Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring

Abstract

Abstract-Home blood pressure monitoring (HBPM) overcomes many of the limitations of traditional office blood pressure (BP) measurement and is both cheaper and easier to perform than ambulatory BP monitoring. Monitors that use the oscillometric method are currently available that are accurate, reliable, easy to use, and relatively inexpensive. An increasing number of patients are using them regularly to check their BP at home, but although this has been endorsed by national and international guidelines, detailed recommendations for their use have been lacking. There is a rapidly growing literature showing that measurements taken by patients at home are often lower than readings taken in the office and closer to the average BP recorded by 24-hour ambulatory monitors, which is the BP that best predicts cardiovascular risk. Because of the larger numbers of readings that can be taken by HBPM than in the office and the elimination of the white-coat effect (the increase of BP during an office visit), home readings are more reproducible than office readings and show better correlations with measures of target organ damage. In addition, prospective studies that have used multiple home readings to express the true BP have found that home BP predicts risk better than office BP (Class IIa; Level of Evidence A). This call-to-action article makes the following recommendations: (1) It is recommended that HBPM should become a routine component of BP measurement in the majority of patients with known or suspected hypertension; (2) Patients should be advised to purchase oscillometric monitors that measure BP on the upper arm with an appropriate cuff size and that have been shown to be accurate according to standard international protocols. They should be shown how to use them by their healthcare providers; (3) Two to 3 readings should be taken while the subject is resting in the seated position, both in the morning and at night, over a period of 1 week. A total of Ն12 readings are recommended for making clinical decisions; (4) HBPM is indicated in patients with newly diagnosed or suspected hypertension, in whom it may distinguish between white-coat and sustained hypertension. If the results are equivocal, ambulatory BP monitoring may help to establish the diagnosis; (5) In patients with prehypertension, HBPM may be useful for detecting masked hypertension; (6) HBPM is recommended for evaluating the response to any type of antihypertensive treatment and may improve adherence; (7) The target HBPM goal for treatment is Ͻ135/85 mm Hg or Ͻ130/80 mm Hg in high-risk patients; (8) HBPM is useful in the elderly, in whom both BP variability and the white-coat effect are increased; (9) HBPM is of value in patients with diabetes, in whom tight BP control is of paramount importance; (10) Other populations in whom HBPM may be beneficial include pregnant women, children, and patients with kidney disease; and (11) HBPM has the potential to improve the quality of care while reducing costs and should be reimbursed. (Hypertension. 2008;52:10-29.)

Use of home sphygmomanometers in Turkey: a nation-wide survey

“…14 Cuspidi et al 15 conducted a multicenter survey in Italy and found that 640 (75%) of 855 hypertensive patients had been regularly performing home BP measurements. Almost all hypertensive patients in the United States and Japan have a home sphygmomanometer 4,16,17 and 90-95% of the physicians recommend HBPM in Japan. 17 Because of lower income level and educational status, the lower rate of ownership of home sphygmomanometers in Turkey, a developing country, compared with developed countries, was not surprising.…”

“…Incorrect recording of readings and inappropriate cuff size are two factors affecting the reliability of HBPM. 4 The feature of memory associated with the devices is quite useful and therefore is recommended. [2][3][4] Bringing the device to the physician, when visiting, serves to reduce problems due to inaccurate recording of readings and increases the reliability of HBPM, but only a limited number of patients were performing this, according to our survey.…”

“…4 The feature of memory associated with the devices is quite useful and therefore is recommended. [2][3][4] Bringing the device to the physician, when visiting, serves to reduce problems due to inaccurate recording of readings and increases the reliability of HBPM, but only a limited number of patients were performing this, according to our survey. As increased prevalence of obesity leads to a larger mean arm circumference in the hypertensive population, 25 and as appropriate cuff size is essential for accurate measurement of BP, 2-4 overweight and obese patients often require sphygmomanometers with large-or extra-large-sized cuffs.…”

“…Despite common ownership of a home sphygmomanometer, daily practice of HBPM in Turkey was far from the recommendations of the current guidelines. [2][3][4]18 In spite of common ownership of a home sphygmomanometer, the regular measurement of BP by a small group of patients, before visits with their physicians, indicated ineffective BP measurement at home. We suspect that the main findings of the current study, namely, the lack of training by health-care professionals and the dominance of wrist devices, would also be found in other developing and underdeveloped countries.…”

“…In 2008, two guidelines specifically focusing on the clinical application of HBPM were published by the European Society of Hypertension, 2 in which its practice version was summarized recently, 3 and by the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. 4 A recent systematic review found HBPM to be superior to office measurements in diagnosing uncontrolled hypertension, assessing anti-hypertensive drug efficiency, and improving patients' compliance and hypertension control. 5 Moreover, preliminary evidence suggests that HBPM is cost effective.…”