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self measured blood pressure monitoring: comparative effectiveness

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). This video from NACHC features DAngelo, a patient who explains how he has taken control of his blood pressure with the help of SMBP monitoring. For additional assistance, please contact us. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Centers for Disease Control and Prevention. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. 8600 Rockville Pike Taking Control of My Blood Pressure: Natalias Story Use this printable and shareable list of questions to ask your health care team to help you manage your blood pressure. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines. Patients are instructed to keep an activity log throughout the testing period for evaluation of stress- and activity-related BP changes. Numerous health professional and government organizations have developed various guidelines for BP management. Cookies used to make website functionality more relevant to you. Measure your blood pressure regularly to help your health care team diagnose any health problems early. SMBP plus clinical support interventions should be delivered by a trained healthcare provider, such as a pharmacist or nurse, and include regular communication of patient SMBP readings to providers and a patient-provider feedback loop. You've successfully added to your alerts. Topic Initiated. PMID: 23922064. Agency for Healthcare Research and Quality (US), Rockville (MD). The trials were greatly heterogeneous, varying in population, intervention, and outcome measures and definitions. This 2012 AHRQ review examined the comparative effectiveness of SMBP alone, of SMBP plus additional clinical support, and of usual care. This website requires cookies, and the limited processing of your personal data in order to function. Federal government websites often end in .gov or .mil. These blood pressure monitors are easy and safe to use. government site. ECG Challenge: What's Causing This Woman's Slow Pulse? Purpose: To systematically review the trial evidence on the comparative effectiveness of hypertension management with versus without SMBP monitoring, and of different additional support interventions with SMBP. Project Timeline. Thank you. The Forum convenes online quarterly. SMBP with or without additional support may confer a small benefit in BP control compared with usual care, but the BP effect beyond 12 months and the attendant long-term clinical consequences remain unclear. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Share this graphic with family and friends to show them the correct way to measure blood pressure. The review addressed SMBP monitoring performed by the patient or the patient's companion at home; it did not include monitoring done at the doctor's office, clinic, pharmacy, or health unit at work, nor did it include blood pressure (BP) monitoring done at home by nurses or other health care professionals. No trials compared different SMBP devices or provided evidence on the relationship between BP control and clinical or surrogate outcomes. This resource from the Public Health Informatics Institute provides a checklist of helpful characteristics for SMBP telemonitoring software. 45. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. The Correct Way to Measure Blood Pressure In otherwise healthy adults, hypertension is defined as a persistently elevated BP equal to or greater than 140/90 mmHg.1 The recommended BP measurement technique is to average two readings taken in a person after 5 minutes quietly seated in chair.1 In children, the diagnosis is made from an average of three or more BP readings greater than the 95th percentile for age, sex, and height.2,3 The Seventh Joint National Committee (JNC 7) guideline recommends a BP goal of 140/90 mmHg or less in the general population and a lower goal of 130/80 mmHg or less in patients with diabetes mellitus or chronic kidney disease.1. People using assistive technology may not be able to fully access information in these files. The .gov means its official. How can I measure my blood pressure at home? Cite this: Self-Measured Blood Pressure Monitoring to Control Hypertension-Medscape-May06,2013. A 2012 comparative-effectiveness review by the Agency for Healthcare Research and Quality found strong evidence that SMBP plus clinical support was . Please enable it to take advantage of the complete set of features! 343 0 obj <>stream There is insufficient evidence concerning predictors of SMBP adherence. sharing sensitive information, make sure youre on a federal Oscillometric Blood Pressure Devices Validated for Accuracy During Pregnancy [PDF 441 KB] For SMBP plus additional support versus usual care, the strength of evidence is high and supports a lower BP with SMBP use (SBP/DBP -3.4 to -8.9/-1.9 to -4.4 mmHg) up to 12 months. He has led the Evidence Review Teams for numerous guidelines for management of kidney disease, gynecological surgery, orthopedic surgery, and triaging in resource-poor countries. Patient-provider feedback loop.Source:Centers for Disease Control and Prevention. Background Hypertension often requires lifelong treatment. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Ann Intern Med. Patient-provider feedback loop with clinical support for SMBP monitoring. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. An official website of the United States government. Bookshelf SMBP monitoring is the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere. This article outlines high-level SMBP barriers that federal/national partners have encountered and offers potential solutions to achieve widespread SMBP implementation. Self-measured blood pressure (SMBP) monitoring, the regular measurement of blood pressure (BP) by the patient at home, has been proposed as a means of improving treatment adherence and BP control. Sit correctly. Hypertension Medication for Specific Comorbidities, Individualized Weight Monitoring Using the Heartphone, Home Blood Pressure Monitoring in Patients With Hypertension. Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers. Allison Goldstein, MPH, government site. Lin JS, O'Connor E, Rossom RC, Perdue LA, Burda BU, Thompson M, Eckstrom E. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Nov. Report No. We standardized extraction by training on multiple articles, after which each study was extracted by one methodologist and the extraction reviewed by at least one other. This program from the AMA and Johns Hopkins University School of Medicine is designed to help physician offices and health centers engage patients in SMBP monitoring. https://www.ahrq.gov/evidencenow/heart-health/blood-pressure/smbp-effectiveness.html. This summary is provided to assist in clinical decisionmaking along with consideration of a patient's values and preferences. To determine predictors of adherence with SMBP monitoring. Randomized-controlled trials have shown that self-measured blood pressure predicts cardiovascular morbidity and mortality better than office BP measurements. is a member of the Million Hearts Science team with the Centers for Disease Control and Prevention (CDC) Division for Heart Disease and Stroke Prevention. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. You can review and change the way we collect information below. Obtaining Adequate Fixation in a Periprosthetic Humerus Fracture Around a Shoulder Arthroplasty Stem in 81-Year-Old Man, ECG Challenge: Irregular Pulse During Cardiology Visit. There are also a variety of kiosks available in stores and pharmacies. If using a digital or automatic blood pressure cuff, the health care professional will not need to use a stethoscope. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Thank you for taking the time to confirm your preferences. On the other hand, if more frequent home BP measurements lead to more encounters for counseling, modification of lifestyle behaviors, drug treatments along with management of adverse effects, SMBP may actually increase cost, at least in the short term, since it takes several years for improved BP control to improve clinical outcomes. If you have high blood pressure, talk to your health care team about steps to take to control your blood pressureto lower your risk for heart disease and stroke. Technically, SMBP monitoring refers to regular measurement by the patient of his or her own BP. They help us to know which pages are the most and least popular and see how visitors move around the site. Would you like email updates of new search results? Effective Health Care Program . Unable to load your collection due to an error, Unable to load your delegates due to an error, Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. Comparative Effectiveness Review Number 45 Self-Measured Blood Pressure Monitoring: Comparative Effectiveness Executive Summary Background High blood pressure (BP), or hypertension, is a common, long-term health condition, particularly among older adults. BP as recorded in the office or clinic setting at medical encounters is the most commonly used approach for measurement of BP. Thank you for taking the time to confirm your preferences. Updated Hypertension Guidelines: Implications for Treatment? Other factors that can improve accuracy include the use of an appropriately sized cuff and slow cuff deflation. SMBP Coverage Insights: Medicaid [PDF 232 KB] These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. and transmitted securely. Target: BP: CME Course: Using SMBP to Diagnose and Manage High Blood Pressure Unauthorized use of these marks is strictly prohibited. Self-measured BP (SMBP) monitoring is another option that allows for more frequent measurements, and possibly more accurate readings of a patient's typical BP. The choice of treatment is largely dependent on the cause of hypertension, severity of the condition, as well as the presence or absence of existing comorbid states. SMBP with or without additional support may confer a small benefit in BP control compared with usual care, but the BP effect beyond 12 months and the attendant long-term clinical consequences remain unclear. In studies of SMBP monitoring, how do clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence) vary by the type of additional support provided? Data extraction Data on . Clinic measurements may not reflect the usual BP outside of the clinic setting throughout a day. https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure/research. Use this tool to keep track of your blood pressure measurements at home. Research shows that SMBP: Can improve adherence and health outcomes for hypertensive patients1 In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Systematic Review: Million Hearts Science team, Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GeorgiaDisclosure: Allison Goldstein, MPH, has disclosed no relevant financial relationships. The site is secure. 12-EHC002-EF. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. This report focuses on SMBP monitoring as a strategy to help patients and clinicians to better manage and control hypertension while avoiding under- or overtreatment or treatment-related hypotension. John M Eisenberg Center for Clinical Decisions and Communications Science. Measurements may interfere with a patient's activity or sleep. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. Research Protocol . Bookshelf The Community Preventive Services Task Force (CPSTF) Recommendations on Self-Measured Blood Pressure Monitoring Interventions To increase nationwide implementation of SMBP plus clinical support, multiple issues must be addressed. Content last reviewed August 2018. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 8. 2012 Mar 19. CDCs 6|18 Initiative: Accelerating Evidence into Action All information these cookies collect is aggregated and therefore anonymous. No studies of SMBP monitoring in children were identified. The bold lines correspond to the comparisons covered in this report: SMBP versus usual care (Key Question 1, part 1); SMBP plus additional support versus support without SMBP (also Key Question 1, part 1); SMBP plus additional support versus usual care (Key Question 1, part 2); SMBP plus additional support versus SMBP (Key Question 2). Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. A reading that says your blood pressure is lower than it actually is may give you a false sense of security about your health. They can help you make a plan to manage high blood pressure. Rockville, MD 20857 Several national and international hypertension guidelines endorse self-measured BP monitoring. Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care, Agency for Healthcare Research and Quality (US). Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association The direct and indirect cost of high BP and its complications has been estimated at more than $43.5 billion in 2007 in the U.S.7 Thus, it cannot be viewed simply as an individual health issue given the large public health impact and the potential for cost savings with effective prevention or treatment. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. This graphic from Target: BP demonstrates how to prepare for a blood pressure reading, the correct position to take your own blood pressure, and how to measure it. The bold lines indicate the comparisons addressed in the Key Questions (see below). This tool was developed by the National Association of Community Health Centers to help health care professionals compare blood pressure measurement devices from the U.S. Validated Device Listing across device features including cost, available cuff sizes, and data/technology capabilities. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Murakami L, Rakotz M. Improving health outcomes: Blood pressure. Future research should standardize patient inclusion criteria, BP treatment targets for home BP, and SMBP and additional support protocols to maximize the interpretability and applicability of SMBP trials. This one-page overview outlines the viability, costs, and returns for implementing an SMBP monitoring program based on Medicare reimbursement. Data Extraction: Self-blood pressure monitoring, by itself, has been shown to be an effective tool in predominantly white populations, but less studied in minority, urban communities. Repeated measurements are needed to facilitate accurate classification of patients. This process is quick and painless. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Given the inconvenience and expense of setting up and using the device, ambulatory BP monitoring is predominantly used to diagnose white coat or masked hypertension, to identify people with abnormal daily BP patters, or to help with management of hard to control or highly variable BP. The https:// ensures that you are connecting to the We included studies that used arm (not wrist) monitors for at least 8 weeks and excluded studies of pregnant women or people on hemodialysis. To systematically review the trial evidence on the comparative effectiveness of hypertension management with versus without SMBP monitoring, and of different additional support interventions with SMBP. Resources for Public Health Professionals, Improving Medication Adherence Among Patients with Hypertension, Hypertension Control Challenge Rules and Eligibility, Hypertension Control Champions Success Stories, Hospitals & Health Systems Recognition Program, Spotlight: NYC Health + Hospitals/Metropolitan, Spotlight: The Ohio State University and Wexner Medical Center, Spotlight: New Hanover Regional Medical Center, COVID-19 and Cardiovascular Disease Partner Toolkit, Heart-Healthy Steps Campaign Partner Toolkit, "Live to the Beat" Campaign Partner Toolkit, Self-Measured Blood Pressure (SMBP) Monitoring Implementation Toolkit [PDF - 2 MB], U.S. Resource title: Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension Resource description: This research summary of a systematic review compares the effectiveness of various methods and approaches to blood pressure measurement by patients or companions. SMBP monitoring may not be suitable in certain patients, such as those with arrhythmias and ectopic beats, large arm circumferences (as a too-small cuff size may give falsely elevated BP readings), with physical or mental disabilities that interfere with device operation. Addressing Barriers Beyond the Published Literature Talk with your health care team about how often you should have your blood pressure measured or when to measure it yourself. Providers can help with SMBP implementation by promoting SMBP to their hypertensive patients and establishing clinical feedback systems. 5600 Fishers Lane Taking Control of My Blood Pressure: DAngelos Story Patients may require some instruction on how to use SMBP devices.30,31. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness, https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure/research, Comment on Key Questions and Draft Reports, 25 Years of the AHRQ Evidence-based Practice Center Program, Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis, Postpartum Home Blood Pressure Monitoring, Postpartum Treatment of Hypertensive Disorders of Pregnancy, and Peripartum Magnesium Sulfate Regimens for Preeclampsia With Severe Features, Cervical Ripening in the Outpatient Setting, Sodium and Potassium Intake: Effects on Chronic Disease Outcomes and Risks, Effects of Dietary Sodium and Potassium Intake on Chronic Disease Outcomes and Related Risk Factors, U.S. Department of Health & Human Services. We included studies that used arm (not wrist) monitors for at least 8 weeks and excluded studies of pregnant women or people on hemodialysis. This includes encouraging the purchase of fully automated, validated home blood pressure monitors with a properly sized arm cuff, training patients in SMBP techniques, checking patients' measurement techniques for accuracy, and interpreting and providing counseling based on shared blood pressure readings. 1, 2 The TASMINH (Telemonitoring And SelfManagement in the Control of Hypertension) trials demonstrated that SMBP plus support, including telemonitoring (remotely monitoring patients using communication We also included longitudinal cohort studies in addressing adherence predictors. %PDF-1.6 % Study Selection: For all comparisons, evidence for clinical outcomes was insufficient; for all other outcomes (surrogate and intermediate outcomes, and health care encounters) strength of evidence was low, thus failing to support a difference. Self-measured blood pressure (SMBP) monitoring, sometimes called home blood pressure monitoring, is a patient- performed measurement of their own blood pressure outside of a clinical setting. %%EOF This site needs JavaScript to work properly. Content last reviewed March 2021. Untreated or ineffectively treated hypertension leads to increased cardiovascular morbidity and mortality in individuals, increased consumption of health care resources, high financial and human costs to society. 0 There are two BP monitoring strategies that can currently be used at home: Ambulatory and SMBP monitoring. Resource description: This research summary of a systematic review compares the effectiveness of various methods and approaches to blood pressure measurement by patients or companions. This site needs JavaScript to work properly. The cost of a home BP monitor ranges between $40 to $150, and the insurance coverage and approval for these devices vary across states.33 However, provision of the device could be cost-saving if it resulted in a reduced number of office visits for BP measurement or management or resulted in improved BP, which could translate into reduced morbidity and health care utilization. Collaborative Care Models for Improving Hypertension Control Through SMBP Monitoring A health care team member can show you how to use one if you need help. Today, as part of the CDC Expert Commentary Series on Medscape, I would like to talk about self-measured blood pressure (SMBP) monitoring plus clinical support as a way to help patients manage their hypertension. I am Allison Goldstein from the Division for Heart Disease and Stroke Prevention at CDC. See the resources below for specific recommendations. 8600 Rockville Pike These evidence-based action steps and resources, assembled by Million Hearts, can help practices implement SMBP monitoring. Finally, SMBP may be useful in preventing overtreatment in individuals with white coat syndrome, orthostatic BP changes, or hypotensive episodes from medication. First, a health care professional wraps an inflatable cuff around your arm. Strategies aimed at the control of high BP as well as adherence to medication continue to be of foremost concern to providers and patients, health care payers, policymakers, and governments worldwide. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Further debate focuses on the role of additional support needed to enhance adherence with SMBP monitoring and, possibly, achieve the clinical benefit from it. A connected monitor is preprogrammed to regularly record BP, usually every 15 to 20 minutes while awake and every 20 to 30 minutes while asleep. Self-Measured Blood Pressure Monitoring Program: Engaging Patients in Self-Measurement [PDF 1.5 MB] Whether or not to advise the use of an SMBP monitoring device for a patient with hypertension is a common clinical question for clinicians. Learn the correct way to have your blood pressure taken, whether youre getting it checked at the doctors office or checking it yourself at home. May 28, 2010. 12-EHC002-EF. Federal government websites often end in .gov or .mil. Readings by a person can be affected by observer training, preference, and bias. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. E-mail questions about the Forum toMillionHeartsSMBP@nachc.com. Background: Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. No studies evaluated children. Reliable clinic measurements require an adequate rest period prior to measurement in order to enhance the consistency of BP readings. What should I do if my blood pressure numbers are high? MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. We take your privacy seriously. >gL/?eEAV c,1t D~ 8-?x}0 KQUo~TJa&A6@sY(|x D G&pA32^Y|VLEcx 71HbFFhi3"9#+Z~GqESHm,Y-G1. Agency for Healthcare Research and Quality, Rockville, MD. In people with hypertension (adults and children), does self-measured blood pressure (SMBP) monitoring, compared with usual care or other interventions without SMBP, have an effect on clinically important outcomes? . The CDC 6|18 Initiative supports providing access for SMBP monitoring for home use and creating individual, provider, and health system incentives for compliance and meeting goals. SMBP Health IT Checklist [PDF 136 KB] As self-measurement requires patient participation, certain patient characteristics may affect compliance with SMBP monitoring, such as the willingness and ability to self-monitor BP and the technical literacy in operating the device or an interface for telemonitoring. Unable to load your collection due to an error, Unable to load your delegates due to an error, Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. In addition, ambulatory BP monitoring is often used in research studies as an outcome, since many consider it to be more accurate than clinic-based BP measurement. CDC twenty four seven. This is an official U.S. government web site managed by the Hypertension is a major risk factor for cardiovascular disease and mortality and accounts for an estimated 14 percent of cardiovascular deaths worldwide and 18 percent in developed countries.10 It is an important modifiable risk factor for coronary artery disease, stroke, chronic kidney disease, congestive heart failure, and peripheral vascular disease.1 The World Health Organization ranks high BP as the third highest risk factor for burden of disease, after underweight and unsafe sex, highlighting the contribution of hypertension directly and indirectly to the development of numerous diseases.5.

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