Other factors that can improve accuracy include the use of an appropriately sized cuff and slow cuff deflation. Findings may be used for research purposes, but should not be considered current. A 2012 comparative-effectiveness review by the Agency for Healthcare Research and Quality found strong evidence that SMBP plus clinical support was . b W 35D43zi&J &lbP K 7X Self-Measured Blood Pressure Monitoring . Europe PMC is an archive of life sciences journal literature. This video from NACHC features DAngelo, a patient who explains how he has taken control of his blood pressure with the help of SMBP monitoring. The Correct Way to Measure Blood Pressure 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. How does SMBP monitoring compare with usual care or other interventions without SMBP in its effect on relevant surrogate outcomes (cardiac measures: LVH [left ventricular hypertrophy], LVM [left ventricular mass], LVMI [left ventricular mass index]) and intermediate outcomes (BP control, BP treatment adherence, or health care process measures)? Oscillometric Blood Pressure Devices Validated for Accuracy During Pregnancy [PDF 441 KB] SMBP = self-measured BP; KQ = Key Question The figure shows a schematic of possible comparisons between SMBP, SMBP plus additional, support without (more), In light of the potential health care benefits and knowledge gaps highlighted above, a topic titled Self Blood Pressure Monitoring was developed through the processes of topic identification, selection, and refinement for Comparative Effectiveness Review (CER) within the Agency for Healthcare Research and Quality (AHRQ) Effective Health Care program.34. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners [PDF 1 MB] Self Measured Blood Pressure Monitoring (SMBP), the self measurement of blood pressure (BP) outside of the health care setting may be an effective tool to facilitate BP control. Your feet should be flat on the floor and your legs . There are also a variety of kiosks available in stores and pharmacies. Self-Measured Blood Pressure Monitoring Definition and Indications SMBP plus additional clinical support is one alternative to traditional oce care that could improve access to care and quality of care for individuals with hypertension while making blood pressure control more convenient and accessible across the population. For example it is unclear whether simply providing a device for SMBP will improve BP control or whether this needs to be combined with additional support such as the telemetric transmission of readings to a provider to allow more frequent titration of drugs, regular nursing contact, or other types of interactions with a provider regarding hypertension management. In total, 49 studies met eligibility criteria. Content last reviewed March 2021. Many things can affect a blood pressure reading, including: Its important to get an accurate blood pressure reading so that you have a clearer picture of your risk for heart disease and stroke. 2011 Jan-Feb;46(1):99-102. doi: 10.4085/1062-6050-46.1.99. Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care, Agency for Healthcare Research and Quality (US). Content last reviewed March 2021. AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. Self-Measured Blood Pressure Monitoring Program: Engaging Patients in Self-Measurement [PDF 1.5 MB] An official website of the United States government. hbbd```b``A$ug`rX|" o/XDLHp0{W$5)"30^` w The CDC 6|18 Initiative supports providing access for SMBP monitoring for home use and creating individual, provider, and health system incentives for compliance and meeting goals. 45.) See the resources below for specific recommendations. government site. European Associations Review Dietary Therapies for Obesity, AHA Statement Ranks 10 Popular Diets for Heart Health. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care. Readings by a person can be affected by observer training, preference, and bias. There is growing evidence that selfmonitoring of blood pressure (SMBP) with guided support beyond usual primary care improves BP control. How often should I measure my blood pressure? Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence predictors of SMBP monitoring. Brown Affiliations Home BP monitoring (HBPM) has been utilized for regular monitoring of BP at home to improve HTN control or regulate antihypertensive medications. This AMAAHA joint initiative can help health care professionals launch an SMBP monitoring program. 2012 Mar 19. National Library of Medicine In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Resource title: Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension. Cookies used to make website functionality more relevant to you. Is immediate imaging important in managing low back pain? This list of resources from the Million Hearts Hypertension Control Change Package can help assign care team roles for an SMBP monitoring program and guide patients on selecting a home blood pressure monitor. CDCs 6|18 Initiative: Accelerating Evidence into Action Measuring your blood pressure is the only way to know whether you have high blood pressure. If you have high blood pressure, talk to your health care team about steps to take to control your blood pressureto lower your risk for heart disease and stroke. i` V04s7.w`t32Cc( L4M\ES}*vWe+= 4a)\5O)si8hQ[^}.L01>#t7On,c7g K>=}NrMo4;Zj:97MgN1m#6+U6i High blood pressure (BP), or hypertension, is a common, long-term health condition, particularly among older adults. This site provides a list of clinically validated blood pressure devices, based on the American Medical Associations (AMA) established criteria to independently validate clinical accuracy. SMBP = self-measured BP; KQ = Key Question. This process is quick and painless. It predicted a rise by 24 percent in developed countries and 80 percent in developing countries by 2025.4 The World Health Report 2002 estimates that over 1 billion people have hypertension, which is estimated to cause 4.5 percent of the global disease burden.5 In addition, high BP directly results in 7 million deaths annually.6 Within the United States, about 76.4 million adults are affected.7 Data from the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2008 indicated that 30 percent of all adults in the U.S. 18 years and older were hypertensive, with a higher prevalence among African Americans and the elderly.8 The prevalence of verified hypertension in children is more than 3 percent.2 A study from 2002 reported a lifetime risk of developing hypertension among adults aged 55 to 65 years in the U.S. as greater than 90 percent.9 Despite improvements in the quality of health care and life expectancy, it is expected that the prevalence of hypertension will continue to rise as the population ages. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. These types of minimally intensive approaches are important to test in all populations, especially those experiencing related health disparities, for broad implementation with . In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Measurements can be read by a person or provided digitally by a device. For SMBP plus additional support versus SMBP alone or with less intense additional support, the strength of evidence is low, failing to support a difference in BP. Conclusions: Systematic Review: Today, as part of the CDC Expert Commentary Series on Medscape, I would like to talk about self-measured blood pressure (SMBP) monitoring plus clinical support as a way to help patients manage their hypertension. SMBP monitoring is also commonly referred to as home blood pressure monitoring. Internet Citation: Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. SMBP with or without additional support may confer a small benefit in BP control compared with usual care, but the BP effect beyond 12 months and the attendant long-term clinical consequences remain unclear. This 2012 AHRQ review examined the comparative effectiveness of SMBP alone, of SMBP plus additional clinical support, and of usual care. The .gov means its official. A reading that says your blood pressure is lower than it actually is may give you a false sense of security about your health. >gL/?eEAV c,1t D~ 8-?x}0 KQUo~TJa&A6@sY(|x D G&pA32^Y|VLEcx 71HbFFhi3"9#+Z~GqESHm,Y-G1. Careers. Lin JS, O'Connor E, Rossom RC, Perdue LA, Burda BU, Thompson M, Eckstrom E. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Nov. Report No. Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians [PDF 947 KB] 45. This patient-friendly video from the Release the Pressure Coalition highlights the key steps people can take for accurate SMBP monitoring. BP as recorded in the office or clinic setting at medical encounters is the most commonly used approach for measurement of BP. Take this form with you to your doctors office to record important blood pressure-related information. The gauge uses a unit of measurement called millimeters of mercury (mmHg) to measure the pressure in your blood vessels. Whether or not to advise the use of an SMBP monitoring device for a patient with hypertension is a common clinical question for clinicians. This article presents strategies for strengthening the United States ability to address hypertension in women focusing on pregnancy-related considerations for self-measured blood pressure monitoring. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness, https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure/research, Comment on Key Questions and Draft Reports, 25 Years of the AHRQ Evidence-based Practice Center Program, Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis, Postpartum Home Blood Pressure Monitoring, Postpartum Treatment of Hypertensive Disorders of Pregnancy, and Peripartum Magnesium Sulfate Regimens for Preeclampsia With Severe Features, Cervical Ripening in the Outpatient Setting, Sodium and Potassium Intake: Effects on Chronic Disease Outcomes and Risks, Effects of Dietary Sodium and Potassium Intake on Chronic Disease Outcomes and Related Risk Factors, U.S. Department of Health & Human Services. SMBP plus clinical support can improve access to care and quality of care for people with hypertension while making blood pressure control more convenient and accessible across the population. Further debate focuses on the role of additional support needed to enhance adherence with SMBP monitoring and, possibly, achieve the clinical benefit from it. This tool was developed by the National Association of Community Health Centers to help health care professionals compare blood pressure measurement devices from the U.S. Validated Device Listing across device features including cost, available cuff sizes, and data/technology capabilities. A recent CDC study found that 67 million adult Americans have hypertension, and of those, 36 million are uncontrolled. In addition, ambulatory BP monitoring is often used in research studies as an outcome, since many consider it to be more accurate than clinic-based BP measurement. is a member of the Million Hearts Science team with the Centers for Disease Control and Prevention (CDC) Division for Heart Disease and Stroke Prevention. Unauthorized use of these marks is strictly prohibited. %%EOF There is insufficient evidence concerning predictors of SMBP adherence. Sit with your back straight and supported (on a dining chair, rather than a sofa). This summary is provided to assist in clinical decisionmaking along with consideration of a patient's values and preferences. Patient-provider feedback loop.Source:Centers for Disease Control and Prevention. Comparative Effectiveness Review No. Details on design, patients, interventions, outcomes, and quality were extracted into standard forms. Allison is trained as an emergency medical technician and received a bachelor of science degree in biology and anthropology from the University of Michigan and a master of public health degree, with a focus in behavioral science and education, from Emory University. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Ambulatory BP monitoring requires a technologist to program the machine, fit it on the patient, remove it and download the results and a physician to interpret them. The cost of a home BP monitor ranges between $40 to $150, and the insurance coverage and approval for these devices vary across states.33 However, provision of the device could be cost-saving if it resulted in a reduced number of office visits for BP measurement or management or resulted in improved BP, which could translate into reduced morbidity and health care utilization. SMBP CPT Coding [PDF 1 MB] official website and that any information you provide is encrypted Given the inconvenience and expense of setting up and using the device, ambulatory BP monitoring is predominantly used to diagnose white coat or masked hypertension, to identify people with abnormal daily BP patters, or to help with management of hard to control or highly variable BP. Self-measured blood pressure (SMBP) has been used in the treatment of hypertension with three major aims: 1) to avoid undertreatment of hypertension 2) to enhance self-participation in disease management and to enhance adherence; and 3) to avoid overtreatment in those with lower BP out of the clinic compared with in the clinic26, SMBP is being used to avoid undertreatment of hypertension. Patients may require some instruction on how to use SMBP devices.30,31. No studies of SMBP monitoring in children were identified. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. MeSH The cuff has a gauge on it that will measure your blood pressure. https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure. The primary objective of this review is to evaluate whether the use of SMBP monitoring influences outcomes in adults and children with hypertension and to what extent these changes in outcomes can be attributable to the use of self monitoring devices alone or the use of SMBP with additional support or attention provided. Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care. The goals of this report, therefore, are to inform physicians' decision whether to encourage the use of SMBP monitoring alone or along with additional support and to assist health care policymakers and payers with decisions regarding coverage and promotion of SMBP monitoring. . SMBP Health IT Checklist [PDF 136 KB] Learn the correct way to have your blood pressure taken, whether youre getting it checked at the doctors office or checking it yourself at home. May 28, 2010. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Dec. Report No. There is insufficient evidence concerning predictors of SMBP adherence. An official website of the United States government. : 12-EHC002-EF. Measurements may interfere with a patient's activity or sleep. Many studies were of moderate to poor quality and had short followup periods. Purpose Generate prioritized topics for future research on SMBP, building on evidence gaps identified in a prior comparative effectiveness review and following an . hb```f`` & B,@Q+g~ Future research should standardize patient inclusion criteria, BP treatment targets for home BP, and SMBP and additional support protocols to maximize the interpretability and applicability of SMBP trials. This 2020 joint policy statement from the American Heart Association (AHA) and the AMA addresses barriers to implementing SMBP monitoring. This patient-friendly video from NACHC outlines clear instructions for using home blood pressure monitors. Choosing-a-Home-BP-Monitor At-a-Glance-Comparison [PDF 446 KB] You've successfully added to your alerts. People using assistive technology may not be able to fully access information in these files. However, consistently attaining reliable BP measurements is problematic. More broadly, though, it is the regular use of a BP measurement device that is owned by (or lent to) the patient to be used outside the office/clinic setting. For SMBP alone versus usual care, the strength of evidence is moderate and supports a lower BP with SMBP (SBP/DBP -3.1/-2.0 mmHg at 6 months). Measure your blood pressure regularly to help your health care team diagnose any health problems early. PMC While patient self-participation in chronic disease management appears promising, the sustainability and clinical impact of SMBP remains uncertain. In addition, SMBP may carry the risk of unreliable BP readings if not obtained in a standard fashion, inappropriate self adjustments of antihypertensive medications, as well as increased anxiety in susceptible patients. Public Information from the CDC and Medscape. Untreated or ineffectively treated hypertension leads to increased cardiovascular morbidity and mortality in individuals, increased consumption of health care resources, high financial and human costs to society. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. This document provides action steps for public health practitioners to facilitate the implementation of SMBP monitoring plus additional support in five key areas: Understanding the environment; Working with payers and purchasers; Working with health care providers; Spreading the word to the public; and Monitoring/assessment of SMBP, plus additional support implementation. In studies of SMBP monitoring, how do clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence) vary by the type of additional support provided? Kallioinen N, Hill A, Horswill MS, Ward HE, Watson MO. 293 0 obj <> endobj They can help you make a plan to manage high blood pressure. These include ambulatory BP monitoring (ABPM), self monitoring (or self measurement or home based) BP which is usually done by the patient at home, at work, or in any conducive environment. You can review and change the way we collect information below. Several national and international hypertension guidelines endorse self-measured BP monitoring. You will be subject to the destination website's privacy policy when you follow the link. Talk with your health care team about how often you should have your blood pressure measured or when to measure it yourself. However, there is uncertainty about the appropriate home BP targets for guiding treatment decisions and whether these should be based on the same cut-points from clinic BP or from ABPM for defining hypertension.32. For appropriate diagnosis and therapy, accurate BP measurement is of great importance. Untreated or ineffectively treated hypertension leads to increased cardiovascular . How to Measure Your Blood Pressure at Home [PDF 255 KB] Strategies aimed at the control of high BP as well as adherence to medication continue to be of foremost concern to providers and patients, health care payers, policymakers, and governments worldwide. Content last reviewed March 2020. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. The trials were greatly heterogeneous, varying in population, intervention, and outcome measures and definitions. Hypertension also imposes a heavy financial burden on society at large. In: Daniel D, Prall M, editors. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Aug. Report No. These blood pressure monitors are easy and safe to use. HHS Vulnerability Disclosure, Help Research shows that SMBP: Can improve adherence and health outcomes for hypertensive patients1 Study Selection: Hypertension is a major risk factor for cardiovascular disease and mortality and accounts for an estimated 14 percent of cardiovascular deaths worldwide and 18 percent in developed countries.10 It is an important modifiable risk factor for coronary artery disease, stroke, chronic kidney disease, congestive heart failure, and peripheral vascular disease.1 The World Health Organization ranks high BP as the third highest risk factor for burden of disease, after underweight and unsafe sex, highlighting the contribution of hypertension directly and indirectly to the development of numerous diseases.5. Take your blood pressure at the same time every day. Comparative Effectiveness Review Number 45 Self-Measured Blood Pressure Monitoring: Comparative Effectiveness Executive Summary Background High blood pressure (BP), or hypertension, is a common, long-term health condition, particularly among older adults. %PDF-1.6 % These cookies may also be used for advertising purposes by these third parties. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Please enable it to take advantage of the complete set of features! For the purpose of this report, BP measurement by the patient in the office/clinic/pharmacy or a health unit at work is not included under SMBP monitoring since it does not reliably overcome the problem of white coat hypertension nor provide the privacy and opportunity for more frequent measurements of home self measurement. We take your privacy seriously. Rockville, MD 20857 Finally, SMBP may be useful in preventing overtreatment in individuals with white coat syndrome, orthostatic BP changes, or hypotensive episodes from medication. Please enter a Recipient Address and/or check the Send me a copy checkbox. Unable to load your collection due to an error, Unable to load your delegates due to an error, Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. SMBP means you regularly use a personal blood pressure measurement device away from a doctor's office or hospitalusually at home. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. This program from the AMA and Johns Hopkins University School of Medicine is designed to help physician offices and health centers engage patients in SMBP monitoring. They help us to know which pages are the most and least popular and see how visitors move around the site. Self-blood pressure monitoring, by itself, has been shown to be an effective tool in predominantly white populations, but less studied in minority, urban communities. : 14-05204-EF-1. January 2012 As they were scoping their work for SMBP, they started by searching multiple databases There is within-individual biological variability as well as measurement error. The bold lines indicate the comparisons addressed in the Key Questions (see below). In that role, she provides scientific expertise to support research translation related to Million Hearts priority strategies. Target: BP: CME Course: Using SMBP to Diagnose and Manage High Blood Pressure ECG Challenge: What's Causing This Woman's Slow Pulse? Randomized-controlled trials have shown that self-measured blood pressure predicts cardiovascular morbidity and mortality better than office BP measurements. Future research should standardize patient inclusion criteria, BP treatment targets for home BP, and SMBP and additional support protocols to maximize the interpretability and applicability of SMBP trials. Accessibility As self-measurement requires patient participation, certain patient characteristics may affect compliance with SMBP monitoring, such as the willingness and ability to self-monitor BP and the technical literacy in operating the device or an interface for telemonitoring. You will be subject to the destination website's privacy policy when you follow the link. HHS Vulnerability Disclosure, Help sharing sensitive information, make sure youre on a federal This report can help policymakers learn more about which payers have programs that cover and reimburse for SMBP monitoring. Apr 11, 2011. The HOME BP intervention for SMBP is an integrated patient-practitioner online digital tool. Associate Director, Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Project Timeline. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. Addressing Barriers Beyond the Published Literature, Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association, An Opportunity to Better Address Hypertension in Women: Self-Measured Blood Pressure Monitoring, Agency for Healthcare Research and Quality (AHRQ) Self-Measured Blood Pressure Monitoring: Comparative Effectiveness, U.S. Preventive Services Task Force (USPSTF) Final Recommendation Statement: Hypertension in Adults: Screening, Division for Heart Disease and Stroke Prevention, Live to the Beat Campaign Partner Toolkit.

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