Generally, individuals with hypertension would use such devices at home to measure their own BP and provide written lists of readings to their provider at office visits. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners [PDF 1 MB] PDF Self-Measured Blood Pressure Monitoring - Centers for Disease Control Agency for Healthcare Research and Quality (AHRQ) Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [PDF 1.2 MB] Rockville, MD 20857 January 2012 As they were scoping their work for SMBP, they started by searching multiple databases Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. government site. Release the Pressure Self-Measured Blood Pressure (SMBP) Training Video We take your privacy seriously. Addressing Barriers Beyond the Published Literature, Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association, An Opportunity to Better Address Hypertension in Women: Self-Measured Blood Pressure Monitoring, Agency for Healthcare Research and Quality (AHRQ) Self-Measured Blood Pressure Monitoring: Comparative Effectiveness, U.S. Preventive Services Task Force (USPSTF) Final Recommendation Statement: Hypertension in Adults: Screening, Division for Heart Disease and Stroke Prevention, Live to the Beat Campaign Partner Toolkit. 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. 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 People who have high blood pressure may need to measure their blood pressure more often than people who do not have high blood pressure. 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. hbbd```b``A$ug`rX|" o/XDLHp0{W$5)"30^` w A 2012 comparative-effectiveness review by the Agency for Healthcare Research and Quality found strong evidence that SMBP plus clinical support was . 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. This process is quick and painless. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Measure Your Blood Pressure | cdc.gov MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. Accessibility The trials were greatly heterogeneous, varying in population, intervention, and outcome measures and definitions. This 2020 AMA handout for Current Procedural Terminology (CPT) provides codes and descriptions for SMBP-related services. Hypertension Medication for Specific Comorbidities, Individualized Weight Monitoring Using the Heartphone, Home Blood Pressure Monitoring in Patients With Hypertension. Bethesda, MD 20894, Web Policies 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. Newer SMBP devices can automatically store readings and some are equipped to electronically transmit readings to a provider. Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. Many SMBP devices are commercially available. 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. 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. 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. Measurements can be read by a person or provided digitally by a device. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. A BP cuff is placed around the upper arm and left in place for approximately 24 hours. The primary objective of this review is to evaluate whether the use of SMBP monitoring influences outcomes in adults and children with hypertension and to what extent these changes in outcomes can be attributable to the use of self monitoring devices alone or the use of SMBP with additional support or attention provided. 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. 2012 Sep 21. For the purpose of this report, BP measurement by the patient in the office/clinic/pharmacy or a health unit at work is not included under SMBP monitoring since it does not reliably overcome the problem of white coat hypertension nor provide the privacy and opportunity for more frequent measurements of home self measurement. What you need to know about self-measured blood pressure monitoring No studies evaluated children. Given clinical heterogeneity and limited head to head comparisons, the evidence limits our ability to draw definitive conclusions about the incremental effect of any specific additional support. No studies of SMBP monitoring in children were identified. Take this form with you to your doctors office to record important blood pressure-related information. In total, 49 studies met eligibility criteria. 5600 Fishers Lane 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: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. However, even when measured according to established guidelines, clinic BP measurements have several limitations. Sit with your back straight and supported (on a dining chair, rather than a sofa). 343 0 obj <>stream Readings by a person can be affected by observer training, preference, and bias. 0 This site provides a list of clinically validated blood pressure devices, based on the American Medical Associations (AMA) established criteria to independently validate clinical accuracy. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Take this form [PDF 105 KB]with you on your first blood pressure visit to record important blood pressure-related information. The current report evaluates ambulatory BP monitoring only as an outcome measurement tool, not as an intervention of interest. 45.) 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. This summary is provided to assist in clinical decisionmaking along with consideration of a patient's values and preferences. What should I do if my blood pressure numbers are high? pharmacists and nurse practitioners) to manage patients' HBP (Figure 1). Impact of SelfMonitoring of Blood Pressure on Processes of Self-Measured Blood Pressure Monitoring: Comparative Effectiveness Please confirm that you would like to log out of Medscape. How does adherence with SMBP monitoring vary by patient factors? 315 0 obj <>/Filter/FlateDecode/ID[]/Index[293 51]/Info 292 0 R/Length 113/Prev 421311/Root 294 0 R/Size 344/Type/XRef/W[1 3 1]>>stream An official website of the United States government. 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. Piper MA, Evans CV, Burda BU, Margolis KL, OConnor E, Smith N, Webber E, Perdue LA, Bigler KD, Whitlock EP. Limitations: That the mean number of BP measurements recorded per week for users who continued recording blood pressure at 6 weeks was 6 compared to 8 among those who continued for at least 14 weeks, demonstrates high levels of engagement with respect to self-measured BP monitoring. We included studies that used arm (not wrist) monitors for at least 8 weeks and excluded studies of pregnant women or people on hemodialysis. The https:// ensures that you are connecting to the Sit correctly. Is immediate imaging important in managing low back pain? sharing sensitive information, make sure youre on a federal Please enable it to take advantage of the complete set of features! Addressing Barriers Beyond the Published Literature PMID: 23922064. 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. Disclaimer. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Patients may require some instruction on how to use SMBP devices.30,31. Register for the Million HeartsSMBP Forum, an opportunity for clinical, public health, and community-based partners to exchange best and promising practices, identify solutions to common obstacles, and share resources to accelerate SMBP monitoring uptake. There is insufficient evidence concerning predictors of SMBP adherence. endstream endobj startxref All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Thank you for taking the time to confirm your preferences. Would you like email updates of new search results? Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. 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 The present Comparative Effectiveness Review (CER) evaluates the effects of self-measured blood pressure (SMBP) monitoring in hypertensive patients. 12-EHC002-EF. One study estimated that the global prevalence of hypertension in 2000 was 26 percent in the adult population. This patient-friendly video from NACHC outlines clear instructions for using home blood pressure monitors. Use this tool to keep track of your blood pressure measurements at home. To determine predictors of adherence with SMBP monitoring. This is an official U.S. government web site managed by the Data Synthesis: This resource from the Public Health Informatics Institute provides a checklist of helpful characteristics for SMBP telemonitoring software. Clinic measurements may not reflect the usual BP outside of the clinic setting throughout a day. Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task Force [Internet]. This report can help policymakers learn more about which payers have programs that cover and reimburse for SMBP monitoring. This AMAAHA joint initiative can help health care professionals launch an SMBP monitoring program. This 2012 AHRQ review examined the comparative effectiveness of SMBP alone, of SMBP plus additional clinical support, and of usual care. For example it is unclear whether simply providing a device for SMBP will improve BP control or whether this needs to be combined with additional support such as the telemetric transmission of readings to a provider to allow more frequent titration of drugs, regular nursing contact, or other types of interactions with a provider regarding hypertension management. Data Extraction: The goals of this report, therefore, are to inform physicians' decision whether to encourage the use of SMBP monitoring alone or along with additional support and to assist health care policymakers and payers with decisions regarding coverage and promotion of 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. HHSA 290-2007-10055-I.) 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. : 13-05194-EF-1. High blood pressure usually has no warning signs or symptoms, and many people do not know they have it. In response, providers offer customized support and advice, such as medication or lifestyle adjustments. There is growing evidence that selfmonitoring of blood pressure (SMBP) with guided support beyond usual primary care improves BP control. 8600 Rockville Pike Measurements may interfere with a patient's activity or sleep. These types of minimally intensive approaches are important to test in all populations, especially those experiencing related health disparities, for broad implementation with . BP as recorded in the office or clinic setting at medical encounters is the most commonly used approach for measurement of BP. BP may rise in the clinic in response to the medical environment (referred to as white coat hypertension), or may be normal in the clinic but not outside of the clinic (referred to as masked hypertension).19,20 Prevalence of white coat hypertension ranges from 10 to more than 20 percent,21,22 and the prevalence of masked hypertension (MH) reaches 40 percent in some studies.23 The prognostic significance of either is unclear.24. The health care professional then inflates the cuff, which gently tightens on your arm. Unauthorized use of these marks is strictly prohibited. Would you like email updates of new search results? 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. While patient self-participation in chronic disease management appears promising, the sustainability and clinical impact of SMBP remains uncertain. Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians [PDF 947 KB] Cite this: Self-Measured Blood Pressure Monitoring to Control Hypertension-Medscape-May06,2013. 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. 8600 Rockville Pike SMBP measurements can be obtained from the upper arm, wrist, or fingers (or, if necessary, the lower extremity); however, experts recommend the use of upper arm devices due to the lack of validation and the high number of inaccurate measurements from the wrist and finger devices.26-28 Models for SMBP devices range from mechanical aneroid gauges (sphygmomanometers), which require self-inflation and auscultation (manual devices), to manually-inflated sphygmomanometers with automatic displays (semiautomated devices), to fully automated configurations that automatically inflate the sphygmomanometer and measure the BP (automated devices). 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. Conclusions: 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. This video from the NACHC features Natalia, a patient who explains how she has taken control of her blood pressure with SMBP monitoring. Federal government websites often end in .gov or .mil. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Self-Measured Blood Pressure Monitoring - Medscape Use this printable and shareable list of questions to ask your health care team to help you manage your blood pressure. The HOME BP intervention for SMBP is an integrated patient-practitioner online digital tool. Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers, Self-Measured Blood Pressure Monitoring: Comparative Effectiveness, https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure, Comment on Key Questions and Draft Reports, 25 Years of the AHRQ Evidence-based Practice Center Program, U.S. Department of Health & Human Services. : 14-05198-EF-1. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. Balk has over 125 publications on systematic reviews of a broad range of medical, surgical, health, and nutrition topics. The Correct Way to Measure Blood Pressure 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. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jan. Report No. 45. Please enter a Recipient Address and/or check the Send me a copy checkbox. HHS Vulnerability Disclosure, Help 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]. Talk with your health care team about how often you should have your blood pressure measured or when to measure it yourself. Centers for Disease Control and Prevention. SMBP Health IT Checklist [PDF 136 KB] This 1-hour continuing medical education (CME) course focuses on the appropriate use of SMBP monitoring in clinical practice and trains physicians, care teams, and other participants who are registered for Target: BP. Why do I need to measure my blood pressure? Accelerating Use of Self-measured Blood Pressure Monitoring (SMBP 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. To determine predictors of adherence with SMBP monitoring. Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care, Agency for Healthcare Research and Quality (US). Figure 1. CER 45 Self-Measured Blood Pressure Monitoring Comparative Effectiveness Surveillance Final 4.7 AHRQ%Systematic%Review%% Surveillance%Program% CER$#45:$Self'Measured"Blood"Pressure"Monitoring:"$ Comparative"Effectiveness" Original$Release$Date:$nuary Ja "2012" Surveillance$Report: "vember"2012No " Surveillance$Report: "rchMa "2016"" 7 HBPM is also known as self-measured BP. sharing sensitive information, make sure youre on a federal : 12-EHC002-EF. 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. Use this checklist: If you are keeping track of your blood pressure at home, use these additional tips. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Aug. Report No. 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. European Associations Review Dietary Therapies for Obesity, AHA Statement Ranks 10 Popular Diets for Heart Health. Agency for Healthcare Research and Quality, Rockville, MD. Show details Contents < Prev Next > Key Informants Susan Booth Project Leader, Personal Care & Wellness Consumer Reports Yonkers, NY Hayden Bosworth, Ph.D. 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. SMBP differs from clinic-based and ambulatory blood . Target: BP: Implement SMBP For SMBP alone versus usual care, the strength of evidence is moderate and supports a lower BP with SMBP (SBP/DBP -3.1/-2.0 mmHg at 6 months). i` V04s7.w`t32Cc( L4M\ES}*vWe+= 4a)\5O)si8hQ[^}.L01>#t7On,c7g K>=}NrMo4;Zj:97MgN1m#6+U6i John M Eisenberg Center for Clinical Decisions and Communications Science. People using assistive technology may not be able to fully access information in these files. sX Ndb`T~ Self-Measured Blood Pressure Monitoring: Comparative Effectiveness May 28, 2010. Types of clinical support include one-on-one counseling, Web-based and telephone support, and educational classes. There are also a variety of kiosks available in stores and pharmacies. How to Measure Your Blood Pressure at Home [PDF 255 KB] The site is secure. AHRQ Publication No. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. They help us to know which pages are the most and least popular and see how visitors move around the site. Topic Initiated. official website and that any information you provide is encrypted Monitoring Your Blood Pressure at Home | American Heart Association See the resources below for specific recommendations.