self measured blood pressure monitoring: comparative effectiveness
government site. They help us to know which pages are the most and least popular and see how visitors move around the site. Content last reviewed March 2021. This video from the NACHC features Natalia, a patient who explains how she has taken control of her blood pressure with SMBP monitoring. Support interventions can be delivered outside of a normal office visit -- for example via telephone, email, or Internet portal -- thereby reducing the necessary frequency of face-to-face visits. Past forum recordings, slides, and other resources can be found on the SMBP ForumConfluence page. 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. While patient self-participation in chronic disease management appears promising, the sustainability and clinical impact of SMBP remains uncertain. is a member of the Million Hearts Science team with the Centers for Disease Control and Prevention (CDC) Division for Heart Disease and Stroke Prevention. Thank you. A 2012 comparative-effectiveness review by the Agency for Healthcare Research and Quality found strong evidence that SMBP plus clinical support was more effective than usual care in improving blood pressure control among patients with hypertension. Many SMBP devices are commercially available. sharing sensitive information, make sure youre on a federal Ann Intern Med. Page originally created December 2020. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. National Library of Medicine All information these cookies collect is aggregated and therefore anonymous. 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. include self-measured blood pressure monitoring (SMBP) plus additional clinical support and empowerment of non-physician clinicians (e.g. 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. They can help you make a plan to manage high blood pressure. Effective BP control has been shown to decrease incidence for stroke by 35 to 40 percent, myocardial infarction by 20 to 25 percent, and heart failure more than 50 percent.11,12 Systematic reviews have also shown the beneficial effects of lowering BP on reducing fatal and nonfatal stroke, cardiac events, and total among individuals with severe hypertension or at increased risk (such as of older age or with other comorbid risk factors).11,13,14 A decrease of 5 mmHg in systolic BP has been estimated to result in a 14 percent overall reduction in mortality due to stroke, 9 percent reduction in mortality due to chronic heart disease and 7 percent reduction in all-cause mortality.1,15,16 However, long-term adherence to lifestyle modification and medication remains a challenge in the management of hypertension, which is usually a lifelong condition. Background: AHRQ Publication No. The trials were greatly heterogeneous, varying in population, intervention, and outcome measures and definitions. 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)? 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. 5600 Fishers Lane 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. Purpose (Prepared by the Tufts Evidence-based Practice Center under Contract No. You can review and change the way we collect information below. 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. Federal government websites often end in .gov or .mil. Bethesda, MD 20894, Web Policies Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. Unauthorized use of these marks is strictly prohibited. Public Information from the CDC and Medscape. The site is secure. Rockville, MD 20857 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. 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]. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Associate Director, Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center 2012 Feb 15. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. SMBP monitoring is the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere. 8. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Sit with your back straight and supported (on a dining chair, rather than a sofa). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Findings may be used for research purposes, but should not be considered current. How can I measure my blood pressure at home? FOIA Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. Taking Control of My Blood Pressure: DAngelos Story Talk with your health care team about how often you should have your blood pressure measured or when to measure it yourself. The present Comparative Effectiveness Review (CER) evaluates the effects of self-measured blood pressure (SMBP) monitoring in hypertensive patients. We take your privacy seriously. How do health care professionals measure my blood pressure? 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. Saving Lives, Protecting People. Home BP monitoring (HBPM) has been utilized for regular monitoring of BP at home to improve HTN control or regulate antihypertensive medications. This 2020 AMA handout for Current Procedural Terminology (CPT) provides codes and descriptions for SMBP-related services. and transmitted securely. 45.) Randomized-controlled trials have shown that self-measured blood pressure predicts cardiovascular morbidity and mortality better than office BP measurements. MeSH We also included longitudinal cohort studies in addressing adherence predictors. HHS Vulnerability Disclosure, Help 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. SMBP Health IT Checklist [PDF 136 KB] Bookshelf %PDF-1.6 % Details on design, patients, interventions, outcomes, and quality were extracted into standard forms. All information these cookies collect is aggregated and therefore anonymous. This website requires cookies, and the limited processing of your personal data in order to function. Patients in the intervention group and their providers, received feedback on self-monitored blood pressure results and optional lifestyle advice and motivational support. Use this tool to keep track of your blood pressure measurements at home. 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. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Murakami L, Rakotz M. Improving health outcomes: Blood pressure. 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. To increase nationwide implementation of SMBP plus clinical support, multiple issues must be addressed. Federal government websites often end in .gov or .mil. The Correct Way to Measure Blood Pressure Please enable it to take advantage of the complete set of features! In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. No studies of SMBP monitoring in children were identified. 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 health care professional will slowly let air out of the cuff while listening to your pulse with a stethoscope and watching the gauge. In response, providers offer customized support and advice, such as medication or lifestyle adjustments. The HOME BP intervention for SMBP is an integrated patient-practitioner online digital tool. On the other hand, if more frequent home BP measurements lead to more encounters for counseling, modification of lifestyle behaviors, drug treatments along with management of adverse effects, SMBP may actually increase cost, at least in the short term, since it takes several years for improved BP control to improve clinical outcomes. 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. Readings by a person can be affected by observer training, preference, and bias. In that role, she provides scientific expertise to support research translation related to Million Hearts priority strategies. Internet Citation: Systematic Review: https://www.ahrq.gov/evidencenow/heart-health/blood-pressure/smbp-effectiveness.html. SMBP means you regularly use a personal blood pressure measurement device away from a doctors office or hospitalusually at home. The https:// ensures that you are connecting to the More broadly, though, it is the regular use of a BP measurement device that is owned by (or lent to) the patient to be used outside the office/clinic setting. 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. To determine predictors of adherence with SMBP monitoring. HHS Vulnerability Disclosure, Help Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. 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. This website also contains material copyrighted by 3rd parties. Use this list of questions to ask your health care team [PDF 173 KB]to help you manage your blood pressure. Background Hypertension often requires lifelong treatment. 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. First, a health care professional wraps an inflatable cuff around your arm. Figure 1 shows possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care. 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. 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. Finally, SMBP may be useful in preventing overtreatment in individuals with white coat syndrome, orthostatic BP changes, or hypotensive episodes from medication. Providers can help with SMBP implementation by promoting SMBP to their hypertensive patients and establishing clinical feedback systems. No studies evaluated children. Measuring your blood pressure is the only way to know whether you have high blood pressure. Share this graphic with family and friends to show them the correct way to measure blood pressure. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. Untreated or ineffectively treated hypertension leads to increased cardiovascular . The health care professional then inflates the cuff, which gently tightens on your arm. Accessibility Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care, Agency for Healthcare Research and Quality (US). National Library of Medicine Self-Measured Blood Pressure Monitoring: Key Findings from a National Health Information Technology Landscape Analysis[PDF 1.3 MB] 2011 Jan-Feb;46(1):99-102. doi: 10.4085/1062-6050-46.1.99. How often should I measure my blood pressure? The .gov means its official. AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. Patients may require some instruction on how to use SMBP devices.30,31. 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. 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. These cookies may also be used for advertising purposes by these third parties. 52 prospective comparative studies of SMBP monitoring with or without additional support versus usual care or an alternative SMBP monitoring intervention in persons with hypertension. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. official website and that any information you provide is encrypted Choosing-a-Home-BP-Monitor At-a-Glance-Comparison [PDF 446 KB] John M. Eisenberg Center for Clinical Decisions and Communications Science. You will be subject to the destination website's privacy policy when you follow the link. Current insurance coverage for SMBP plus clinical support is limited and improvements are planned or are under way. Take at least two readings, 1 or 2 minutes apart. 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. Many studies were of moderate to poor quality and had short followup periods. What should I do if my blood pressure numbers are high? Uhlig K, Balk EM, Patel K, et al. This 2015 CPSTF systematic review evaluates the effectiveness of using SMBP with additional clinical support to manage high blood pressure and SMBP alone. This one-page overview outlines the viability, costs, and returns for implementing an SMBP monitoring program based on Medicare reimbursement. . You can review and change the way we collect information below. Source:Centers for Disease Control and Prevention. If you log out, you will be required to enter your username and password the next time you visit. John M Eisenberg Center for Clinical Decisions and Communications Science. 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. The bold lines indicate the comparisons addressed in the Key Questions (see below). We included studies that used arm (not wrist) monitors for at least 8 weeks and excluded studies of pregnant women or people on hemodialysis. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners. 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. 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. Please enable it to take advantage of the complete set of features! The full report, listing all studies, is available at www.effectivehealthcare.ahrq.gov/selfmeasuredbp.cfm. 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. Centers for Disease Control and Prevention. This patient-friendly video from the Release the Pressure Coalition highlights the key steps people can take for accurate SMBP monitoring. [1] SMBP monitoring plus clinical support has been found to be effective in helping patients control their blood pressure.[2]. Measure your blood pressure regularly to help your health care team diagnose any health problems early. The https:// ensures that you are connecting to the 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 clinic 26 PMID: 23922064. 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). Details on design, patients, interventions, outcomes, and quality were extracted into standard forms. 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. 8600 Rockville Pike 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. Patient-provider feedback loops may involve patients reporting blood pressure readings for a given time period, concerns about medications, and progress on lifestyle changes to their providers. There are also a variety of kiosks available in stores and pharmacies. OF SELF-MEASURED BLOOD PRESSURE MONITORING INTERVENTIONS CENTERS FOR DISEASE CONTROL AND PREVENTION . 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. Figure 2. A reading that says your blood pressure is lower than it actually is may give you a false sense of security about your health. The gauge uses a unit of measurement called millimeters of mercury (mmHg) to measure the pressure in your blood vessels. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. SMBP monitoring is also commonly referred to as home blood pressure monitoring. 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. Content last reviewed March 2021. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Hypertension Medication for Specific Comorbidities, Individualized Weight Monitoring Using the Heartphone, Home Blood Pressure Monitoring in Patients With Hypertension. b W 35D43zi&J &lbP K 7X Types of clinical support include one-on-one counseling, Web-based and telephone support, and educational classes. Would you like email updates of new search results? https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure/research. [3] (Figure 2). Many studies were of moderate to poor quality and had short followup periods. Ann Intern Med. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. If you have high blood pressure, talk to your health care team about steps to take to control your blood pressureto lower your risk for heart disease and stroke. 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. official website and that any information you provide is encrypted Internet Citation: Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Content last reviewed August 2018. Release the Pressure Self-Measured Blood Pressure (SMBP) Training Video 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. Tools to Establish a Self-Measured BP (SMBP) Monitoring Program [PDF 2 MB] 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. 343 0 obj <>stream 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. Target: BP: Implement SMBP PMC People using assistive technology may not be able to fully access information in these files. Several national and international hypertension guidelines endorse self-measured BP monitoring. Hello. government site. FOIA This 2020 joint policy statement from the American Heart Association (AHA) and the AMA addresses barriers to implementing SMBP monitoring. Updated Hypertension Guidelines: Implications for Treatment? 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. 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. Prior to joining CDC, Allison worked on the Global Polio Eradication Initiative at CARE International where she designed curricula for health workers and conducted evaluation field research on global polio eradication efforts. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. %%EOF 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 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. Europe PMC is an archive of life sciences journal literature. European Associations Review Dietary Therapies for Obesity, AHA Statement Ranks 10 Popular Diets for Heart Health. A reading that says your blood pressure is higher than it actually is may lead to treatment you dont need.
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