Self-Measured Blood Pressure Monitoring in the Management of Hypertension

Uhlig, Katrin; Patel, Kamal; Ip, Stanley; Kitsios, Georgios D.; Balk, Ethan M

doi:10.7326/0003-4819-159-3-201308060-00008

Cited by 336 publications

(282 citation statements)

References 64 publications

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“…6,10,13,18 Use of a home BP monitor was coded as follows: 0 = Bnone,^1 = "less than once per er month,^2 = Ba few times per month,^and 3 = Bonce a week or more.^BP medication class counts were gathered using medication inventories at baseline and follow-up, and ranged from 0 to 6. Self-reported adherence to BP medications was calculated as the sum of four items indicating non-adherence, and could range from 0 (good adherence) to 4 (poor adherence).…”

Section: Methodsmentioning

confidence: 99%

“…[5][6][7][8][9] Home BP monitoring has also been found to be a useful adjunct to team-based care for hypertension. 10 We have reported the main results of a cluster-randomized trial that compared usual care to an intervention combining home BP telemonitoring and pharmacist management. 11 At 6 months of follow-up, 72 % of participants in the intervention group had achieved BP control, compared with 45 % in the usual care group (p<0.001).…”

Section: Introductionmentioning

confidence: 99%

“…A recent meta-analysis found that home BP monitoring interventions with additional support were more effective in lowering BP than monitoring without additional support. 10 It was not possible to measure the effect of the improved feedback loop created by the intervention equally between the two groups, since the usual care group was not intentionally exposed to pharmacist management. In contrast, both groups continued to receive regular care from their primary care clinician and other providers, and the frequency of these contacts did not differ (unpublished data).…”

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confidence: 99%

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A Successful Multifaceted Trial to Improve Hypertension Control in Primary Care: Why Did it Work?

et al. 2015

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BACKGROUND: It is important to understand which components of successful multifaceted interventions are responsible for study outcomes, since some components may be more important contributors to the intervention effect than others. OBJECTIVE: We conducted a mediation analysis to determine which of seven factors had the greatest effect on change in systolic blood pressure (BP) after 6 months in a trial to improve hypertension control. DESIGN: The study was a preplanned secondary analysis of a cluster-randomized clinical trial. Eight clinics in an integrated health system were randomized to provide usual care to their patients (n=222), and eight were randomized to provide a telemonitoring intervention (n=228). PARTICIPANTS: Four hundred three of 450 trial participants completing the 6-month follow-up visit were included. INTERVENTIONS: Intervention group participants received home BP telemonitors and transmitted measurements to pharmacists, who adjusted medications and provided advice to improve adherence to medications and lifestyle modification via telephone visits. MAIN MEASURES: Path analytic models estimated indirect effects of the seven potential mediators of intervention effect (defined as the difference between the intervention and usual care groups in change in systolic BP from baseline to 6 months). The potential mediators were change in home BP monitor use, number of BP medication classes, adherence to BP medications, physical activity, salt intake, alcohol use, and weight. KEY RESULTS: The difference in change in systolic BP was 11.3 mmHg. The multivariable mediation model explained 47 % (5.3 mmHg) of the intervention effect. Nearly all of this was mediated by two factors: an increase in medication treatment intensity (24 %) and increased home BP monitor use (19 %). The other five factors were not significant mediators, although medication adherence and salt intake improved more in the intervention group than in the usual care group. CONCLUSIONS: Most of the explained intervention effect was attributable to the combination of self-monitoring and medication intensification. High adherence at baseline and the relatively low intensity of resources directed toward lifestyle change may explain why these factors did not contribute to the improvement in BP.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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A Successful Multifaceted Trial to Improve Hypertension Control in Primary Care: Why Did it Work?

et al. 2015

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“…[5] The use of HBPM improves hypertension control and associated outcomes. [11][12][13][14] Home BP is predominantly measured with an oscillometric BP monitor which uses an arm cuff. In daily practice, patients use all sorts of different BP monitors of which most devices are not officially validated.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of a New Cuffless Device for Ambulatory Blood Pressure Measurement in Patients With Hypertension: Mixed Methods Study (Preprint)

Ogink¹,

Jong²,

Koeneman³

et al. 2018

Preprint

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“…2 The best evidence for the efficacy of HBPM comes from trials using HBPM in conjunction with additional support, usually nurse-or pharmacist-led follow-up of patients with uncontrolled blood pressure. 8,11 Whether the major impact of these trials came from HBPM, intensive pharmacist-or nurseled follow-up, lifestyle and adherence counseling by pharmacists or nurses, or a combination of these is unclear.…”

mentioning

confidence: 99%

Success in the Achieving CARdiovascular Excellence in Colorado (A CARE) Home Blood Pressure Monitoring Program: A Report from the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP)

DeAlleaume

Parnes

Zittleman

et al. 2015

The Journal of the American Board of Family Medicine

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Background: Blood pressure (BP) control among primary care patients with hypertension is suboptimal. Home BP monitoring (HBPM) has been shown to be effective but is underused.Methods: This study was a quasi-experimental evaluation of the impact of the A CARE HBPM program on hypertension control. Nonpregnant adults with hypertension or cardiovascular disease risk factors were given validated home BP monitors and reported monthly average home BP readings by Internet or phone. Patients and providers received feedback. Change in average home and office BP and the percentage of patients achieving target BP were assessed based on patient HBPM reports and a chart audit of office BPs.Results: A total of 3578 patients were enrolled at 26 urban and rural primary care practices. Of these, 36% of participants submitted >2 HBPM reports. These active participants submitted a mean of 13.5 average HBPM reports, with a mean of 19.3 BP readings per report. The mean difference in home BP between initial and final HBPM reports for active participants was ؊6.5/؊4.4 mmHg (P < .001) and ؊6.7/؊4.7 mmHg (P < .001) for those with diabetes. The percentage of active participants at or below target BP increased from 34.5% to 53.3% (P < .001) and increased 24.6% to 40.0% (P < .001) for those with diabetes. The mean difference in office BP over 1 year between participants and nonparticipants was ؊5.4/؊2.7 mmHg (P < .001 for systolic BP, P ‫؍‬ .01 for diastolic BP) for all participants and ؊8.5/؊1.5 mmHg (P ‫؍‬ .014 for systolic BP, P ‫؍‬ .405 for diastolic BP) for those with diabetes.Conclusions: An HBPM program with patient and provider feedback can be successfully implemented in a range of primary care practices and can play a significant role in BP control and decreased cardiovascular disease risk in patients with hypertension. (J Am Board Fam Med 2015;28:548 -555.)

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Self-Measured Blood Pressure Monitoring in the Management of Hypertension

Abstract: Agency for Healthcare Research and Quality.

Cited by 336 publications

References 64 publications

A Successful Multifaceted Trial to Improve Hypertension Control in Primary Care: Why Did it Work?

A Successful Multifaceted Trial to Improve Hypertension Control in Primary Care: Why Did it Work?

Feasibility of a New Cuffless Device for Ambulatory Blood Pressure Measurement in Patients With Hypertension: Mixed Methods Study (Preprint)

Success in the Achieving CARdiovascular Excellence in Colorado (A CARE) Home Blood Pressure Monitoring Program: A Report from the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP)

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