[49] Another SR and meta-analysis comparing blood pressure self-monitoring alone to usual care found that self- monitoring was not associated with lower blood pressure. However, when paired with co-interventions (including tailored medication titration and education or lifestyle counseling) blood pressure self- monitoring was associated with a lower blood pressure (MD in SBP -6.1 mm Hg).[50] Three additional RCTs had results consistent with the SRs, finding self-monitoring more effective than usual care when accompanied by a co-intervention involving medication titration in response to self- monitoring data.[51-53] Studies in which medication adherence was examined revealed no difference in medication adherence between self-monitoring of blood pressure and usual care. Despite general consistency in the evidence supporting home blood pressure monitoring and self- monitoring and ease of implementation, there is some variability in provider and patient preferences regarding this treatment. There was some question among the Work Group members whether a 2-4 mm Hg reduction in blood pressure was clinically significant. Some patient focus group participants expressed a desire for additional education on the use of home blood pressure management and additional interventions that they could institute on their own. However, some patients may not want the extra burden of monitoring their own blood pressure at home. Other considerations include the added cost of a home blood pressure monitor if not provided by the institution, patients in whom HBPM is not feasible, and the additional time patients would have to devote to the co-intervention. An informational video for patients on how to use a home blood pressure monitor is available on the VA/DoD Clinical Practice 10 Home blood pressure monitoring video is available on the VA/DoD Clinical Practice Guidelines page at https://www.healthquality.va.gov/guidelines/cd/htn/index.asp; or directly at https://www.youtube.com/watch?v=IHY5MJc4Z_M&feature=youtu.be. 