Comparative Effectiveness Review No. Hypertension Medication for Specific Comorbidities, Individualized Weight Monitoring Using the Heartphone, Home Blood Pressure Monitoring in Patients With Hypertension. Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers. In studies of SMBP monitoring, how do clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence) vary by the type of additional support provided? This AMAAHA joint initiative can help health care professionals launch an SMBP monitoring program. 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. 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. How does adherence with SMBP monitoring vary by patient factors? 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. Self-measured blood pressure (SMBP) monitoring, sometimes called home blood pressure monitoring, is a patient- performed measurement of their own blood pressure outside of a clinical setting. HHS Vulnerability Disclosure, Help Whether or not to advise the use of an SMBP monitoring device for a patient with hypertension is a common clinical question for clinicians. Why do I need to measure my blood pressure? Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Saving Lives, Protecting People. CER 45 Self-Measured Blood Pressure Monitoring Comparative Effectiveness Surveillance Final 4.7 AHRQ%Systematic%Review%% Surveillance%Program% CER$#45:$Self'Measured"Blood"Pressure"Monitoring:"$ Comparative"Effectiveness" Original$Release$Date:$nuary Ja "2012" Surveillance$Report: "vember"2012No " Surveillance$Report: "rchMa "2016"" Self-Measured Blood Pressure Monitoring: Comparative Effectiveness Introduction. Apr 11, 2011. Self-Measured Blood Pressure Monitoring at Home: A Joint Policy The HOME BP intervention for SMBP is an integrated patient-practitioner online digital tool. Clinic measurements may not reflect the usual BP outside of the clinic setting throughout a day. With training, additional support and treatment algorithms, patients may be able to self adjust medications based on SMBP results. No studies evaluated children. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Given clinical heterogeneity and limited head to head comparisons, the evidence limits our ability to draw definitive conclusions about the incremental effect of any specific additional support. What you need to know about self-measured blood pressure monitoring Figure 1 shows possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care. 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. The gauge uses a unit of measurement called millimeters of mercury (mmHg) to measure the pressure in your blood vessels. Systematic Review: Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. It has been the subject of a 2002 Evidence Practice Center (EPC) Evidence Report.25 A fuller description of ambulatory BP monitoring can be found there. Research shows that SMBP: Can improve adherence and health outcomes for hypertensive patients1 PMID: 23922064. Neither is there consensus on how many serial measurements should be taken and which ones should be used or averaged to derive an accurate reading. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. FOIA Self-Measured Blood Pressure Monitoring: Comparative Effectiveness This report addresses questions regarding the clinical value of SMBP monitoring with or without additional support and what factors may predict adherence with SMBP monitoring. Where can I get my blood pressure checked? Randomized-controlled trials have shown that self-measured blood pressure predicts cardiovascular morbidity and mortality better than office BP measurements. Self-measured BP monitoring, the measurement of BP by an individual outside of the office at home, is a validated approach for out-of-office BP measurement. There are two BP monitoring strategies that can currently be used at home: Ambulatory and SMBP monitoring. Generally, individuals with hypertension would use such devices at home to measure their own BP and provide written lists of readings to their provider at office visits. Centers for Disease Control and Prevention. 45. Take this form [PDF 105 KB]with you on your first blood pressure visit to record important blood pressure-related information. Before Details on design, patients, interventions, outcomes, and quality were extracted into standard forms. These cookies may also be used for advertising purposes by these third parties. Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. To sign up for updates or to access your subscriberpreferences, please enter your email address below. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Rockville, MD: Agency for Healthcare Research and Quality. There is insufficient evidence concerning predictors of SMBP adherence. 45. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. All information these cookies collect is aggregated and therefore anonymous. Limitations: Strong scientific evidence shows that self-measured blood pressure (SMBP) monitoring, also known as home blood pressure monitoring, plus clinical support helps people with hypertension lower their blood pressure. and transmitted securely. You and your health care team can take steps to control your blood pressureif it is too high. Unauthorized use of these marks is strictly prohibited. The trials were greatly heterogeneous, varying in population, intervention, and outcome measures and definitions. . PMC This SMBP coverage summary from the American Medical Association shows Medicaid coverage by state for automated SMBP blood pressure devices, standalone cuffs, and related clinical services. SMBP measurements can be obtained from the upper arm, wrist, or fingers (or, if necessary, the lower extremity); however, experts recommend the use of upper arm devices due to the lack of validation and the high number of inaccurate measurements from the wrist and finger devices.26-28 Models for SMBP devices range from mechanical aneroid gauges (sphygmomanometers), which require self-inflation and auscultation (manual devices), to manually-inflated sphygmomanometers with automatic displays (semiautomated devices), to fully automated configurations that automatically inflate the sphygmomanometer and measure the BP (automated devices). 2011 Jan-Feb;46(1):99-102. doi: 10.4085/1062-6050-46.1.99. Data Sources: This 2020 joint policy statement from the American Heart Association (AHA) and the AMA addresses barriers to implementing SMBP monitoring. 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. I am Allison Goldstein from the Division for Heart Disease and Stroke Prevention at CDC. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Balk, Ethan - Brown University We included studies that used arm (not wrist) monitors for at least 8 weeks and excluded studies of pregnant women or people on hemodialysis. Document author(s)/institution of origin: Effective Health Care Program, Agency for Healthcare Research and . May 28, 2010. 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. John M Eisenberg Center for Clinical Decisions and Communications Science. Oscillometric Blood Pressure Devices Validated for Accuracy During Pregnancy [PDF 441 KB] MeSH Collaborative Care Models for Improving Hypertension Control Through SMBP Monitoring Updated Hypertension Guidelines: Implications for Treatment? Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Aug. Report No. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Content last reviewed August 2018. Newer SMBP devices can automatically store readings and some are equipped to electronically transmit readings to a provider. 315 0 obj <>/Filter/FlateDecode/ID[]/Index[293 51]/Info 292 0 R/Length 113/Prev 421311/Root 294 0 R/Size 344/Type/XRef/W[1 3 1]>>stream Recommended management strategies for BP control include lifestyle and behavior modification (such as smoking cessation, moderation of alcohol consumption, salt restriction and other dietary modifications, regular exercise, and weight loss in obese persons), usually combined with the use of antihypertensive medication. MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. Page originally created December 2020. This easy-to-read graphic from CDC shows patients the correct way to measure blood pressure and can be shared on your social channels and patient websites. This toolkit, developed by the National Association of Community Health Centers (NACHC) for Million Hearts, can help organizations successfully integrate SMBP monitoring into care processes and workflows. Background: Untreated or ineffectively treated hypertension leads to increased cardiovascular . How can I measure my blood pressure at home? 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. The choice of treatment is largely dependent on the cause of hypertension, severity of the condition, as well as the presence or absence of existing comorbid states. 0 January 2012 As they were scoping their work for SMBP, they started by searching multiple databases National Library of Medicine This review does not explore the validity, reproducibility, or comparability of BP measurements across devices or techniques (which was addressed by the 2002 EPC report25), or the use of SMBP as a diagnostic tool. On the other hand, if more frequent home BP measurements lead to more encounters for counseling, modification of lifestyle behaviors, drug treatments along with management of adverse effects, SMBP may actually increase cost, at least in the short term, since it takes several years for improved BP control to improve clinical outcomes. Improving patient engagement in self-measured blood pressure monitoring Sit correctly. Division for Heart Disease and Stroke Prevention. How to Measure Your Blood Pressure at Home [PDF 255 KB] Topline Findings: A National Analysis of Self-Measured Blood Pressure Monitoring Coverage and Reimbursement [PDF 1.7 MB] Study Selection: (Prepared by the Tufts Evidence . Effective BP control has been shown to decrease incidence for stroke by 35 to 40 percent, myocardial infarction by 20 to 25 percent, and heart failure more than 50 percent.11,12 Systematic reviews have also shown the beneficial effects of lowering BP on reducing fatal and nonfatal stroke, cardiac events, and total among individuals with severe hypertension or at increased risk (such as of older age or with other comorbid risk factors).11,13,14 A decrease of 5 mmHg in systolic BP has been estimated to result in a 14 percent overall reduction in mortality due to stroke, 9 percent reduction in mortality due to chronic heart disease and 7 percent reduction in all-cause mortality.1,15,16 However, long-term adherence to lifestyle modification and medication remains a challenge in the management of hypertension, which is usually a lifelong condition. This website requires cookies, and the limited processing of your personal data in order to function. 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. There is no consensus on the precise protocol for SMBP monitoring in the management of hypertension regarding timing, frequency and duration. 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. Associate Director, Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Home BP monitoring (HBPM) has been utilized for regular monitoring of BP at home to improve HTN control or regulate antihypertensive medications. Measurements may interfere with a patient's activity or sleep. hbbd```b``A$ug`rX|" o/XDLHp0{W$5)"30^` w To determine predictors of adherence with SMBP monitoring. This 2015 CPSTF systematic review evaluates the effectiveness of using SMBP with additional clinical support to manage high blood pressure and SMBP alone. National Library of Medicine However, even when measured according to established guidelines, clinic BP measurements have several limitations. No studies evaluated children. If using a digital or automatic blood pressure cuff, the health care professional will not need to use a stethoscope.