Influence of ethnicity on acceptability of method of blood pressure monitoring: a cross-sectional study in primary care

Abstract

BackgroundAmbulatory and/or home monitoring are recommended in the UK and the US for the diagnosis of hypertension but little is known about their acceptability.AimTo determine the acceptability of different methods of measuring blood pressure to people from different minority ethnic groups.Design and settingCross-sectional study with focus groups in primary care in the West Midlands.MethodPeople of different ethnicities with and without hypertension were assessed for acceptability of clinic, home, and ambulatory blood pressure measurement using completion rate, questionnaire, and focus groups.ResultsA total of 770 participants were included, who were white British (n = 300), South Asian (n = 241), and African Caribbean (n = 229). White British participants had significantly higher successful completion rates across all monitoring modalities compared with the other ethnic groups, especially for ambulatory monitoring: white British (n = 277, 92% [95% confidence interval [CI] = 89% to 95%]) versus South Asian (n = 171, 71% [95% CI = 65% to 76%], P<0.001) and African Caribbean (n = 188, 82% [95% CI = 77% to 87%], P<0.001), respectively. There were significantly lower acceptability scores for minority ethnic participants across all monitoring methods compared with white British participants. Focus group results highlighted self-monitoring as most acceptable and ambulatory monitoring least acceptable without consistent differences by ethnicity. Clinic monitoring was seen as inconvenient and anxiety provoking but with the advantage of immediate professional input.ConclusionReduced acceptability and completion rates among minority ethnic groups raise important questions for the implementation and interpretation of blood pressure monitoring. Selection of method of blood pressure monitoring should take into account clinical need, patient preference, and potential cultural barriers to monitoring.

Implementing self-management: a mixed-methods study of women’s experiences of a postpartum hypertension intervention

“…In contrast to the fairly consistent views of self-management, women's experiences of doctor-and midwife-led care were more variable, perhaps reflecting the paucity of clinical guidance and evidence that currently underpins postpartum hypertension management (16,17). Some participants reported Themes emerging from previous qualitative work evaluating BP self-management were echoed by this study: confidence with HBPM (9) and preference for self-monitoring (10,18,19). Patients have previously reported HBPM to be more straightforward, time efficient and potentially more accurate in terms of representing their true BP (19).…”

“…Some participants reported Themes emerging from previous qualitative work evaluating BP self-management were echoed by this study: confidence with HBPM (9) and preference for self-monitoring (10,18,19). Patients have previously reported HBPM to be more straightforward, time efficient and potentially more accurate in terms of representing their true BP (19). Participants in this cohort reported a higher level of confidence when down-titrating medication than has been reported in relation to up-titration of antihypertensive medications, in poorly controlled essential hypertension (9,20).…”

Implementing self-management: a mixed-methods study of women’s experiences of a postpartum hypertension intervention (SNAP-HT)

“…Themes emerging from previous qualitative work evaluating BP self-management were echoed by this study: confidence with HBPM (9) and preference for self-monitoring (10,18,19). Patients have previously reported HBPM to be more straightforward, time efficient and potentially more accurate in terms of representing their true BP (19).…”

Home blood pressure monitoring in the 21st century

“…Outcome studies have demonstrated that on‐treatment HBPM has superior prognostic value than OBP . Advantages of using HBPM are: (1) in treated patients, the phenomena of white‐coat effect and masked uncontrolled hypertension are as common as white‐coat and masked hypertension in untreated patients and can be identified by HBPM or ABPM; (2) HBPM is widely available in many countries and is inexpensive (in fact, patients have decided to cover the cost of the technique themselves); (3) most patients prefer HBPM rather than ABPM for out‐of‐office BP evaluation, particularly for repeated long‐term use, because it causes less discomfort and restriction of daily activities and sleep and (4) this method motivates patients by increasing their awareness and getting them actively involved in their BP monitoring and long‐term control. Several randomized controlled trials have shown that patients with treated hypertension who perform HBPM have improved hypertension control rates, which are caused by improved long‐term adherence to drug therapy .…”