., & Packer, M. Role of surrogate end points in the evaluation of drugs for heart failure. (1993) J Am Coll Cardiol, 22 (suppl A), 179A-184A.

MacMahon, S., Peto, R., Cutler, J., Collins, R., Sorlie, P., Neaton, J., et al. (1990) Blood pressure, stroke and coronary heart disease, II: short-term reductions in blood pressure: overview of randomized drug trials in their epidemiological context. Lancet, 335, 827–838.

Mallick, S., Kanthety, R., Rahman, M. (2009) Home blood pressure monitoring in clinical practice: a review. Am J Med, 122 (9), 803-810.

Mehos, B.M., Saseen, J.J., & MacLaughlin, E.J. (2000) Effect of pharmacist intervention and initiation of home blood pressure monitoring in patients with uncontrolled hypertension. Pharmacotherapy, 20 (11), 1384-1389.

Midanik, L.T., Resnick, B., Hurley, L.B., Smith, E.J., & McCarthy, M. (1991) Home blood pressure monitoring for mild hypertensives. Public Health Rep, 106 (1), 85-89.

Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., & PRISMA Group. (2010) Preferred reporting items for systematic

reviews and meta-analyses: the PRISMA statement. Int J

Surg, 8 (5), 336-341. Papadopoulos, D.P., & Makris, T.K. (2007) Masked

hypertension definition, impact, outcomes: a critical

review. J Clin Hypertens, 9 (12), 956-963. Parati, G., Stergiou, G.S., Asmar, R., Bilo, G., de Leeuw, P., Imai, Y., et al. (2008) European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring. J

Hypertens, 26 (8), 1505-2156. Pickering,, T.G., Miller, N.H., Ogedegbe, G., Krakoff, L.R.,

Artinian, N.T., & Goff, D. (2008) Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension, 52 (1), 1-9.

Possidente Kaufman, J., & Ongaro Roberts, S. (2001) The role of home blood pressure monitoring in hypertension control. J Clin Hypertens, 3 (3), 171-173.

Primatesta, P., Brookes, M., & Poulter, N.R. (2001) Improved hypertension management and control: results from the health survey for England 1998. Hypertension, 38 (4), 827-832.

Psaty, B.M., Weiss, N.S., Furberg, C.D., Koepsell, T.D., Siscovick, D.S., Rosendaal, F.R., et al. (1999) Surrogate end points, health outcomes, and the drug-approval process for the treatment of risk factors for cardiovascular disease. JAMA, 282 (8), 786-790.

Shea, B.J., Grimshaw, J.M., Wells, G.A., Boers, M., Andersson, N., Hamel, C., et al (2007) Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 7 (10), 1-7.

Smith, V., Devane, D., Begley, C.M., & Clarke, M. (2011) Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC Med Res Methodol, 11 (1), 1-6.

Sociedade Brasileira de Cardiologia-SBC, Sociedade Brasileira de Hipertensão-SBH, & Sociedade Brasileira de Nefrologia-SBN. (2007) V Brazilian Guidelines in Arterial Hypertension. Arq Bras Cardiol. 2007, 89 (3), e24-79.

Soghikian, K., Casper, S.M., Fireman, B.H., Hunkeler, E.M., Hurley, L.B., Tekawa, I.S., et al. (1992) Home blood pressure monitoring. Effect on use of medical services and medical care costs. Med Care, 30 (9), 855-865.

Uhlig, K., Balk, E.M., Patel, K., Ip, S., Kitsios, G.D., Obadan, N.O., et al. (2012) Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Agency for Healthcare Research and Quality, Report N° 12- EHC002-EF.

Uhlig, K., Patel, K., Ip, S., Kitsios, G.D., & Balk, E.M. (2013) Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Ann Intern Med, 159 (3), 185-194.

WHO (2013) World Health Day 2013. A global brief on Hypertension. Silent killer, global public health crisis. Data accesso 2 maggio 2016, da http://ish- world.com/downloads/pdf/global_brief_hypertension.pd f

Wolf-Maier, K., Cooper, R.S., Kramer, H., Banegas, J.R., Giampaoli, S., Joffres, M.R., et al. (2004) Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension, 43 (1), 10- 17.

Yarows, S.A., Julius, S., & Pickering, T.G. (2000) Home blood pressure monitoring. Arch Intern Med, 160 (9), 1251- 1257.

Yarows, S.A., & Staessen, J.A. (2002) How to use home blood pressure monitors in clinical practice. Am J Hypertens, 15 (1 Pt 1), 93-96.

Refback

  • Non ci sono refbacks, per ora.