self measured blood pressure monitoring: comparative effectiveness

He has led the Evidence Review Teams for numerous guidelines for management of kidney disease, gynecological surgery, orthopedic surgery, and triaging in resource-poor countries. Please confirm that you would like to log out of Medscape. However, even when measured according to established guidelines, clinic BP measurements have several limitations. Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. European Associations Review Dietary Therapies for Obesity, AHA Statement Ranks 10 Popular Diets for Heart Health. Given the inconvenience and expense of setting up and using the device, ambulatory BP monitoring is predominantly used to diagnose white coat or masked hypertension, to identify people with abnormal daily BP patters, or to help with management of hard to control or highly variable BP. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. Systematic Review: Out-of-Office Blood Pressure Monitoring: A Comparison of Ambulatory An Opportunity to Better Address Hypertension in Women: Self-Measured Blood Pressure Monitoring Associate Director, Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Target: BP: CME Course: Using SMBP to Diagnose and Manage High Blood Pressure This website requires cookies, and the limited processing of your personal data in order to function. Document author(s)/institution of origin: Effective Health Care Program, Agency for Healthcare Research and Quality, Internet Citation: Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension. include self-measured blood pressure monitoring (SMBP) plus additional clinical support and empowerment of non-physician clinicians (e.g. 293 0 obj <> endobj Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians [PDF 947 KB] Finally, SMBP may be useful in preventing overtreatment in individuals with white coat syndrome, orthostatic BP changes, or hypotensive episodes from medication. 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. For example, terminal digit preference (i.e., preference for 0, 5, and even numbers) and single number preference (i.e., preference for specific values such as 130/80 or 140/90 mmHg) can lead to inaccuracies in measurement readings and variability across observers.17,18 This can be prevented when machines provide readings automatically. Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. Take this form with you to your doctors office to record important blood pressure-related information. Unauthorized use of these marks is strictly prohibited. Bethesda, MD 20894, Web Policies How can I measure my blood pressure at home? Register for the Million HeartsSMBP Forum, an opportunity for clinical, public health, and community-based partners to exchange best and promising practices, identify solutions to common obstacles, and share resources to accelerate SMBP monitoring uptake. 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. In a comparative effectiveness review supported by the Agency for . Addressing Barriers Beyond the Published Literature Cookies used to make website functionality more relevant to you. Patients in the intervention group and their providers, received feedback on self-monitored blood pressure results and optional lifestyle advice and motivational support. Together we can empower patients to take control of their hypertension, thereby reducing their risk for heart attack and stroke. Figure 1 shows possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care. 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. 7 HBPM is also known as self-measured BP. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Many studies were of moderate to poor quality and had short followup periods. To increase nationwide implementation of SMBP plus clinical support, multiple issues must be addressed. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. National Library of Medicine 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. Self-blood pressure monitoring, by itself, has been shown to be an effective tool in predominantly white populations, but less studied in minority, urban communities. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. High blood pressure (BP), or hypertension, is a common, long-term health condition, particularly among older adults. How do different devices for SMBP monitoring compare with each other (specifically semiautomatic or automatic versus manual) in their effects on clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence)? Bookshelf 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. Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care, Agency for Healthcare Research and Quality (US). These types of minimally intensive approaches are important to test in all populations, especially those experiencing related health disparities, for broad implementation with . Collaborative Care Models for Improving Hypertension Control Through SMBP Monitoring 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. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. 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. Addressing Barriers Beyond the Published Literature, Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association, An Opportunity to Better Address Hypertension in Women: Self-Measured Blood Pressure Monitoring, Agency for Healthcare Research and Quality (AHRQ) Self-Measured Blood Pressure Monitoring: Comparative Effectiveness, U.S. Preventive Services Task Force (USPSTF) Final Recommendation Statement: Hypertension in Adults: Screening, Division for Heart Disease and Stroke Prevention, Live to the Beat Campaign Partner Toolkit. Where can I get my blood pressure checked? 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. Patient-provider feedback loop.Source:Centers for Disease Control and Prevention. Read the full Million Hearts Hypertension Control Change Package. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. government site. John M Eisenberg Center for Clinical Decisions and Communications Science. SMBP = self-measured BP; KQ = Key Question. Allison Goldstein, MPH, This article outlines high-level SMBP barriers that federal/national partners have encountered and offers potential solutions to achieve widespread SMBP implementation. 8600 Rockville Pike Untreated or ineffectively treated hypertension leads to increased cardiovascular . Comparative Effectiveness Review No. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. MeSH MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. Rockville, MD 20857 This may facilitate direct communication with a provider via phone call or email and result in shorter turn-around times in responding to a BP reading and thus ultimately to better BP control. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. For appropriate diagnosis and therapy, accurate BP measurement is of great importance. 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. https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure/research. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness This site provides a list of clinically validated blood pressure devices, based on the American Medical Associations (AMA) established criteria to independently validate clinical accuracy. In response, providers offer customized support and advice, such as medication or lifestyle adjustments. You've successfully added to your alerts. Why do I need to measure my blood pressure? Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task Force [Internet]. 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 Use this tool to keep track of your blood pressure measurements at home. Data Sources: 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. PDF Self-measured BP monitoring - American Medical Association Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Dec. Report No. Federal government websites often end in .gov or .mil. Taking Control of My Blood Pressure: DAngelos Story J Athl Train. PDF CER 45 Self-Measured Blood Pressure Monitoring Comparative In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. This patient-friendly video from the Release the Pressure Coalition highlights the key steps people can take for accurate SMBP monitoring. In brief, ambulatory BP monitoring is a noninvasive, fully automated technique in which BP is recorded over an extended period of time, typically 24 hours. Readings by a person can be affected by observer training, preference, and bias. 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. Future research should standardize patient inclusion criteria, BP treatment targets for home BP, and SMBP and additional support protocols to maximize the interpretability and applicability of SMBP trials. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness Effective Health Care Program . 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. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. No studies evaluated children. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. The .gov means its official. : 14-05198-EF-1. 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. I am Allison Goldstein from the Division for Heart Disease and Stroke Prevention at CDC. Sit with your back straight and supported (on a dining chair, rather than a sofa). 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.