self measured blood pressure monitoring: comparative effectiveness

Self-measured blood pressure (SMBP) monitoring, the regular measurement of blood pressure (BP) by the patient at home, has been proposed as a means of improving treatment adherence and BP control. 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. Limitations: Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jan. Report No. An official website of the Department of Health & Human Services. 8. 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. Brown Affiliations Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Ann Intern Med. PMID: 23922064. For all comparisons, evidence for clinical outcomes was insufficient; for all other outcomes (surrogate and intermediate outcomes, and health care encounters) strength of evidence was low, thus failing to support a difference. This resource from the Public Health Informatics Institute provides a checklist of helpful characteristics for SMBP telemonitoring software. Content last reviewed August 2018. In: Daniel D, Prall M, editors. An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care. The current report evaluates ambulatory BP monitoring only as an outcome measurement tool, not as an intervention of interest. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. National Library of Medicine endstream endobj startxref Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. 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. Purpose Hypertension often requires lifelong treatment. 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. Centers for Disease Control and Prevention. y ^]J[_tFe^~4:;:Cxbh jXd%SElY*Oi1h{_DsnL [1] SMBP monitoring plus clinical support has been found to be effective in helping patients control their blood pressure.[2]. In that role, she provides scientific expertise to support research translation related to Million Hearts priority strategies. 1, 2 The TASMINH (Telemonitoring And SelfManagement in the Control of Hypertension) trials demonstrated that SMBP plus support, including telemonitoring (remotely monitoring patients using communication You will receive email when new content is published. No studies of SMBP monitoring in children were identified. 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. Addressing Barriers Beyond the Published Literature 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. That the mean number of BP measurements recorded per week for users who continued recording blood pressure at 6 weeks was 6 compared to 8 among those who continued for at least 14 weeks, demonstrates high levels of engagement with respect to self-measured BP monitoring. January 2012 As they were scoping their work for SMBP, they started by searching multiple databases We take your privacy seriously. Clipboard, Search History, and several other advanced features are temporarily unavailable. Measurements can be read by a person or provided digitally by a device. 12-EHC002-EF. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. 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. Data extraction Data on . Centers for Disease Control and Prevention. A reading that says your blood pressure is lower than it actually is may give you a false sense of security about your health. Details on design, patients, interventions, outcomes, and quality were extracted into standard forms. This video from NACHC, showcases several community health centers work to implement SMBP monitoring programs in their clinics. 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. Cookies used to make website functionality more relevant to you. E-mail questions about the Forum toMillionHeartsSMBP@nachc.com. Patient-provider feedback loop.Source:Centers for Disease Control and Prevention. We standardized extraction by training on multiple articles, after which each study was extracted by one methodologist and the extraction reviewed by at least one other. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. I am Allison Goldstein from the Division for Heart Disease and Stroke Prevention at CDC. Unauthorized use of these marks is strictly prohibited. Take this form [PDF 105 KB]with you on your first blood pressure visit to record important blood pressure-related information. Show details Contents < Prev Next > Key Informants Susan Booth Project Leader, Personal Care & Wellness Consumer Reports Yonkers, NY Hayden Bosworth, Ph.D. This summary is provided to assist in clinical decisionmaking along with consideration of a patient's values and preferences. %PDF-1.6 % Figure 1. The https:// ensures that you are connecting to the in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence predictors of SMBP monitoring. Take at least two readings, 1 or 2 minutes apart. Other factors that can improve accuracy include the use of an appropriately sized cuff and slow cuff deflation. sX Ndb`T~ There is insufficient evidence concerning predictors of SMBP adherence. Numerous health professional and government organizations have developed various guidelines for BP management. Purpose: However, even when measured according to established guidelines, clinic BP measurements have several limitations. Using SMBP to guide you in diagnosing and treating hypertension likely will produce better outcomes than using office blood pressure readings alone. Home BP monitoring (HBPM) has been utilized for regular monitoring of BP at home to improve HTN control or regulate antihypertensive medications. Murakami L, Rakotz M. Improving health outcomes: Blood pressure. 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. endstream endobj 294 0 obj <>/Metadata 50 0 R/Names 317 0 R/Outlines 332 0 R/PageMode/UseOutlines/Pages 291 0 R/StructTreeRoot 110 0 R/Type/Catalog/ViewerPreferences<>>> endobj 295 0 obj <>/Font<>/ProcSet[/PDF/Text]/Properties<>>>/Rotate 0/StructParents 0/Tabs/S/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 296 0 obj <>stream 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. Allison Goldstein, MPH, SMBP Coverage Insights: Medicaid [PDF 232 KB] Findings may be used for research purposes, but should not be considered current. Associate Director, Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center 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. U.S. Preventive Services Task Force (USPSTF) Final Recommendation Statement: Hypertension in Adults: Screening Study Selection: See the resources below for specific recommendations. 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. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. There were 24 comparisons of SMBP alone versus usual care, 24 of SMBP plus additional support versus usual care, 12 of SMBP plus additional support versus SMBP without additional support or with less intense additional support, and 1 study evaluating predictors of adherence to SMBP. Current settings for BP measurement include BP measurement in a healthcare setting, or BP measurement in a patient's usual environment with either ambulatory BP monitoring, or self-measured BP (SMBP) monitoring. 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. https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure. https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure/research. 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. Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care, Agency for Healthcare Research and Quality (US). sharing sensitive information, make sure youre on a federal hXio8EIbHr)_cBCq{(1KLL)}]IDb)Pb"VL *&DSK28ijMqXLG:a/^~ vs:?COe+Y1~504ye49ucTSQZGUI+'O+ {EQZu]`^.7t n\B^9~: You will be subject to the destination website's privacy policy when you follow the link. To sign up for updates or to access your subscriberpreferences, please enter your email address below. OF SELF-MEASURED BLOOD PRESSURE MONITORING INTERVENTIONS CENTERS FOR DISEASE CONTROL AND PREVENTION . b W 35D43zi&J &lbP K 7X BP may rise in the clinic in response to the medical environment (referred to as white coat hypertension), or may be normal in the clinic but not outside of the clinic (referred to as masked hypertension).19,20 Prevalence of white coat hypertension ranges from 10 to more than 20 percent,21,22 and the prevalence of masked hypertension (MH) reaches 40 percent in some studies.23 The prognostic significance of either is unclear.24. A connected monitor is preprogrammed to regularly record BP, usually every 15 to 20 minutes while awake and every 20 to 30 minutes while asleep. This 2021 recommendation from the USPSTF includes additional guidance for obtaining blood pressure measurements away from the clinical setting. Uhlig K, Balk EM, Patel K, et al. The site is secure. SMBP means you regularly use a personal blood pressure measurement device away from a doctor's office or hospitalusually at home. Please enable it to take advantage of the complete set of features! Hypertension often requires lifelong treatment. This 2020 AMA handout for Current Procedural Terminology (CPT) provides codes and descriptions for SMBP-related services. Topic Initiated. This video from the NACHC features Natalia, a patient who explains how she has taken control of her blood pressure with SMBP monitoring. This report from the Public Health Informatic Institute provides key findings from a national health information technology assessment on SMBP and identifies gaps, barriers, and recommendations to advance the collection, transfer, and use of patient-generated SMBP data to improve hypertension management. 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. Cookies used to make website functionality more relevant to you. In otherwise healthy adults, hypertension is defined as a persistently elevated BP equal to or greater than 140/90 mmHg.1 The recommended BP measurement technique is to average two readings taken in a person after 5 minutes quietly seated in chair.1 In children, the diagnosis is made from an average of three or more BP readings greater than the 95th percentile for age, sex, and height.2,3 The Seventh Joint National Committee (JNC 7) guideline recommends a BP goal of 140/90 mmHg or less in the general population and a lower goal of 130/80 mmHg or less in patients with diabetes mellitus or chronic kidney disease.1. Agency for Healthcare Research and Quality, Rockville, MD. To increase nationwide implementation of SMBP plus clinical support, multiple issues must be addressed. No trials compared different SMBP devices or provided evidence on the relationship between BP control and clinical or surrogate outcomes. 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. 2011 Jan-Feb;46(1):99-102. doi: 10.4085/1062-6050-46.1.99. For appropriate diagnosis and therapy, accurate BP measurement is of great importance. Figure 1 shows possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care. Hypertension Medication for Specific Comorbidities, Individualized Weight Monitoring Using the Heartphone, Home Blood Pressure Monitoring in Patients With Hypertension. 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 clinic 26 Types of clinical support include one-on-one counseling, Web-based and telephone support, and educational classes. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. This process is quick and painless. SMBP monitoring is the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere. Untreated or ineffectively treated hypertension leads to increased cardiovascular . Clinic measurements may not reflect the usual BP outside of the clinic setting throughout a day. The direct and indirect cost of high BP and its complications has been estimated at more than $43.5 billion in 2007 in the U.S.7 Thus, it cannot be viewed simply as an individual health issue given the large public health impact and the potential for cost savings with effective prevention or treatment. This article outlines high-level SMBP barriers that federal/national partners have encountered and offers potential solutions to achieve widespread SMBP implementation. 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.
Shooting In Cedartown, Ga Last Night, Phoenix Interclub Tennis, Smith Funeral Home Monroe, La Obituaries, Football Players Born In Monaco, Articles S