self measured blood pressure monitoring: comparative effectiveness self measured blood pressure monitoring: comparative effectiveness

A reading that says your blood pressure is higher than it actually is may lead to treatment you dont need. This article presents strategies for strengthening the United States ability to address hypertension in women focusing on pregnancy-related considerations for self-measured blood pressure monitoring. PMC 5600 Fishers Lane official website and that any information you provide is encrypted The .gov means its official. 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. 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. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. endstream endobj 294 0 obj <>/Metadata 50 0 R/Names 317 0 R/Outlines 332 0 R/PageMode/UseOutlines/Pages 291 0 R/StructTreeRoot 110 0 R/Type/Catalog/ViewerPreferences<>>> endobj 295 0 obj <>/Font<>/ProcSet[/PDF/Text]/Properties<>>>/Rotate 0/StructParents 0/Tabs/S/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 296 0 obj <>stream 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. Whether or not to advise the use of an SMBP monitoring device for a patient with hypertension is a common clinical question for clinicians. Comparative Effectiveness Review No. These cookies may also be used for advertising purposes by these third parties. MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. Self-measured blood pressure monitoring (SMBP), the regular measurement of blood pressure by a patient outside the clinical setting, plus additional support, is a proven, cost-effective but underutilized strategy to improve hypertension outcomes. This report from the Public Health Informatic Institute provides key findings from a national health information technology assessment on SMBP and identifies gaps, barriers, and recommendations to advance the collection, transfer, and use of patient-generated SMBP data to improve hypertension management. Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. Tools to Establish a Self-Measured BP (SMBP) Monitoring Program [PDF 2 MB] Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jan. (Comparative Effectiveness Reviews, No. Self-Measured Blood Pressure Monitoring Definition and Indications SMBP plus additional clinical support is one alternative to traditional oce care that could improve access to care and quality of care for individuals with hypertension while making blood pressure control more convenient and accessible across the population. This report can help policymakers learn more about which payers have programs that cover and reimburse for SMBP monitoring. There is insufficient evidence concerning predictors of SMBP adherence. 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. Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians [PDF 947 KB] John M. Eisenberg Center for Clinical Decisions and Communications Science. In brief, ambulatory BP monitoring is a noninvasive, fully automated technique in which BP is recorded over an extended period of time, typically 24 hours. In total, 49 studies met eligibility criteria. Thank you for taking the time to confirm your preferences. Content last reviewed August 2018. Internet Citation: Please confirm that you would like to log out of Medscape. pharmacists and nurse practitioners) to manage patients' HBP (Figure 1). Allison is trained as an emergency medical technician and received a bachelor of science degree in biology and anthropology from the University of Michigan and a master of public health degree, with a focus in behavioral science and education, from Emory University. The actual BP measurement can be done either by the patient, or less frequently by a companion, who is usually not a medical professional. These types of minimally intensive approaches are important to test in all populations, especially those experiencing related health disparities, for broad implementation with . Measure your blood pressure regularly to help your health care team diagnose any health problems early. 45. 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. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. For SMBP plus additional support versus SMBP alone or with less intense additional support, the strength of evidence is low, failing to support a difference in BP. Public Information from the CDC and Medscape. Hypertension Medication for Specific Comorbidities, Individualized Weight Monitoring Using the Heartphone, Home Blood Pressure Monitoring in Patients With Hypertension. 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. For SMBP plus additional support versus SMBP alone or with less intense additional support, the strength of evidence is low, failing to support a difference in 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. 5600 Fishers Lane Using SMBP to guide you in diagnosing and treating hypertension likely will produce better outcomes than using office blood pressure readings alone. Regardless of the mode of support delivered, the patient-provider feedback loop is essential. 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. endstream endobj startxref No trials compared different SMBP devices or provided evidence on the relationship between BP control and clinical or surrogate outcomes. This easy-to-read graphic from CDC shows patients the correct way to measure blood pressure and can be shared on your social channels and patient websites. Centers for Disease Control and Prevention. Self-Measured Blood Pressure Monitoring: Key Findings from a National Health Information Technology Landscape Analysis[PDF 1.3 MB] A 2012 comparative-effectiveness review by the Agency for Healthcare Research and Quality found strong evidence that SMBP plus clinical support was . This list of resources from the Million Hearts Hypertension Control Change Package can help assign care team roles for an SMBP monitoring program and guide patients on selecting a home blood pressure monitor. All information these cookies collect is aggregated and therefore anonymous. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. SMBP requires the use of a home blood pressure measurement device by the patient to measure blood pressure at different points in time. Neither is there consensus on how many serial measurements should be taken and which ones should be used or averaged to derive an accurate reading. Patient-provider feedback loop.Source:Centers for Disease Control and Prevention. 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. government site. . SMBP monitoring is the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere. Evidence shows that people with high blood pressure are more likely to lower their blood pressure if they use SMBP combined with support from their health care team than if they dont use SMBP.3. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. 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. SMBP = self-measured BP; KQ = Key Question The figure shows a schematic of possible comparisons between SMBP, SMBP plus additional, support without (more), In light of the potential health care benefits and knowledge gaps highlighted above, a topic titled Self Blood Pressure Monitoring was developed through the processes of topic identification, selection, and refinement for Comparative Effectiveness Review (CER) within the Agency for Healthcare Research and Quality (AHRQ) Effective Health Care program.34. 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. in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence Uhlig K, Balk EM, Patel K, Ip S, Kitsios GD, Obadan NO, et al. 2012 Mar 19. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Aug. Report No. Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association 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 Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. (Prepared by the Tufts Evidence-based Practice Center under Contract No. SMBP means you regularly use a personal blood pressure measurement device away from a doctors office or hospitalusually at home. AHRQ Publication No. [3] (Figure 1). These include ambulatory BP monitoring (ABPM), self monitoring (or self measurement or home based) BP which is usually done by the patient at home, at work, or in any conducive environment. Very few trials evaluated objective clinical outcomes. People using assistive technology may not be able to fully access information in these files. Don't smoke, drink caffeinated beverages or exercise within 30 minutes before measuring your blood pressure. E-mail questions about the Forum toMillionHeartsSMBP@nachc.com. Source:Centers for Disease Control and Prevention. High blood pressure (BP), or hypertension, is a common, long-term health condition, particularly among older adults. Strong scientific evidence shows that self-measured blood pressure (SMBP) monitoring, also known as home blood pressure monitoring, plus clinical support helps people with hypertension lower their blood pressure. BP as recorded in the office or clinic setting at medical encounters is the most commonly used approach for measurement of BP. This patient-friendly video from NACHC outlines clear instructions for using home blood pressure monitors. Thank you. Hypertension often requires lifelong treatment. This report addresses questions regarding the clinical value of SMBP monitoring with or without additional support and what factors may predict adherence with SMBP monitoring. This 2020 AMA handout for Current Procedural Terminology (CPT) provides codes and descriptions for SMBP-related services. It predicted a rise by 24 percent in developed countries and 80 percent in developing countries by 2025.4 The World Health Report 2002 estimates that over 1 billion people have hypertension, which is estimated to cause 4.5 percent of the global disease burden.5 In addition, high BP directly results in 7 million deaths annually.6 Within the United States, about 76.4 million adults are affected.7 Data from the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2008 indicated that 30 percent of all adults in the U.S. 18 years and older were hypertensive, with a higher prevalence among African Americans and the elderly.8 The prevalence of verified hypertension in children is more than 3 percent.2 A study from 2002 reported a lifetime risk of developing hypertension among adults aged 55 to 65 years in the U.S. as greater than 90 percent.9 Despite improvements in the quality of health care and life expectancy, it is expected that the prevalence of hypertension will continue to rise as the population ages. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Regular BP measurement by visiting nurses or other health care professionals at home is not considered to be SMBP monitoring. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. You will be subject to the destination website's privacy policy when you follow the link. AHRQ Publication No. Agency for Healthcare Research and Quality, Rockville, MD. https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure/research. SMBP monitoring is also commonly referred to as home blood pressure monitoring. Topline Findings: A National Analysis of Self-Measured Blood Pressure Monitoring Coverage and Reimbursement [PDF 1.7 MB] AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. Take at least two readings, 1 or 2 minutes apart. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Conclusions: Ann Intern Med. Figure 1. This toolkit, developed by the National Association of Community Health Centers (NACHC) for Million Hearts, can help organizations successfully integrate SMBP monitoring into care processes and workflows. 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. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. If using a digital or automatic blood pressure cuff, the health care professional will not need to use a stethoscope. Brown Affiliations This video from NACHC, showcases several community health centers work to implement SMBP monitoring programs in their clinics. Europe PMC is an archive of life sciences journal literature. Current insurance coverage for SMBP plus clinical support is limited and improvements are planned or are under way. However, even when measured according to established guidelines, clinic BP measurements have several limitations. This feature requires the newest version of Flash. Internet Citation: Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. No studies evaluated children. It has been the subject of a 2002 Evidence Practice Center (EPC) Evidence Report.25 A fuller description of ambulatory BP monitoring can be found there. There were 24 comparisons of SMBP alone versus usual care, 24 of SMBP plus additional support versus usual care, 12 of SMBP plus additional support versus SMBP without additional support or with less intense additional support, and 1 study evaluating predictors of adherence to SMBP. How Do We Jump-Start Self-measured Blood Pressure Monitoring in the United States? This AMAAHA joint initiative can help health care professionals launch an SMBP monitoring program. Telephone: (301) 427-1364, Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension, https://www.ahrq.gov/evidencenow/heart-health/blood-pressure/smbp-effectiveness.html, AHRQ Publishing and Communications Guidelines, Evidence-based Practice Center (EPC) Reports, Healthcare Cost and Utilization Project (HCUP), AHRQ Quality Indicator Tools for Data Analytics, United States Health Information Knowledgebase (USHIK), AHRQ Informed Consent & Authorization Toolkit for Minimal Risk Research, Grant Application, Review & Award Process, Study Sections for Scientific Peer Review, Getting Recognition for Your AHRQ-Funded Study, AHRQ Research Summit on Diagnostic Safety, AHRQ Research Summit on Learning Health Systems, National Action Alliance To Advance Patient Safety, Blood Pressure Control Evidence and Resources, Cholesterol Management Evidence and Resources, Advancing Heart Health Research and Results, U.S. Department of Health & Human Services. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. The trials were greatly heterogeneous, varying in population, intervention, and outcome measures and definitions. Hypertension often requires lifelong treatment. Clipboard, Search History, and several other advanced features are temporarily unavailable. How does adherence with SMBP monitoring vary by patient factors? In that role, she provides scientific expertise to support research translation related to Million Hearts priority strategies. We also included longitudinal cohort studies in addressing adherence predictors. [3] (Figure 2). CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Hello. Content last reviewed March 2021. i` V04s7.w`t32Cc( L4M\ES}*vWe+= 4a)\5O)si8hQ[^}.L01>#t7On,c7g K>=}NrMo4;Zj:97MgN1m#6+U6i https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure. Use this printable and shareable list of questions to ask your health care team to help you manage your blood pressure. John M Eisenberg Center for Clinical Decisions and Communications Science. and transmitted securely. High blood pressure usually has no warning signs or symptoms, and many people do not know they have it. The bold lines indicate the comparisons addressed in the Key Questions (see below). This 2021 recommendation from the USPSTF includes additional guidance for obtaining blood pressure measurements away from the clinical setting. These blood pressure monitors are easy and safe to use. For example, terminal digit preference (i.e., preference for 0, 5, and even numbers) and single number preference (i.e., preference for specific values such as 130/80 or 140/90 mmHg) can lead to inaccuracies in measurement readings and variability across observers.17,18 This can be prevented when machines provide readings automatically. European Associations Review Dietary Therapies for Obesity, AHA Statement Ranks 10 Popular Diets for Heart Health. 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. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. This 2012 AHRQ review examined the comparative effectiveness of SMBP alone, of SMBP plus additional clinical support, and of usual care. The Correct Way to Measure Blood Pressure An official website of the Department of Health & Human Services, Internet Citation: 0 Current settings for BP measurement include BP measurement in a healthcare setting, or BP measurement in a patient's usual environment with either ambulatory BP monitoring, or self-measured BP (SMBP) monitoring. Cookies used to make website functionality more relevant to you. 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]. government site. Clinical support includes regular one-on-one counseling, web-based or telephonic support tools, and educational classes. HHS Vulnerability Disclosure, Help We included studies that used arm (not wrist) monitors for at least 8 weeks and excluded studies of pregnant women or people on hemodialysis. Use this tool to keep track of your blood pressure measurements at home. The Forum convenes online quarterly. Accessibility Before Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care, Agency for Healthcare Research and Quality (US). Details on design, patients, interventions, outcomes, and quality were extracted into standard forms. Data Synthesis: We included studies that used arm (not wrist) monitors for at least 8 weeks and excluded studies of pregnant women or people on hemodialysis. 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. 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. SMBP means you regularly use a personal blood pressure measurement device away from a doctor's office or hospitalusually at home. Progestogens for Prevention of Preterm Birth. Click the topic below to receive emails when new articles are available. No trials compared different SMBP devices or provided evidence on the relationship between BP control and clinical or surrogate outcomes. Project Timeline. Taking Control of My Blood Pressure: DAngelos Story Kallioinen N, Hill A, Horswill MS, Ward HE, Watson MO. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Bethesda, MD 20894, Web Policies Talk with your health care team about how often you should have your blood pressure measured or when to measure it yourself. This 2020 joint policy statement from the American Heart Association (AHA) and the AMA addresses barriers to implementing SMBP monitoring. 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. Self Measured Blood Pressure Monitoring (SMBP), the self measurement of blood pressure (BP) outside of the health care setting may be an effective tool to facilitate BP control. Self-Measured Blood Pressure Monitoring Program: Engaging Patients in Self-Measurement [PDF 1.5 MB] This document provides action steps for public health practitioners to facilitate the implementation of SMBP monitoring plus additional support in five key areas: Understanding the environment; Working with payers and purchasers; Working with health care providers; Spreading the word to the public; and Monitoring/assessment of SMBP, plus additional support implementation. CDC twenty four seven. Ann Intern Med. MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults. This patient-friendly video from the Release the Pressure Coalition highlights the key steps people can take for accurate SMBP monitoring. Many things can affect a blood pressure reading, including: Its important to get an accurate blood pressure reading so that you have a clearer picture of your risk for heart disease and stroke. y ^]J[_tFe^~4:;:Cxbh jXd%SElY*Oi1h{_DsnL First, a health care professional wraps an inflatable cuff around your arm. 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. While patient self-participation in chronic disease management appears promising, the sustainability and clinical impact of SMBP remains uncertain. This review does not explore the validity, reproducibility, or comparability of BP measurements across devices or techniques (which was addressed by the 2002 EPC report25), or the use of SMBP as a diagnostic tool. Accessibility 2011 Jan-Feb;46(1):99-102. doi: 10.4085/1062-6050-46.1.99. Centers for Disease Control and Prevention. Thus an alternative term for SMBP monitoring which better captures the application of self measurement for this report is the term home BP monitoring; however since the term is relatively rarely used in the literature, we will continue to use SMBP. How does SMBP monitoring compare with usual care or other interventions without SMBP in its effect on relevant surrogate outcomes (cardiac measures: LVH [left ventricular hypertrophy], LVM [left ventricular mass], LVMI [left ventricular mass index]) and intermediate outcomes (BP control, BP treatment adherence, or health care process measures)? SMBP Health IT Checklist [PDF 136 KB] An official website of the Department of Health & Human Services. Take this form [PDF 105 KB]with you on your first blood pressure visit to record important blood pressure-related information. How do different devices for SMBP monitoring compare with each other (specifically semiautomatic or automatic versus manual) in their effects on clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence)? This summary is provided to assist in clinical decisionmaking along with consideration of a patient's values and preferences. Reliable clinic measurements require an adequate rest period prior to measurement in order to enhance the consistency of BP readings. sharing sensitive information, make sure youre on a federal Unauthorized use of these marks is strictly prohibited. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Research shows that SMBP: Can improve adherence and health outcomes for hypertensive patients1 Shareable Handouts and Tools in English and Spanish, steps to take to control your blood pressure, this list of questions to ask your health care team, take steps each day to help keep your blood pressure in a healthy range, Heart disease and stroke statistics-2020 update: a report from the American Heart Association, Sources of inaccuracy in the measurement of adult patients resting blood pressure in clinical settings: A systematic review, National Center for Chronic Disease Prevention and Health Promotion, 5 Surprising Facts About High Blood Pressure, Hypertension Statistical Reports for Health Professionals, Morbidity and Mortality Weekly Reports About Hypertension, Hypertension Resources for Health Professionals, U.S. Department of Health & Human Services. Numerous health professional and government organizations have developed various guidelines for BP management. Screening for High Blood Pressure in Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. In addition, SMBP may carry the risk of unreliable BP readings if not obtained in a standard fashion, inappropriate self adjustments of antihypertensive medications, as well as increased anxiety in susceptible patients. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. 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. No studies of SMBP monitoring in children were identified. 2012 Feb 15. Would you like email updates of new search results? To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. A health care team member can show you how to use one if you need help. Rockville, MD: Agency for Healthcare Research and Quality. Topic Initiated. I am Allison Goldstein from the Division for Heart Disease and Stroke Prevention at CDC. They help us to know which pages are the most and least popular and see how visitors move around the site. Cite this: Self-Measured Blood Pressure Monitoring to Control Hypertension-Medscape-May06,2013. [1] SMBP monitoring plus clinical support has been found to be effective in helping patients control their blood pressure.[2]. You will receive email when new content is published. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. These evidence-based action steps and resources, assembled by Million Hearts, can help practices implement SMBP monitoring. Addressing Barriers Beyond the Published Literature b W 35D43zi&J &lbP K 7X These cookies may also be used for advertising purposes by these third parties. 2012 Sep 21. in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence predictors of SMBP monitoring. 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. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Balk has over 125 publications on systematic reviews of a broad range of medical, surgical, health, and nutrition topics.