Value of Home Blood Pressure Monitoring Confirmed

Megan Brooks

September 20, 2018

CHICAGO — Home blood pressure monitoring improves control of blood pressure and saves money, results of a pilot initiative suggest.

"Home blood pressure monitoring is not only an evidence-based best practice, but is also a cost-effective way to achieve high-value healthcare," Roy Champion Jr, clinical quality RN, Scott and White Health Plan in Temple, Texas, told | Medscape Cardiology.

Champion and two colleagues examined the effects of a pragmatic home blood pressure program on blood pressure control in 2550 adults with persistent uncontrolled high blood pressure. Participants received free home blood pressure monitors, online and print resources for tracking their blood pressure readings, and monitoring reminders.

Office-based blood pressure readings in the electronic health record allowed them to calculate the change in blood pressure control for each subsequent visit and year over year.

Champion presented the results September 8 during the American Heart Association (AHA) Joint Hypertension 2018 Scientific Sessions.

Among the key findings:

  • By the third office visit, nearly 67% of patients had their blood pressure under control (office-based BP, <140/90 mm Hg).

  • By the sixth visit, nearly 60% of patients had their blood pressure under control. The decline from the third to sixth visit is likely the result of adjustments in blood pressure medications that providers made to reflect information from home blood pressure monitoring, the researchers say.

  • At the end of the 1-year intervention, systolic blood pressures had decreased an average of 16.9 mm Hg and diastolic blood pressures fell an average of 6.5 mm Hg.

  • In the 6 months after the intervention, nearly 80% of participants achieved blood pressure control that met HEDIS 2018 standards.

  • And 72% achieved blood pressure control that met 2017 American Heart Association/American College of Cardiology (AHA/ACC) guidelines. "Even with the more stringent guidelines, we showed home blood pressure monitoring is vital to achieving control among hypertensive patients," Champion said in a press release.

The study team notes that each program kit, including the monitor, cost an average of $38.50. And the cost savings were substantial. They estimate that each participant had 1.2 fewer office visits per year, as well as fewer emergency department and medication costs.

Champion noted that home blood pressure monitoring carries a grade A recommendation (strong evidence) from the US Preventive Services Task Force, and numerous professional organizations, including the AHA, recommend it for the diagnosis and treatment of hypertension. Yet, home blood pressure monitoring is often not part of the routine care of hypertensive patients, Champion noted.

"Unfortunately, there is significant industry-wide clinical inertia (patients, providers, and payers)," he said in an interview.

That has to change, he said. "Putting it into proper perspective, we would never dare treat a diabetic with insulin without reviewing his or her home glucose readings. So why," wonders Champion, "are we treating hypertensive patients without reviewing their home blood pressure readings?"

Important and Timely Study

Reached for comment, AHA spokesperson Richard Becker, MD, University of Cincinnati, said this is an important and timely study.

"It's been recognized for decades that for some individuals, an isolated blood pressure determination in the clinic is not really reflective of what a blood pressure may be like in a 24-hour period outside of a physician's office. The new guidelines recommend that home blood pressure monitoring be part of the management paradigm," said Becker.

"For all of my patients with high blood pressure, I recommend that they have a cuff that they can use at home. I ask them to keep a log and send it to me regularly," Becker told | Medscape Cardiology. "If they have known blood pressure and they are on the right medicines, it might be once a month. If they are newly diagnosed and I have placed them on medicines, I may ask for their readings on a weekly basis."

Occasionally, he said, he'll use ambulatory continuous blood pressure monitoring in patients. "We have found that that is an important way to gather even more information about blood pressure. We know that controlling high blood pressure reduces the likelihood of heart attack, stroke, and kidney failure, and we really want to be sure that we know as much as we can about blood pressure and that it is controlled in a variety of settings," said Becker.

The study was supported by a grant from the American Heart Association. The authors and Becker have disclosed no relevant financial relationships.

American Heart Association Joint Hypertension 2018 Scientific Sessions (HYP): Poster 351. Presented September 8, 2018.


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