self measured blood pressure monitoring: comparative effectiveness

This patient-friendly video from the Release the Pressure Coalition highlights the key steps people can take for accurate SMBP monitoring. Ann Intern Med. 5600 Fishers Lane Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. To determine predictors of adherence with SMBP monitoring. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Saving Lives, Protecting People. Topline Findings: A National Analysis of Self-Measured Blood Pressure Monitoring Coverage and Reimbursement [PDF 1.7 MB] Why do I need to measure my blood pressure? 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. Current insurance coverage for SMBP plus clinical support is limited and improvements are planned or are under way. 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. 45. Release the Pressure Self-Measured Blood Pressure (SMBP) Training Video 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. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. Home BP monitoring (HBPM) has been utilized for regular monitoring of BP at home to improve HTN control or regulate antihypertensive medications. CDC twenty four seven. Regardless of the mode of support delivered, the patient-provider feedback loop is essential. Lozano P, Henrikson NB, Morrison CC, Dunn J, Nguyen M, Blasi P, Whitlock EP. You will receive email when new content is published. 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). 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. government site. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. These cookies may also be used for advertising purposes by these third parties. There are two BP monitoring strategies that can currently be used at home: Ambulatory and SMBP monitoring. MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. Read the full Million Hearts Hypertension Control Change Package. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. 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]. Screening for High Blood Pressure in Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. Data extraction Data on . To increase nationwide implementation of SMBP plus clinical support, multiple issues must be addressed. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Apr 11, 2011. Click the topic below to receive emails when new articles are available. 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. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Murakami L, Rakotz M. Improving health outcomes: Blood pressure. 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 Collaborative Care Models for Improving Hypertension Control Through SMBP Monitoring endstream endobj startxref Details on design, patients, interventions, outcomes, and quality were extracted into standard forms. Clipboard, Search History, and several other advanced features are temporarily unavailable. Comparative Effectiveness Review No. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. SMBP monitoring can provide more frequent BP readings and if these are transmitted back to the provider, they can be used for more rapid and frequent adjustments in blood pressure medication to ensure adequate BP control. 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. 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. First, a health care professional wraps an inflatable cuff around your arm. 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.) However, consistently attaining reliable BP measurements is problematic. Many studies were of moderate to poor quality and had short followup periods. 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. Sit with your back straight and supported (on a dining chair, rather than a sofa). 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. Clinic measurements may not reflect the usual BP outside of the clinic setting throughout a day. https://www.ahrq.gov/evidencenow/heart-health/blood-pressure/smbp-effectiveness.html. Sit correctly. 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. 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. We take your privacy seriously. These blood pressure monitors are easy and safe to use. Further debate focuses on the role of additional support needed to enhance adherence with SMBP monitoring and, possibly, achieve the clinical benefit from it. Please enter a Recipient Address and/or check the Send me a copy checkbox. The health care professional then inflates the cuff, which gently tightens on your arm. This 2020 joint policy statement from the American Heart Association (AHA) and the AMA addresses barriers to implementing SMBP monitoring. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Data Extraction: National Library of Medicine How to Use Your Home Blood Pressure Monitor MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. : 13-05194-EF-1. In response, providers offer customized support and advice, such as medication or lifestyle adjustments. How to Measure Your Blood Pressure at Home [PDF 255 KB] This summary is provided to assist in clinical decisionmaking along with consideration of a patient's values and preferences. i` V04s7.w`t32Cc( L4M\ES}*vWe+= 4a)\5O)si8hQ[^}.L01>#t7On,c7g K>=}NrMo4;Zj:97MgN1m#6+U6i If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Limitations: Figure 2. 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. In studies of SMBP monitoring, how do clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence) vary by the type of additional support provided? Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task Force [Internet]. This 2012 AHRQ review examined the comparative effectiveness of SMBP alone, of SMBP plus additional clinical support, and of usual care. You've successfully added to your alerts. 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. All information these cookies collect is aggregated and therefore anonymous. Rockville, MD 20857 Updated Hypertension Guidelines: Implications for Treatment? Federal government websites often end in .gov or .mil. FOIA Would you like email updates of new search results? Centers for Disease Control and Prevention. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. No studies of SMBP monitoring in children were identified. J Athl Train. Would you like email updates of new search results? Comparative Effectiveness of Diagnosis and Treatment of Obstructive Sleep Apnea in Adults. 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. Providers can help with SMBP implementation by promoting SMBP to their hypertensive patients and establishing clinical feedback systems. How Do We Jump-Start Self-measured Blood Pressure Monitoring in the United States? 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 population of interest is the general population of people with hypertension, excluding pregnant women or those receiving dialysis. 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. With training, additional support and treatment algorithms, patients may be able to self adjust medications based on SMBP results. We also included longitudinal cohort studies in addressing adherence predictors. in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence predictors of SMBP monitoring. This report can help policymakers learn more about which payers have programs that cover and reimburse for SMBP monitoring. The Community Preventive Services Task Force (CPSTF) Recommendations on Self-Measured Blood Pressure Monitoring Interventions Hypertension also imposes a heavy financial burden on society at large. Together we can empower patients to take control of their hypertension, thereby reducing their risk for heart attack and stroke. No studies of SMBP monitoring in children were identified. SMBP monitoring is the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere. A 2012 comparative-effectiveness review by the Agency for Healthcare Research and Quality found strong evidence that SMBP plus clinical support was . Cite this: Self-Measured Blood Pressure Monitoring to Control Hypertension-Medscape-May06,2013. Choosing-a-Home-BP-Monitor At-a-Glance-Comparison [PDF 446 KB] Before Rockville, MD: Agency for Healthcare Research and Quality. Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. In that role, she provides scientific expertise to support research translation related to Million Hearts priority strategies. They help us to know which pages are the most and least popular and see how visitors move around the site. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners [PDF 1 MB] The health care professional will slowly let air out of the cuff while listening to your pulse with a stethoscope and watching the gauge. Thank you for taking the time to confirm your preferences. May 28, 2010. 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. 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. sharing sensitive information, make sure youre on a federal What is the correct way to measure blood pressure? Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Aug. Report No. Comparative Effectiveness Review No. CDCs 6|18 Initiative: Accelerating Evidence into Action CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. PMC Centers for Disease Control and Prevention. >gL/?eEAV c,1t D~ 8-?x}0 KQUo~TJa&A6@sY(|x D G&pA32^Y|VLEcx 71HbFFhi3"9#+Z~GqESHm,Y-G1. 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. A reading that says your blood pressure is higher than it actually is may lead to treatment you dont need. 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. and transmitted securely. This resource from the Public Health Informatics Institute provides a checklist of helpful characteristics for SMBP telemonitoring software. High blood pressure (BP), or hypertension, is a common, long-term health condition, particularly among older adults. Unauthorized use of these marks is strictly prohibited. Thank you. 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. Use this tool to keep track of your blood pressure measurements at home. Very few trials evaluated objective clinical outcomes. Empty your bladder and ensure at least 5 minutes of quiet rest before measurements. 8600 Rockville Pike HHS Vulnerability Disclosure, Help 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)? Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults. Associate Director, Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Internet Citation: Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. The cuff has a gauge on it that will measure your blood pressure. Patients may require some instruction on how to use SMBP devices.30,31. Readings by a person can be affected by observer training, preference, and bias. SMBP plus clinical support can improve access to care and quality of care for people with hypertension while making blood pressure control more convenient and accessible across the population. Page originally created December 2020. Cookies used to make website functionality more relevant to you. You and your health care team can take steps to control your blood pressureif it is too high. Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care, Agency for Healthcare Research and Quality (US). %%EOF For appropriate diagnosis and therapy, accurate BP measurement is of great importance. 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]. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. 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. Disclaimer. An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care. Very few trials evaluated objective clinical outcomes. Purpose Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. 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. Many SMBP devices are commercially available. Piper MA, Evans CV, Burda BU, Margolis KL, OConnor E, Smith N, Webber E, Perdue LA, Bigler KD, Whitlock EP. Figure 1. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. These evidence-based action steps and resources, assembled by Million Hearts, can help practices implement 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. AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. No trials compared different SMBP devices or provided evidence on the relationship between BP control and clinical or surrogate outcomes. Reliable clinic measurements require an adequate rest period prior to measurement in order to enhance the consistency of BP readings. 2011 Jan-Feb;46(1):99-102. doi: 10.4085/1062-6050-46.1.99. include self-measured blood pressure monitoring (SMBP) plus additional clinical support and empowerment of non-physician clinicians (e.g. Take at least two readings, 1 or 2 minutes apart. See the resources below for specific recommendations. John M Eisenberg Center for Clinical Decisions and Communications Science. 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. Whether or not to advise the use of an SMBP monitoring device for a patient with hypertension is a common clinical question for clinicians. HHSA 290-2007-10055-I.) 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. SMBP means you regularly use a personal blood pressure measurement device away from a doctors office or hospitalusually at home. If using a digital or automatic blood pressure cuff, the health care professional will not need to use a stethoscope. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians [PDF 947 KB] The trials were greatly heterogeneous, varying in population, intervention, and outcome measures and definitions. Untreated or ineffectively treated hypertension leads to increased cardiovascular . To summarize evidence about the effectiveness of self-measured blood pressure (SMBP) monitoring in adults with hypertension. b W 35D43zi&J &lbP K 7X %PDF-1.6 % 12-EHC002-EF. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Accessibility Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. Effective Health Care Program . In a comparative effectiveness review supported by the Agency for . 7 HBPM is also known as self-measured BP. : 14-05198-EF-1. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services; 2012. 8600 Rockville Pike Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. 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"" Centers for Disease Control and Prevention. 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. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. This table from a 2021 Current Atherosclerosis Reports journal article features oscillometric blood pressure devices validated for accuracy during pregnancy. Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers. 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. 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). Recommended management strategies for BP control include lifestyle and behavior modification (such as smoking cessation, moderation of alcohol consumption, salt restriction and other dietary modifications, regular exercise, and weight loss in obese persons), usually combined with the use of antihypertensive medication. Hypertension often requires lifelong treatment. Public Information from the CDC and Medscape.
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