Effect of Home Medication Titration on Blood Pressure Control in Patients With Hypertension: A Meta-Analysis of Randomized Controlled Trials

Ting-Yu Chen, Chi-Wen Kao, Shu-Meng Cheng, Yue-Cune Chang, Ting-Yu Chen, Chi-Wen Kao, Shu-Meng Cheng, Yue-Cune Chang

Abstract

Background: Medication titration has been used in home blood pressure (BP) control, with the expectation of enabling patients with hypertension to better manage their BP.

Objective: The study goal was to estimate the effects of medication titration intervention in lowering the systolic blood pressure and diastolic blood pressure of patients with hypertension.

Methods: The meta-analysis included randomized controlled trials on adults diagnosed with hypertension and BP≧130/80 mm Hg, having a medication-titration intervention, and using a home BP measurement. We systematically searched PubMed, CINAHL, Ovid-Medline, and the Cochrane Library, for studies published from 1997 to 2017. The quality of the studies was evaluated by the Modified Jadad scale. Statistical heterogeneity among the trials was evaluated using Q statistics and I. Publication bias was assessed with the funnel plot and Rosenthal's fail-safe N.

Results: The meta-analysis included 4 studies randomizing 1335 participants. Medication-titration intervention significantly assisted hypertensive patients to improve BP control; systolic blood pressure was reduced by 6.86 mm Hg [95% confidence interval (CI), 4.80-8.93, P<0.0001] and diastolic blood pressure by 3.03 mm Hg (95% CI, 2.07-3.99, P<0.0001), did not significantly affect EQ-5D scores (mean difference, 0.02; 95% CI, -0.01 to 0.04, P=0.13).

Conclusions: Our findings suggest home medication titration of antihypertensive medication for hypertensive patients significantly improved home BP control. However, the strategy did not enhance quality of life in patients with hypertension.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram for the selection process of clinical trials for meta-analysis, showing inclusion and exclusion criteria, selection, and inclusion process. RCT indicates randomized controlled trial.
FIGURE 2
FIGURE 2
Forest plot of random-effects model for studies examining the effects of medication titration on systolic blood pressure between intervention and nonintervention groups: mean differences between groups. CI indicates confidence intervals.
FIGURE 3
FIGURE 3
Forest plot of fixed-effects model on studies looking at the effect of self-titration of medication on diastolic blood pressure between intervention and nonintervention groups: mean differences between groups. CI indicates confidence intervals.
FIGURE 4
FIGURE 4
Forest plot of fixed-effects model for on studies looking at the effects of a medication titration strategy on quality of life. Mean differences in EQ-5D scores between intervention and nonintervention groups. CI indicates confidence intervals.

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Source: PubMed

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