PURLs

Monitoring Home BP Readings Just Got Easier

Clinician Reviews. 2016 November;26(11):24,26-27

References

1. Sharman JE, Blizzard L, Kosmala W, et al. Pragmatic method using blood pressure diaries to assess blood pressure control. Ann Fam Med. 2016;14:63-69.
2. Sebo P, Pechère-Bertschi A, Herrmann FR, et al. Blood pressure measurements are unreliable to diagnose hypertension in primary care. J Hypertens. 2014;32:509-517.
3. Siu AL; US Preventive Services Task Force. Screening for high blood pressure in adults: US Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2015;163:778-786.
4. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA. 2003;289:2560-2572.
5. Mallion JM, de Gaudemaris R, Baguet JP, et al. Acceptability and tolerance of ambulatory blood pressure measurement in the hypertensive patient. Blood Press Monit. 1996; 1:197-203.
6. Gaborieau V, Delarche N, Gosse P. Ambulatory blood pressure monitoring versus self-measurement of blood pressure at home: correlation with target organ damage. J Hypertens. 2008;26:1919-1927.
7. Ward AM, Takahashi O, Stevens R, et al. Home measurement of blood pressure and cardiovascular disease: systematic review and meta-analysis of prospective studies. J Hypertens. 2012;30:449-456.
8. Pickering TG, Miller NH, Ogedegbe G, et al. Call to action on use and reimbursement for home blood pressure monitoring: executive summary. A joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008;52:1-9.
9. Parati G, Stergiou GS, Asmar R, et al; ESH Working Group on Blood Pressure Monitoring. European Society of Hypertension practice guidelines for home blood pressure monitoring. J Hum Hypertens. 2010;24:779-785.
10. The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103-2116.
11. Brunström M, Carlberg B. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses. BMJ. 2016;352:i717.
12. British Hypertension Society. BP Monitors. http://bhsoc.org/bp-monitors/bp-monitors. Accessed June 27, 2016.

WHAT’S NEW

Monitoring home BP can be simplified

The researchers found that HBP monitoring correlates well with ABPM and that their method provides clinicians with a simple way (three of the past 10 measurements ≥ 135 mm Hg systolic) to use HBP readings to make clinical decisions regarding BP management.

CAVEATS

BP goals are hazy, patient education is required

Conflicting information and opinions remain regarding the ideal intensive and standard BP goals in different populations.^10,11 Systolic BP goals in this study (≥ 130 mm Hg for overall 24-hour ABP and ≥ 135 mm Hg for 24-hour ABP daytime readings) are recommended by some experts but are not commonly recognized goals in the United States. This study found good correlation between HBP and ABPM at these goals, and it seems likely that this correlation could be extrapolated for similar BP goals.

Other limitations are that (1) The study focused only on systolic BP goals; (2) patients in the study adhered to precise instructions on BP monitoring; HBP monitoring requires significant patient education on the proper use of the equipment and the monitoring schedule; and (3) while end-organ complication outcomes showed numerical decreases in function, the clinical significance of these reductions for patients is unclear.

CHALLENGES TO IMPLEMENTATION

Cost, sizing of cuffs

The cost of HBP monitors ($40-$60) has decreased significantly over time, but the devices are not always covered by insurance and may be unobtainable for some people.

Additionally, patients should be counseled on how to determine the appropriate cuff size to ensure the accuracy of the measurements. The British Hypertension Society maintains a list of validated BP devices on its website: http://bhsoc.org/bp-monitors/bp-monitors.¹²

ACKNOWLEDGEMENT

The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center For Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health.

Reprinted with permission from the Family Physicians Inquiries Network and The Journal of Family Practice. 2016;65(10):719-722.

Monitoring Home BP Readings Just Got Easier

References

WHAT’S NEW

Monitoring home BP can be simplified

CAVEATS

BP goals are hazy, patient education is required

CHALLENGES TO IMPLEMENTATION

Cost, sizing of cuffs

ACKNOWLEDGEMENT

Pages

Recommended Reading

Related Articles

PURLs

Yeast Infection in Pregnancy? Think Twice About Fluconazole

PURLs

On-demand Pill Protocol Protects Against HIV

PURLs

Light Therapy For Nonseasonal Major Depressive Disorder?