Author + information
- Published online November 13, 2017.
- David M. Reboussin, PhD, Chair, Evidence Review Committee,
- Norrina B. Allen, PhD, MPH, FAHA, Evidence Review Committee Member∗,
- Michael E. Griswold, PhD, Evidence Review Committee Member∗,
- Eliseo Guallar, MD, Evidence Review Committee Member∗,
- Yuling Hong, MD, MSc, PhD FAHA, Evidence Review Committee Member∗,†,
- Daniel T. Lackland, DrPH, FAHA, FASH, Evidence Review Committee Member∗,
- Edgar (Pete) R. Miller III, PhD, MD, Evidence Review Committee Member∗,
- Tamar Polonsky, MD, MSCI, Evidence Review Committee Member∗,
- Angela M. Thompson-Paul, PhD, MSPH, Evidence Review Committee Member∗,† and
- Suma Vupputuri, PhD, MPH, FAHA, Evidence Review Committee Member∗
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.
↵∗ These members of the evidence review committee are listed alphabetically, and all participated equally in the process.
↵† The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
This document was approved by the American College of Cardiology Clinical Policy Approval Committee and the American Heart Association Science Advisory and Coordinating Committee in September 2017 and by the American Heart Association Executive Committee in October 2017.
The American College of Cardiology requests that this document be cited as follows: Reboussin DM, Allen NB, Griswold ME, Guallar E, Hong Y, Lackland DT, Miller ER 3rd, Polonsky T, Thompson-Paul AM, Vupputuri S. Systematic review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;●●:●●●●–●●●●.
This article has been copublished in Hypertension, an American Heart Association journal.
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- 2017 American College of Cardiology Foundation and the American Heart Association, Inc.