self measured blood pressure monitoring: comparative effectiveness

Hypertension often requires lifelong treatment. 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. . Document author(s)/institution of origin: Effective Health Care Program, Agency for Healthcare Research and . U.S. Preventive Services Task Force (USPSTF) Final Recommendation Statement: Hypertension in Adults: Screening 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. 12-EHC002-EF. They can help you make a plan to manage high blood pressure. SMBP monitoring is the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere. BP as recorded in the office or clinic setting at medical encounters is the most commonly used approach for measurement of BP. To review the role of self-measured blood pressure (SMBP) monitoring with or without additional support (interventions such as telemonitoring, counseling, education, Web support, behavioral interventions, home visits, etc.) The .gov means its official. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners. in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence 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. 7 HBPM is also known as self-measured BP. 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. Measure your blood pressure regularly to help your health care team diagnose any health problems early. Take at least two readings, 1 or 2 minutes apart. Careers. 8600 Rockville Pike 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. A BP cuff is placed around the upper arm and left in place for approximately 24 hours. Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care. Hypertension often requires lifelong treatment. First, a health care professional wraps an inflatable cuff around your arm. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Read the full Million Hearts Hypertension Control Change Package. 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 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. OF SELF-MEASURED BLOOD PRESSURE MONITORING INTERVENTIONS CENTERS FOR DISEASE CONTROL AND PREVENTION . Self-Measured Blood Pressure Monitoring . These types of minimally intensive approaches are important to test in all populations, especially those experiencing related health disparities, for broad implementation with . However, there is uncertainty about the appropriate home BP targets for guiding treatment decisions and whether these should be based on the same cut-points from clinic BP or from ABPM for defining hypertension.32. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. Numerous health professional and government organizations have developed various guidelines for BP management. 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. These blood pressure monitors are easy and safe to use. I am Allison Goldstein from the Division for Heart Disease and Stroke Prevention at CDC. Sit with your back straight and supported (on a dining chair, rather than a sofa). 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. Take this form [PDF 105 KB]with you on your first blood pressure visit to record important blood pressure-related information. Ann Intern Med. Use this list of questions to ask your health care team [PDF 173 KB]to help you manage your blood pressure. 5600 Fishers Lane HHS Vulnerability Disclosure, Help Effective Health Care Program . To determine predictors of adherence with SMBP monitoring. This summary is provided to assist in clinical decisionmaking along with consideration of a patient's values and preferences. AHRQ Publication No. John M Eisenberg Center for Clinical Decisions and Communications Science. Research shows that SMBP: Can improve adherence and health outcomes for hypertensive patients1 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)? Empty your bladder and ensure at least 5 minutes of quiet rest before measurements. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Project Timeline. 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 Types of clinical support include one-on-one counseling, Web-based and telephone support, and educational classes. No matter your age, you also can take steps each day to help keep your blood pressure in a healthy range. . Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. They help us to know which pages are the most and least popular and see how visitors move around the site. Source:Centers for Disease Control and Prevention. 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. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Document author(s)/institution of origin: Effective Health Care Program, Agency for Healthcare Research and Quality, Internet Citation: Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. This video summarizes results from Accelerating Use of Self-measured Blood Pressure Monitoring (SMBP) Through Clinical-Community Care Models article, which discusses a pilot project in nine community health centers across three states to increase the use of SMBP using a collaborative model with health centers, community organizations, and health departments. An official website of the United States government. Murakami L, Rakotz M. Improving health outcomes: Blood pressure. Before 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? Use this checklist: If you are keeping track of your blood pressure at home, use these additional tips. Thank you for taking the time to confirm your preferences. Study Selection: Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. 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. Would you like email updates of new search results? Thank you for taking the time to confirm your preferences. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. 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). Systematic Review: hbbd```b``A$ug`rX|" o/XDLHp0{W$5)"30^` w Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners [PDF 1 MB] To sign up for updates or to access your subscriberpreferences, please enter your contact information below. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. To determine predictors of adherence with SMBP monitoring. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. [3] (Figure 2). There is within-individual biological variability as well as measurement error. 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. Public Information from the CDC and Medscape. This 2021 recommendation from the USPSTF includes additional guidance for obtaining blood pressure measurements away from the clinical setting. 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]. We take your privacy seriously. Careers. These cookies may also be used for advertising purposes by these third parties. This SMBP coverage summary from the American Medical Association shows Medicaid coverage by state for automated SMBP blood pressure devices, standalone cuffs, and related clinical services. Comparative Effectiveness Review No. The trials were greatly heterogeneous, varying in population, intervention, and outcome measures and definitions. This video from NACHC, showcases several community health centers work to implement SMBP monitoring programs in their clinics. 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. Bethesda, MD 20894, Web Policies How do health care professionals measure my blood pressure? 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. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. 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. Hypertension also imposes a heavy financial burden on society at large. You can review and change the way we collect information below. The Evidence-based Practice Center (EPC) reviewed the existing body of evidence on the effects of SMBP on clinical, surrogate, and intermediate outcomes in the management of hypertension. There is no consensus on the precise protocol for SMBP monitoring in the management of hypertension regarding timing, frequency and duration. Past forum recordings, slides, and other resources can be found on the SMBP ForumConfluence page. Is immediate imaging important in managing low back pain? Disclaimer. Patient-provider feedback loop.Source:Centers for Disease Control and Prevention. SMBP requires the use of a home blood pressure measurement device by the patient to measure blood pressure at different points in time. Please enable it to take advantage of the complete set of features! If you are concerned about your blood pressure numbers, talk to your health care team. An Opportunity to Better Address Hypertension in Women: Self-Measured Blood Pressure Monitoring 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. Ambulatory BP monitoring requires a technologist to program the machine, fit it on the patient, remove it and download the results and a physician to interpret them. Apr 11, 2011. 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. 2012 Mar 19. 2011 Jan-Feb;46(1):99-102. doi: 10.4085/1062-6050-46.1.99. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines. 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. 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. 0 The actual BP measurement can be done either by the patient, or less frequently by a companion, who is usually not a medical professional. 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. 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. To accelerate SMBP use, the Centers for Disease Control and Prevention (CDC) funded the National . Europe PMC is an archive of life sciences journal literature. Use this printable and shareable list of questions to ask your health care team to help you manage your blood pressure. FOIA [1] SMBP monitoring plus clinical support has been found to be effective in helping patients control their blood pressure.[2]. 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. 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]. Uhlig K, Balk EM, Patel K, Ip S, Kitsios GD, Obadan NO, et al. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. 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. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. 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. endstream endobj startxref Agency for Healthcare Research and Quality, Rockville, MD. This resource from the Public Health Informatics Institute provides a checklist of helpful characteristics for SMBP telemonitoring software. PMC Unauthorized use of these marks is strictly prohibited. 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. This 2020 AMA handout for Current Procedural Terminology (CPT) provides codes and descriptions for SMBP-related services. 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. 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. Hello. Ann Intern Med. This patient-friendly video from the Release the Pressure Coalition highlights the key steps people can take for accurate SMBP monitoring. This site needs JavaScript to work properly. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association 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). These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure. MeSH Very few trials evaluated objective clinical outcomes. Many studies were of moderate to poor quality and had short followup periods. May 28, 2010. How does SMBP monitoring compare with usual care or other interventions without SMBP in its effect on relevant clinical outcomes (cardiovascular events, mortality, patient satisfaction, quality of life, and adverse events related to antihypertensive agents)? Content last reviewed March 2021. John M. Eisenberg Center for Clinical Decisions and Communications Science. 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. Very few trials evaluated objective clinical outcomes. Self-measured blood pressure (SMBP) has been used in the treatment of hypertension with three major aims: 1) to avoid undertreatment of hypertension 2) to enhance self-participation in disease management and to enhance adherence; and 3) to avoid overtreatment in those with lower BP out of the clinic compared with in the clinic26, SMBP is being used to avoid undertreatment of hypertension. Conclusions: Resource title: Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension. 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. One study estimated that the global prevalence of hypertension in 2000 was 26 percent in the adult population. National Library of Medicine Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Aug. Report No. Division for Heart Disease and Stroke Prevention. 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. Randomized-controlled trials have shown that self-measured blood pressure predicts cardiovascular morbidity and mortality better than office BP measurements. PMID: 23922064. You will receive email when new content is published. Disclaimer. Addressing Barriers Beyond the Published Literature Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. 45. MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. This article outlines high-level SMBP barriers that federal/national partners have encountered and offers potential solutions to achieve widespread SMBP implementation. The site is secure. Regular BP measurement by visiting nurses or other health care professionals at home is not considered to be SMBP monitoring. https://www.ahrq.gov/evidencenow/heart-health/blood-pressure/smbp-effectiveness.html. These blood pressure monitors are easy and safe to use. Talk with your health care team about how often you should have your blood pressure measured or when to measure it yourself. 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. 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. 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. Show details Contents < Prev Next > Key Informants Susan Booth Project Leader, Personal Care & Wellness Consumer Reports Yonkers, NY Hayden Bosworth, Ph.D. 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. The bold lines indicate the comparisons addressed in the Key Questions (see below). Background: Agency for Healthcare Research and Quality (AHRQ) Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [PDF 1.2 MB] However, consistently attaining reliable BP measurements is problematic. The health care professional will slowly let air out of the cuff while listening to your pulse with a stethoscope and watching the gauge. 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. Rockville, MD 20857 Figure 2. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. This may facilitate direct communication with a provider via phone call or email and result in shorter turn-around times in responding to a BP reading and thus ultimately to better BP control. ECG Challenge: What's Causing This Woman's Slow Pulse? 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.

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