Comparative Effectiveness of Home Blood-Pressure Monitoring vs Clinic-Based Monitoring in Hypertension Control: Systematic Review of Randomized Controlled Trials

Abstract

Background: Hypertension management traditionally relies on clinic-based blood pressure (BP) measurements, an approach limited by variability and the white-coat effect. Home blood pressure monitoring (HBPM) offers a more comprehensive assessment, but its comparative effectiveness in achieving BP control remains nuanced. This systematic review aimed to synthesize evidence from randomized controlled trials (RCTs) comparing the effectiveness of HBPM versus clinic-based monitoring alone on BP control in adults with hypertension. Methods: We conducted a systematic review of RCTs published between 2004 and 2025, identified via searches of PubMed/MEDLINE, Embase, CENTRAL, CINAHL, and PsycINFO. Eligible studies enrolled hypertensive adults, compared structured HBPM (with or without co-interventions) to usual clinic care, and reported change in systolic BP (SBP) as a primary outcome. Eleven RCTs (n=5,326 patients) were included, following exclusion of one non-randomized (cross-sectional) study identified during full-text review. Data on BP outcomes, adherence, and medication use were extracted and synthesized narratively. Results: HBPM, particularly when integrated with structured education, clinician feedback, or medication titration protocols, demonstrated superior SBP reduction (ranging from -1.5 to -8.4 mmHg) compared to clinic-based care alone. HBPM also improved medication adherence and facilitated more appropriate treatment intensification. However, effectiveness was moderated by several factors: benefits were greatest in older patients, those with less frequent clinic access, and in interventions with active support. Reduced effects were observed in patients on complex drug regimens, those with frequent clinic visits, and within underserved urban minority populations, highlighting equity considerations. Conclusion: HBPM is an effective strategy for improving hypertension control, especially when implemented as a supported intervention within a structured management pathway. Future implementation should focus on integrating HBPM with digital health tools, tailoring approaches to patient subgroups, and ensuring equitable access to overcome socioeconomic and systemic barriers.