There's No Place Like Home to Diagnose Hypertension

Megan Brooks

October 01, 2021

Adults who need to track their blood pressure (BP) to find out if they have hypertension prefer to do it at home rather than at a clinic or kiosk or with a 24-hour ambulatory BP monitoring (ABPM), according to a new study.

"From a patient-centered perspective, home BP monitoring is the most acceptable method for diagnosing hypertension, although participants were willing to complete ABPM and appreciated its accuracy," said Beverly Green, MD, MPH, Kaiser Permanente Washington, Seattle.

Green presented the study September 29 during the virtual American Heart Association (AHA) Hypertension Scientific Sessions 2021.

"Healthcare professionals should work toward relying less on in-clinic visits to diagnose hypertension and supporting their patients in taking their blood pressure measurements at home," Green said in an AHA news release.

"Home blood pressure monitoring is empowering and improves our ability to identify and treat hypertension, and to prevent strokes, heart attacks, heart failure and cardiovascular death," she added.

Convenience Is Key

The BP-CHECK study was a 3-group, randomized controlled diagnostic study that tested the accuracy and acceptability of office, home, and kiosk BP monitoring against the gold-standard — ABPM — for diagnosing hypertension. Green presented the results on patient adherence and acceptability of these methods.

Those assigned to clinic measurements were asked to return to the clinic for at least one additional BP check, as is routine in diagnosing hypertension in clinical practice.

Those in the home group were given and trained to use a bluetooth/web-enabled home BP monitor and were asked to take their BP twice a day (morning and evening, with two measurements each time) for 5 days.

Those in the kiosk group were trained to use a BP kiosk with a smart card and were asked to return to the kiosk (or a nearby pharmacy with the same kiosk) on three separate days and measure their BP three times at each visit.

All participants were asked to complete their group-assigned diagnostic regimens in 3 weeks and then to complete 24-hour ABPM.

The trial enrolled 510 adults who presented to Kaiser Permanente Washington primary care clinics with elevated BP (mean, 150/88 mm Hg) but who had not yet been diagnosed with hypertension. Their mean age was 59 years, 80% of the study participants were White, and 51% were male.

Adherence to the monitoring regimen was highest in the home BP group (90.6%), followed by the clinic group (87.2%), and lowest in the kiosk group (67.9%). Adherence to ABPM among all participants was 91.6%.

Overall, acceptability was highest for the home BP group, followed by the clinic and kiosk groups; 24-hour ABPM monitoring was the least acceptable option.

Home was the "overwhelming" stated preference when asked before randomization and after, Green said.

The findings come as no surprise to Willie Lawrence, Jr., MD, head of the AHA National Hypertension Control Initiative oversight committee. "Patients will do what's most convenient for them," he told | Medscape Cardiology.

"We know from other studies that really all you need to do is measure the blood pressure twice a day for 3 days. That will give you a good idea what that patient's blood pressure is as it relates to future cardiac events," said Lawrence, who wasn't involved in the study.

"We should really begin to focus more on these home, self-measured blood pressures using validated devices, and that's important because a lot of the devices out there aren't validated," he explained.

"Patients with hypertension should have a blood pressure monitor at home that is validated and should be instructed in how to use it properly," Lawrence concluded.

Funding for the study was provided by the Patient-Centered Outcomes Research Institute (PCORI). Green and Lawrence have no relevant disclosures.

Hypertension Scientific Sessions 2021: Presentation 50. Presented September 29, 2021.


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