Primary care physician beliefs regarding usefulness of self-monitoring of blood pressure

Cheng, Cynthia; Studdiford, James; Diamond, James J.; Chambers, Christopher V.

doi:10.1097/00126097-200312000-00005

Cited by 31 publications

(26 citation statements)

References 14 publications

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“…A major reason for the failure of physicians to fully endorse the use of home BP monitoring is the possibility of adverse behavioral effects associated with its use. [21][22][23] Finally, despite reminder messages, there was a decline over time in the number of BP readings per week in the self-care support group, suggesting a fatigue effect with this intervention. The finding highlights the need for changes in or additions to the current system to counter this negative trend.…”

Section: Perspectivesmentioning

confidence: 87%

“…Even more disturbingly, Ϸ40% of those with alarming readings did nothing specific about the results. 21 These findings suggest that the use of home BP monitoring in ongoing clinical management of hypertension is still not well accepted by physicians and that home BP monitoring without linkage to an effective support system does not provide any direct benefits for patients.…”

Section: Discussionmentioning

confidence: 98%

“…In a survey conducted several years ago, American physicians indicated their reluctance to use home BP monitoring results as the primary means of making management decisions. 21 In Ontario, only 19% of physicians preferred home BP monitoring to office or ambulatory readings to guide treatment decisions. 22 In France, only 36% of general practitioners who encouraged their patients to do home BP monitoring actually used the readings to adjust antihypertensive treatment.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Home Blood Pressure Telemonitoring With Self-Care Support on Uncontrolled Systolic Hypertension in Diabetics

et al. 2012

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Abstract-Lowering blood pressure reduces cardiovascular risk, yet hypertension is poorly controlled in diabetic patients.In a pilot study we demonstrated that a home blood pressure telemonitoring system, which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading, improved blood pressure control. Messages were based on care paths defined by running averages of transmitted readings. The present study tests the system's effectiveness in a randomized, controlled trial in diabetic patients with uncontrolled systolic hypertension. Of 244 subjects screened for eligibility, 110 (45%) were randomly allocated to the intervention (nϭ55) or control (nϭ55) group, and 105 (95.5%) completed the 1-year outcome visit. In the intention-to-treat analysis, mean daytime ambulatory systolic blood pressure, the primary end point, decreased significantly only in the intervention group by 9.1Ϯ15.6 mmHg (SD; PϽ0.0001), and the mean between-group difference was 7.1Ϯ2.3 mmHg (SE; PϽ0.005). Furthermore, 51% of intervention subjects achieved the guideline recommended target of Ͻ130/80 mmHg compared with 31% of control subjects (PϽ0.05). These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians. Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale (baseline, 4.1Ϯ3.76; exit, 5.2Ϯ4.30; Pϭ0.014). This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension and improved hypertension control. Home blood pressure monitoring alone had no effect on blood pressure. 3 Such results spurred development of chronic care models that engage patients in their own care. 4 Home BP monitoring promotes self-care, improves BP control, and is endorsed by several prominent organizations as an adjunct to hypertension treatment. 5 A recent meta-analysis suggested that adding telemonitoring to self-measurement of BP is even more effective in reducing BP. 6 In the telemonitoring studies, however, a physician or member of the healthcare team reviewed the transmitted data and contacted the patients to adjust antihypertensive treatment.7-13 Thus, it is unclear whether the better outcome was related to the use of a telemonitoring system or the increased involvement of healthcare providers in the treatment process.Previously we reported the development of a home BP telemonitoring system that provided self-care messages on the smartphone of patients immediately after each reading. A.G.L. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. None of the other authors has real or perceived conflicts of interest related to the study.This trial has been registered at www.clinicaltrials.gov (identifier NCT00717665 eliminate the need for a health provider to re...

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Section: Perspectivesmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Effect of Home Blood Pressure Telemonitoring With Self-Care Support on Uncontrolled Systolic Hypertension in Diabetics

et al. 2012

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mentioning

confidence: 99%

“…At present, in developed countries Ϸ70% of hypertensive patients regularly assess their BP at home, 26,27 and the clinical usefulness of this approach is generally acknowledged by physicians. 28,29 Such a rapidly growing diffusion of HBPM in clinical practice has inevitably raised the question of whether HBPM and ABPM should be considered as alternative methods to obtain the same information or whether instead they represent sources of complementary data. In the former case, the use of ABPM, this approach being a more expensive and more difficult technique, could hardly be justified.…”

mentioning

confidence: 99%

Why Is Out-of-Office Blood Pressure Measurement Needed?

Parati

Omboni²,

Bilo

2009

Hypertension

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O ver the last decades, 2 main techniques for measuring blood pressure (BP) out of the physician's office have gained increasing importance in the clinical approach to arterial hypertension, both being supported by recent international hypertension management guidelines. 1,2 These techniques are home BP monitoring (HBPM) and 24-hour ambulatory BP monitoring (ABPM). Their diffusion in clinical practice has been favored by a number of factors, including on one side technical progress and wider availability of accurate HBPM and ABPM devices and on the other side the increasing awareness of the limitations of office BP (Table 1). 3,4 Office BP is in fact characterized by a random error affecting casual BP readings and by a systematic error related to the patient's alerting reaction to the measurement procedure and setting, known as "white coat effect." 1,3 Both ABPM and HBPM are devoid of these limitations and, thus, provide more stable and reproducible information on BP values, 5 which is also of greater prognostic relevance 6 -21 (Table 2). Furthermore, office BP readings are unable to collect information on BP during a subject's usual activities and over a long period of time, 22 an important limitation in everyday management of hypertensive subjects that can be overcome by out-of-office BP monitoring.ABPM was initially confined to specialized hypertension centers because of its relatively high cost, but over the years its availability has steadily increased. HBPM, on the other hand, has been used rather reluctantly by physicians in routine management of hypertensive patients. Although its potential usefulness in clinical practice was acknowledged many years ago, 23 its application has been limited until the end of last century by the need to use auscultatory measurements, an approach that is difficult to apply correctly, 24 particularly in the home setting, and prone to providing inaccurate information, especially when using aneroid devices. 25 A major breakthrough came with the introduction of inexpensive, easy-to-use, and accurate automated oscillometric BP measuring devices, leading to a widespread use of HBPM. At present, in developed countries Ϸ70% of hypertensive patients regularly assess their BP at home, 26,27 and the clinical usefulness of this approach is generally acknowledged by physicians. 28,29 Such a rapidly growing diffusion of HBPM in clinical practice has inevitably raised the question of whether HBPM

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Home Monitoring of Blood Pressure

Pickering¹

2007

Hypertension

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Primary care physician beliefs regarding usefulness of self-monitoring of blood pressure

Cited by 31 publications

References 14 publications

Effect of Home Blood Pressure Telemonitoring With Self-Care Support on Uncontrolled Systolic Hypertension in Diabetics

Effect of Home Blood Pressure Telemonitoring With Self-Care Support on Uncontrolled Systolic Hypertension in Diabetics

Why Is Out-of-Office Blood Pressure Measurement Needed?

Home Monitoring of Blood Pressure

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