COMMENTARY

Self-Measured Blood Pressure Monitoring to Control Hypertension

Allison Goldstein, MPH

Disclosures

May 06, 2013

Editorial Collaboration

Medscape &

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Hello. I am Allison Goldstein from the Division for Heart Disease and Stroke Prevention at CDC. 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.

A recent CDC study found that 67 million adult Americans have hypertension, and of those, 36 million are uncontrolled.[1] SMBP monitoring plus clinical support has been found to be effective in helping patients control their blood pressure.[2]

A 2012 comparative-effectiveness review by the Agency for Healthcare Research and Quality found strong evidence that SMBP plus clinical support was more effective than usual care in improving blood pressure control among patients with hypertension.

Types of clinical support include one-on-one counseling, Web-based and telephone support, and educational classes. Support interventions can be delivered outside of a normal office visit -- for example via telephone, email, or Internet portal -- thereby reducing the necessary frequency of face-to-face visits. SMBP plus clinical support interventions should be delivered by a trained healthcare provider, such as a pharmacist or nurse, and include regular communication of patient SMBP readings to providers and a patient-provider feedback loop.[3] (Figure 1)

Figure 1. Patient-provider feedback loop.Source:Centers for Disease Control and Prevention. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013.

Regardless of the mode of support delivered, the patient-provider feedback loop is essential. Patient-provider feedback loops may involve patients reporting blood pressure readings for a given time period, concerns about medications, and progress on lifestyle changes to their providers. In response, providers offer customized support and advice, such as medication or lifestyle adjustments.[3] (Figure 2)

Figure 2. Patient-provider feedback loop with clinical support for SMBP monitoring. Source:Centers for Disease Control and Prevention. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013.

To increase nationwide implementation of SMBP plus clinical support, multiple issues must be addressed. Current insurance coverage for SMBP plus clinical support is limited and improvements are planned or are under way. Providers can help with SMBP implementation by promoting SMBP to their hypertensive patients and establishing clinical feedback systems. This includes encouraging the purchase of fully automated, validated home blood pressure monitors with a properly sized arm cuff, training patients in SMBP techniques, checking patients' measurement techniques for accuracy, and interpreting and providing counseling based on shared blood pressure readings. See the resources below for specific recommendations.

Together we can empower patients to take control of their hypertension, thereby reducing their risk for heart attack and stroke. Thank you.

Web Resources

dabl® Educational Trust: Sphygmomanometers for Self-measurement of Blood Pressure

British Hypertension Society: Blood Pressure Monitors Validated for Home Use

AHRQ Self-Measured Blood Pressure Monitoring: Comparative Effectiveness

Allison Goldstein, MPH, 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. In that role, she provides scientific expertise to support research translation related to Million Hearts priority strategies. Prior to joining CDC, Allison worked on the Global Polio Eradication Initiative at CARE International where she designed curricula for health workers and conducted evaluation field research on global polio eradication efforts. 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.

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