At-home blood pressure monitoring is important

Dr Derrick Aarons

Sunday, October 28, 2018

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DO you have high blood pressure, or do you know someone who does? Well, if you do, you should always have a blood pressure monitoring device at home. Use it each morning as soon as you get out of bed to check how well your blood pressure is being controlled.

You should also make a chart of your daily blood pressure readings to determine whether your control is improving or it is getting worse. Further, you should share these records with your doctor each time you visit.

The result of a recent research study suggests that home blood pressure monitoring improves control of blood pressure and saves money. In fact, home blood pressure monitoring is not only an evidence-based best practice standard, but also a cost-effective way to achieve high-value health care.

Research confirms it!

In the study, researchers examined the effects of a practical home blood pressure monitoring programme that was conducted with the aim of good blood pressure control. Two thousand five hundred and fifty adults with persistent, uncontrolled high blood pressure were involved. The participants received free home blood pressure monitors, as well as monitoring reminders.

As doctors had recorded office-based blood pressure readings in their electronic records of patients, it allowed the researchers to calculate the change in blood pressure control for each subsequent visit, and compare them for each visit, year on year. The findings of this research were presented at the September 2018 conference of the American Heart Association Joint Hypertension Scientific Sessions.

In the home monitoring system programme, the research found that by the third office visit, nearly 67 per cent of patients had their blood pressure under control, with readings in the office of less than 140/90 mm Hg. As a result of adjustments in blood pressure medications that doctors made based on the information gleaned from home blood pressure monitoring, within six months after the introduction of home blood pressure monitoring, nearly 80 per cent of patients achieved the blood pressure control that met the Healthcare Effectiveness Data and Information Set 2018 standards.

Achieving the guideline standards

Seventy-two per cent achieved blood pressure control that met the American Heart Association/American College of Cardiology guidelines. These are even more stringent guidelines, and so showed that home blood pressure monitoring is vital to achieving control among hypertensive patients.

By the end of the first year after the home blood pressure monitoring programme was introduced, systolic blood pressures had decreased by an average of 17 mm Hg, and diastolic blood pressures had fallen an average of 6.5 mm Hg.

In doing a cost/benefit analysis, the researchers noted that each program kit and monitor costs an average of US$38, and so the cost savings in regard to medication not needed were very substantial. Further, each patient were required to make 1.2 fewer office visits per year, as well as fewer emergency department visits and associated medication costs.

Strong support

Not surprisingly, home blood pressure monitoring gets a grade A recommendation (that is strong evidence) from the US Preventive Services Task Force, and numerous professional organisations, including the American Heart Association, recommend it for the diagnosis as well as treatment of high blood pressure.

Unfortunately, however, home blood pressure monitoring devices are often not a part of the household of many hypertensive patients nor a part of the routine care provided by doctors. The researchers lamented this industry-wide inertia existing among patients, health care providers, and insurance company payers. Drawing a comparison, they stated that doctors would never seek to treat a diabetic with insulin without the proper reviewing of the patient's home blood sugar readings, and so why should doctors be treating hypertensive patients without reviewing their home blood pressure readings?

Many specialists consider this research to be an important and timely study, as it had been recognised for decades that for some individuals, an isolated blood pressure reading in a clinic is not really reflective of what blood pressure readings may be like over a 24-hour period outside of the doctor's office. Consequently, the new guidelines recommend that home blood pressure monitoring be an important part of the regular management of hypertension.

Take-away message

So, the take away is: Everyone with high blood pressure should have a blood pressure measuring machine at home. They should keep a log of their readings and send them to their doctors regularly. If individuals have known high blood pressure and are on the right medicines, this submission should occur maybe once per month. However, if people are newly diagnosed and recently placed on medication, those readings should be submitted on a weekly basis.

In severe cases, doctors may use ambulatory continuous blood pressure monitoring in patients. This method is an important way to gather even more information about blood pressure. It is well known that controlling high blood pressure reduces the likelihood of a heart attack, stroke, and kidney failure, and so all efforts should be made to know as much as possible about blood pressure readings to ensure it is controlled in a wide variety of settings.

Dr Derrick Aarons MD, PhD, is a family physician and consultant bioethicist; a specialist in ethical issues in health care, research, and the life sciences; the health registrar and head of the health secretariat for the Turks & Caicos Islands, and a member of UNESCO's International Bioethics Committee (IBC).

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