self measured blood pressure monitoring: comparative effectiveness

Strategies aimed at the control of high BP as well as adherence to medication continue to be of foremost concern to providers and patients, health care payers, policymakers, and governments worldwide. Technically, SMBP monitoring refers to regular measurement by the patient of his or her own BP. ECG Challenge: What's Causing This Woman's Slow Pulse? 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. You can review and change the way we collect information below. Bookshelf Topline Findings: A National Analysis of Self-Measured Blood Pressure Monitoring Coverage and Reimbursement [PDF 1.7 MB] Sit with your back straight and supported (on a dining chair, rather than a sofa). MeSH Europe PMC is an archive of life sciences journal literature. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. For SMBP alone versus usual care, the strength of evidence is moderate and supports a lower BP with SMBP (SBP/DBP -3.1/-2.0 mmHg at 6 months). 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. These include ambulatory BP monitoring (ABPM), self monitoring (or self measurement or home based) BP which is usually done by the patient at home, at work, or in any conducive environment. Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. Federal government websites often end in .gov or .mil. This site needs JavaScript to work properly. This patient-friendly video from NACHC outlines clear instructions for using home blood pressure monitors. This 2012 AHRQ review examined the comparative effectiveness of SMBP alone, of SMBP plus additional clinical support, and of usual care. Using SMBP to guide you in diagnosing and treating hypertension likely will produce better outcomes than using office blood pressure readings alone. John M Eisenberg Center for Clinical Decisions and Communications Science. Agency for Healthcare Research and Quality, Rockville, MD. 0 Providers can help with SMBP implementation by promoting SMBP to their hypertensive patients and establishing clinical feedback systems. To review the role of self-measured blood pressure (SMBP) monitoring with or without additional support (interventions such as telemonitoring, counseling, education, Web support, behavioral interventions, home visits, etc.) The bold lines correspond to the comparisons covered in this report: SMBP versus usual care (Key Question 1, part 1); SMBP plus additional support versus support without SMBP (also Key Question 1, part 1); SMBP plus additional support versus usual care (Key Question 1, part 2); SMBP plus additional support versus SMBP (Key Question 2). One study estimated that the global prevalence of hypertension in 2000 was 26 percent in the adult population. 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 with or without additional support may confer a small benefit in BP control compared with usual care, but the BP effect beyond 12 months and the attendant long-term clinical consequences remain unclear. As self-measurement requires patient participation, certain patient characteristics may affect compliance with SMBP monitoring, such as the willingness and ability to self-monitor BP and the technical literacy in operating the device or an interface for telemonitoring. These types of minimally intensive approaches are important to test in all populations, especially those experiencing related health disparities, for broad implementation with . SMBP means you regularly use a personal blood pressure measurement device away from a doctors office or hospitalusually at home. 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. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. 293 0 obj <> endobj January 2012 As they were scoping their work for SMBP, they started by searching multiple databases in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence predictors of SMBP monitoring. sharing sensitive information, make sure youre on a federal The Community Preventive Services Task Force (CPSTF) Recommendations on Self-Measured Blood Pressure Monitoring Interventions 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. Thank you. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers. (Prepared by the Tufts Evidence-based Practice Center under Contract No. Several national and international hypertension guidelines endorse self-measured BP monitoring. This patient-friendly video from the Release the Pressure Coalition highlights the key steps people can take for accurate SMBP monitoring. Take this form with you to your doctors office to record important blood pressure-related information. Self-measured blood pressure monitoring (SMBP), the regular measurement of blood pressure by a patient outside the clinical setting, plus additional support, is a proven, cost-effective but underutilized strategy to improve hypertension outcomes. Cookies used to make website functionality more relevant to you. An official website of the Department of Health & Human Services. In that role, she provides scientific expertise to support research translation related to Million Hearts priority strategies. Hypertension often requires lifelong treatment. The present Comparative Effectiveness Review (CER) evaluates the effects of self-measured blood pressure (SMBP) monitoring in hypertensive patients. In response, providers offer customized support and advice, such as medication or lifestyle adjustments. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Numerous health professional and government organizations have developed various guidelines for BP management. SMBP monitoring is the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere. : 13-05194-EF-1. This document provides action steps for public health practitioners to facilitate the implementation of SMBP monitoring plus additional support in five key areas: Understanding the environment; Working with payers and purchasers; Working with health care providers; Spreading the word to the public; and Monitoring/assessment of SMBP, plus additional support implementation. National Library of Medicine An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. The trials were greatly heterogeneous, varying in population, intervention, and outcome measures and definitions. Progestogens for Prevention of Preterm Birth. Take this form [PDF 105 KB]with you on your first blood pressure visit to record important blood pressure-related information. This easy-to-read graphic from CDC shows patients the correct way to measure blood pressure and can be shared on your social channels and patient websites. official website and that any information you provide is encrypted 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. Patients may require some instruction on how to use SMBP devices.30,31. For SMBP alone versus usual care, the strength of evidence is moderate and supports a lower BP with SMBP (SBP/DBP -3.1/-2.0 mmHg at 6 months). Document author(s)/institution of origin: Effective Health Care Program, Agency for Healthcare Research and . European Associations Review Dietary Therapies for Obesity, AHA Statement Ranks 10 Popular Diets for Heart Health. There is no consensus on the precise protocol for SMBP monitoring in the management of hypertension regarding timing, frequency and duration. These cookies may also be used for advertising purposes by these third parties. 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. 2012 Sep 21. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. To sign up for updates or to access your subscriberpreferences, please enter your contact information below. Centers for Disease Control and Prevention. Resources for Public Health Professionals, Improving Medication Adherence Among Patients with Hypertension, Hypertension Control Challenge Rules and Eligibility, Hypertension Control Champions Success Stories, Hospitals & Health Systems Recognition Program, Spotlight: NYC Health + Hospitals/Metropolitan, Spotlight: The Ohio State University and Wexner Medical Center, Spotlight: New Hanover Regional Medical Center, COVID-19 and Cardiovascular Disease Partner Toolkit, Heart-Healthy Steps Campaign Partner Toolkit, "Live to the Beat" Campaign Partner Toolkit, Self-Measured Blood Pressure (SMBP) Monitoring Implementation Toolkit [PDF - 2 MB], U.S. These blood pressure monitors are easy and safe to use. 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. Rockville, MD 20857 SMBP with or without additional support may confer a small benefit in BP control compared with usual care, but the BP effect beyond 12 months and the attendant long-term clinical consequences remain unclear. Please enable it to take advantage of the complete set of features! In studies of SMBP monitoring, how does achieving BP control relate to clinical and surrogate outcomes? 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. Comparative Effectiveness of Diagnosis and Treatment of Obstructive Sleep Apnea in Adults. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners. The figure shows a schematic of possible comparisons between SMBP, SMBP plus additional, support without SMBP, and usual care. 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. 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. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. Ann Intern Med. I am Allison Goldstein from the Division for Heart Disease and Stroke Prevention at CDC. 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. An official website of the United States government. In addition, SMBP may carry the risk of unreliable BP readings if not obtained in a standard fashion, inappropriate self adjustments of antihypertensive medications, as well as increased anxiety in susceptible patients. Ann Intern Med. 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 in the management of hypertension: a systematic review and meta-analysis. High blood pressure (BP), or hypertension, is a common, long-term health condition, particularly among older adults. The gauge uses a unit of measurement called millimeters of mercury (mmHg) to measure the pressure in your blood vessels. Agency for Healthcare Research and Quality (AHRQ) Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [PDF 1.2 MB] Further debate focuses on the role of additional support needed to enhance adherence with SMBP monitoring and, possibly, achieve the clinical benefit from it. A 2012 comparative-effectiveness review by the Agency for Healthcare Research and Quality found strong evidence that SMBP plus clinical support was . 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. 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. government site. 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. How can I measure my blood pressure at home? This video from NACHC features DAngelo, a patient who explains how he has taken control of his blood pressure with the help of SMBP monitoring. Clinic measurements may not reflect the usual BP outside of the clinic setting throughout a day. This website requires cookies, and the limited processing of your personal data in order to function. 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 clinic26, SMBP is being used to avoid undertreatment of hypertension. Talk with your health care team about how often you should have your blood pressure measured or when to measure it yourself. 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. This 2021 recommendation from the USPSTF includes additional guidance for obtaining blood pressure measurements away from the clinical setting. 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. https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure/research. To determine predictors of adherence with SMBP monitoring. endstream endobj startxref Why do I need to measure my blood pressure? To determine predictors of adherence with SMBP monitoring. A health care team member can show you how to use one if you need help. Resource title: Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension. This report can help policymakers learn more about which payers have programs that cover and reimburse for SMBP monitoring. Purpose: To systematically review the trial evidence on the comparative effectiveness of hypertension management with versus without SMBP monitoring, and of different additional support interventions with SMBP. We also included longitudinal cohort studies in addressing adherence predictors. 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 Uhlig K, Balk EM, Patel K, Ip S, Kitsios GD, Obadan NO, et al. SMBP differs from clinic-based and ambulatory blood . Read the full Million Hearts Hypertension Control Change Package. Archived: This report is greater than 3 years old. How to Use Your Home Blood Pressure Monitor 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. To review the role of self-measured blood pressure (SMBP) monitoring with or without additional support (interventions such as telemonitoring, counseling, education, Web support, behavioral interventions, home visits, etc.) Obtaining Adequate Fixation in a Periprosthetic Humerus Fracture Around a Shoulder Arthroplasty Stem in 81-Year-Old Man, ECG Challenge: Irregular Pulse During Cardiology Visit. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. For the purpose of this report, BP measurement by the patient in the office/clinic/pharmacy or a health unit at work is not included under SMBP monitoring since it does not reliably overcome the problem of white coat hypertension nor provide the privacy and opportunity for more frequent measurements of home self measurement. 45. 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. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. For appropriate diagnosis and therapy, accurate BP measurement is of great importance. Apr 11, 2011. Many studies were of moderate to poor quality and had short followup periods. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. Measurements may interfere with a patient's activity or sleep. Details on design, patients, interventions, outcomes, and quality were extracted into standard forms. Bethesda, MD 20894, Web Policies Patient-provider feedback loop with clinical support for SMBP monitoring. Thank you for taking the time to confirm your preferences. Readings by a person can be affected by observer training, preference, and bias. 8. HHSA 290-2007-10055-I.) Where can I get my blood pressure checked? [1] SMBP monitoring plus clinical support has been found to be effective in helping patients control their blood pressure.[2]. Updated Hypertension Guidelines: Implications for Treatment? Purpose A BP cuff is placed around the upper arm and left in place for approximately 24 hours. Very few trials evaluated objective clinical outcomes. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Comparative Effectiveness Review Number 45 Self-Measured Blood Pressure Monitoring: Comparative Effectiveness Executive Summary Background High blood pressure (BP), or hypertension, is a common, long-term health condition, particularly among older adults. Figure 1 shows possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care. An Opportunity to Better Address Hypertension in Women: Self-Measured Blood Pressure Monitoring This 2020 joint policy statement from the American Heart Association (AHA) and the AMA addresses barriers to implementing SMBP monitoring. Page originally created December 2020. For SMBP plus additional support versus usual care, the strength of evidence is high and supports a lower BP with SMBP use (SBP/DBP -3.4 to -8.9/-1.9 to -4.4 mmHg) up to 12 months. They help us to know which pages are the most and least popular and see how visitors move around the site. 5600 Fishers Lane To determine predictors of adherence with SMBP monitoring. Source:Centers for Disease Control and Prevention. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Self-measured BP monitoring, the measurement of BP by an individual outside of the office at home, is a validated approach for out-of-office BP measurement. PMC Many SMBP devices are commercially available. 8600 Rockville Pike Details on design, patients, interventions, outcomes, and quality were extracted into standard forms. No studies evaluated children. Empty your bladder and ensure at least 5 minutes of quiet rest before measurements. To accelerate SMBP use, the Centers for Disease Control and Prevention (CDC) funded the National . Allison Goldstein, MPH, Figure 2. 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. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners. Past forum recordings, slides, and other resources can be found on the SMBP ForumConfluence page. Bookshelf Murakami L, Rakotz M. Improving health outcomes: Blood pressure. 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. To summarize evidence about the effectiveness of self-measured blood pressure (SMBP) monitoring in adults with hypertension. https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure. i` V04s7.w`t32Cc( L4M\ES}*vWe+= 4a)\5O)si8hQ[^}.L01>#t7On,c7g K>=}NrMo4;Zj:97MgN1m#6+U6i All information these cookies collect is aggregated and therefore anonymous. Choosing-a-Home-BP-Monitor At-a-Glance-Comparison [PDF 446 KB] Please enable it to take advantage of the complete set of features! Many have undergone validation according to the recommendations of the American Association of Medical Instrumentation, the European Society of Hypertension or the British Hypertension Society.25,29 Generally, the use of validated devices is preferred. 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. This video summarizes results from Accelerating Use of Self-measured Blood Pressure Monitoring (SMBP) Through Clinical-Community Care Models article, which discusses a pilot project in nine community health centers across three states to increase the use of SMBP using a collaborative model with health centers, community organizations, and health departments. Take at least two readings, 1 or 2 minutes apart. Hypertension often requires lifelong treatment. To systematically review the trial evidence on the comparative effectiveness of hypertension management with versus without SMBP monitoring, and of different additional support interventions with SMBP. Telephone: (301) 427-1364, Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension, https://www.ahrq.gov/evidencenow/heart-health/blood-pressure/smbp-effectiveness.html, AHRQ Publishing and Communications Guidelines, Evidence-based Practice Center (EPC) Reports, Healthcare Cost and Utilization Project (HCUP), AHRQ Quality Indicator Tools for Data Analytics, United States Health Information Knowledgebase (USHIK), AHRQ Informed Consent & Authorization Toolkit for Minimal Risk Research, Grant Application, Review & Award Process, Study Sections for Scientific Peer Review, Getting Recognition for Your AHRQ-Funded Study, AHRQ Research Summit on Diagnostic Safety, AHRQ Research Summit on Learning Health Systems, National Action Alliance To Advance Patient Safety, Blood Pressure Control Evidence and Resources, Cholesterol Management Evidence and Resources, Advancing Heart Health Research and Results, U.S. Department of Health & Human Services. in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence 343 0 obj <>stream Learn the correct way to have your blood pressure taken, whether youre getting it checked at the doctors office or checking it yourself at home. First, a health care professional wraps an inflatable cuff around your arm.

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