Blood pressure self-monitoring individual patient meta-analysis of registered trials; sub group analyses in a multi-morbid population

Patients suffering more than one long-term clinical condition (multi-morbidity) are common¹ but deciding how to manage them is a problem throughout primary care. Most strategies focus on individual conditions in isolation and as such, multi-morbid patients often end up on high numbers of medications even though levels of adherence are known to be poor in this population. There is little evidence on which interventions improve outcomes in multi-morbidity but that which does exist suggests that interventions which focus on specific risk factor management are most likely to be successful.²

Hypertension is the most common co-morbid condition¹ and effective management represents the most effective way to prevent stroke and cardiovascular disease. Self-monitoring of blood pressure is effective in reducing blood pressure and there is some evidence that self-management of risk factors (including blood pressure) can result in small, but non-significant improvements in outcomes in patients with multi-morbidity.³ A recent trial by this group examined self-monitoring with management in multi-morbid participants and found a bigger effect, though it is not yet clear whether self-titration or the population are responsible for the increased effect⁴.

Although multi-morbid patients are often included in self-monitoring trials, none have been sufficiently powered to examine outcomes in multi-morbid sub-groups. We have recently carried out an Individual Patient Data (IPD) meta-analysis which investigated the benefit of increasing the level of co-intervention used in support of self-monitoring. The planned study will use these data to examine the use of self-monitoring in the multi-morbid population and investigate the most effective methods of delivery in this population by comparing the co-interventions used with the levels of success. This work will inform future studies examining the wider use of self-monitoring and management strategies to improve control of multiple risk factors in patients with multi-morbidity.

The project will build on our collaboration with international collaborators that provided data to our IPD dataset and we have confirmed their willingness to contribute data to these analyses. 

Dr Katherine Tucker and Dr James Sheppard, Oxford