Home blood pressure measurement for hypertension management in the real world: Do not just measure, but share with your physician

Abstract

IntroductionStudies of the effectiveness of home blood pressure (BP) measurement on the treatment of hypertension in the real world are sparse, and the results are controversial. There is an efficacy-effectiveness gap in the treatment of hypertension using home BP measurements. We aimed to investigate the effect of reporting home BP to physicians on ambulatory BP control as a factor contributing to the efficacy-effectiveness gap in treating patients with hypertension.MethodsWe recruited patients ≥20 years of age taking antihypertensive drugs. Office and 24-h ambulatory BP were measured. A questionnaire to the measurement of home BP was conducted. Participants were divided into an HBPM(−) group, home BP was not measured (n = 467); HBPM(+)-R(−) group, home BP was measured but not reported (n = 81); and HBPM(+)-R(+) group, home BP was measured and reported (n = 125).ResultsThe HBPM(+)-R(+) group had significantly lower office systolic BP (SBP, p = 0.035), 24-h SBP (p = 0.009), and daytime SBP (p = 0.016) than the HBPM(−) group, and lower nighttime SBP (p = 0.005) and diastolic BP (DBP, p = 0.008) than the HBPM(+)-R(−) group. In the multivariate analysis, the differences in 24-h SBP, daytime SBP, and nighttime DBP remained significant. There was a significant difference between groups in the target achievement rate of 24-h SBP (p = 0.046), nighttime SBP (p = 0.021), and nighttime DBP (p = 0.023). The nighttime SBP and DBP target achievement rates in the HBPM(+)-R(+) group were higher than those in the HBPM(+)-R(−) group (p = 0.006 and 0.010, respectively). Among patients measuring home BP, the adjusted odds ratio for 24-h and nighttime BP target achievement in the HBPM(+)-R(+) group were 2.233 and 3.658, respectively.ConclusionHome BP measurements should be reported to the treating physician to effectively manage hypertension.Clinical trial registrationhttps://clinicaltrials.gov, identifier NCT03868384.

Status of home blood pressure measurement in treated hypertensive patients. Results of a survey from two cities in Korea

“…Although recommending the purchase of devices does not necessarily imply recommending measurement, the low recommendation rate for device purchase in this survey is presumed to reflect a possibly low rate of recommendation for home BP measurement as well. Moreover, we reported the low rate of patients reporting measured home BP to their physicians and the importance of reporting measured home BPs to physicians for controlling ambulatory BP 10 . This emphasize the need to encourage physicians to actively recommend and incorporate home BP measurement into hypertension treatment, while also urging patients to report their home BP readings to their treating physicians.…”

“…However, previous studies have shown that many patients do not properly perform home BP measurements and report the measured home BPs to their physicians, as recommended by practice guidelines 12,13 . Additionally, physicians’ recommendations and training were important for proper home BP measurements 10,12,13 . In Korea, no studies have investigated the status of the possession of home BP monitoring devices and whether patients properly measure home BP.…”

“…We recruited 701 participants between August 2018 and April 2020. The primary objectives and study protocol are described in detail elsewhere 10 . We recruited research participants via advertisements in Goyang‐si and Paju‐si, Gyeonggi Province, South Korea.…”

“…10 In the previous study, individuals who had been measuring their home BP for less than six months before the survey date were considered not to measure their home BP because we assumed that a measurement period of less than six months from the survey date would not have a sufficient effect on the home BP-based hypertension treatment. 10 In this study, those who answered that they measured home BP were considered as individuals who measured BP at home, irrespective of when home BP measurement was started.…”

Investigating the Sources of Variability in Blood Pressure Monitoring Systems

“…A 5 mm Hg BP measurement error may increase incorrect hypertension classification in approximately 100 million patients worldwide, according to a consensus document published in the Journal of Hypertension [3]. Understanding how BP measurement goes wrong and how to tackle it can improve the diagnosis and management of hypertension [4,5].…”