TUCSON, ARIZ. — Home blood pressure monitoring may have a role in changing diet and exercise habits in adults with type 2 diabetes mellitus, according to results from a small analysis presented at the annual meeting of the North American Primary Care Research Group.
Daily blood pressure monitoring was considered helpful in increasing awareness of blood pressure (BP) and making lifestyle changes in 21 of 24 patients. Overall, 77% of the patients reported making changes in their diet, and 50% exercised more as a result of daily blood pressure monitoring. Of the total, 54% of patients reported that their health status was “much better” or “somewhat better” after 6 months of home monitoring, reported Dr. Lauren DeAlleaume and colleagues at the University of Colorado Health Sciences Center, in Denver.
At baseline, 17 patients (71%) had hypertension, 4 (17%) had a history of myocardial infarction, 2 (8%) had suffered transient ischemic attacks, and 19 (79%) had increased cholesterol, 13 of whom were on cholesterol-lowering medication.
The self-reported finding of improved health status was unexpected, given that the average age was 62 years in patients with diabetes and other health problems, Dr. DeAlleaume noted in an interview. “We think it's a matter of empowerment, but there need to be more studies.”
When asked, 92% of patients said they felt they could make lifestyle changes to control their blood pressure. However, 21% reported that checking their blood pressure makes them feel anxious and that day-to-day BP variations worried them.
“Variations are not uncommon in practice, but patients tend to think their BP should be rock steady, whereas variability is normal and healthier,” said Dr. DeAlleaume of the department of family medicine at the university.
The analysis was part of the Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multivessel Disease (Freedom) trial, an ongoing trial examining cardiovascular risk factors in 34 patients with type 2 diabetes. Of these patients, 75% are female, 64% white, 32% Hispanic, and 71% have prescription coverage.
Overall, 24 patients agreed to monitor their BP daily with an automatic wrist cuff validated by the German Hypertension Society and to report their readings monthly via phone, mail, or the Internet. Feedback was provided to both the patients and their physicians. The target BP was a goal of less than 125 mm Hg/75 mm Hg.
The patients submitted an average of six reports; the average interval between reports was 40 days; and the preferred method of reporting was by mail.
There is evidence to suggest that home BP monitoring correlates better with ambulatory BP monitoring and target-organ damage than does office BP monitoring. Although the data are consistent, the number of studies is limited, Dr. DeAlleaume said.
“The reason everyone hasn't jumped on this bandwagon is that there aren't any major [home] blood pressure studies, but I think home monitoring is going to be the wave of the future,” she said.