Integration of Home Blood Pressure Monitoring in Hypertension Management

Abstract

Background: White coat syndrome, masked hypertension, and poor technique may produce inaccurate offi ce-based blood pressure (BP) readings and lead to over diagnosis and over treatment with antihypertensive agents. National and international hypertension guidelines recommend using home BP monitoring in conjunction with offi ce readings for hypertension diagnostic and/or treatment evaluation.Purpose of study: Evaluate the impact of hypertension diagnosis and medication management for patients referred to a home BP monitoring program integrated with clinic based hypertension management. Results / Main fi ndings:Over the fi rst year of the program, 75 patients were referred for either medication management evaluation (n=41) or hypertension diagnosis confi rmation (n=34). For medication management referred patients, roughly half (n=20) had some clinical action taken and roughly half (n=21) had no action taken. Of the 34 patients referred for hypertension diagnosis confi rmation, 23 (68%) had home BP readings averaging less than 135/85 mmHg resulting in no formal diagnosis of hypertension and no medication prescribed. This was particularly pronounced in those patients with an offi ce BP goal of <150/90 mmHg, a relatively older group. Conclusion:This data suggests that integrating home BP monitoring with offi ce-based hypertension management is clinically important and may have substantial impact in the accuracy of diagnosis and the appropriateness of medication use. Brief summary:Patients with uncontrolled hypertension despite medication therapy or having elevated blood pressure readings in clinic without a diagnosis of hypertension were referred to the clinic's home BP monitor loaner program facilitated by a clinical pharmacist. For a period of at least 5 days, patients recorded 3 consecutive BP readings in the morning and in the evening. At a scheduled follow-up offi ce visit with the clinical pharmacist, the patient returned the monitor with the completed log sheet. The clinical pharmacist facilitated standardized documentation for effi cient evaluation.Potential implications: Facilitating a structured home BP monitoring program for patients with uncontrolled hypertension despite medication therapy or for establishing the diagnosis of hypertension can provide a clinician an accurate and comprehensive view of overall BP control to avoid over-treatment, under-treatment, and misdiagnosis while individualizing patients' therapy

Clinical Implementation of Self-Measured Blood Pressure Monitoring, 2015–2016

“…One emerging strategy is for insurance companies to provide incentives to initiate loaner programs. 23,35 A solution with a broad potential reach could be insurance coverage of devices, as recommended in the 2008 Call to Action. 14 In addition to societal cost effectiveness, 6 from a payer perspective, coverage of SMBP may be cost saving.…”