self measured blood pressure monitoring: comparative effectiveness
MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. Purpose: This site needs JavaScript to work properly. John M Eisenberg Center for Clinical Decisions and Communications Science. Comparative Effectiveness Review No. SMBP monitoring is the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere. To determine predictors of adherence with SMBP monitoring. Patients are instructed to keep an activity log throughout the testing period for evaluation of stress- and activity-related BP changes. This article presents strategies for strengthening the United States ability to address hypertension in women focusing on pregnancy-related considerations for self-measured blood pressure monitoring. SMBP requires the use of a home blood pressure measurement device by the patient to measure blood pressure at different points in time. 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. 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. People using assistive technology may not be able to fully access information in these files. Release the Pressure Self-Measured Blood Pressure (SMBP) Training Video OF SELF-MEASURED BLOOD PRESSURE MONITORING INTERVENTIONS CENTERS FOR DISEASE CONTROL AND PREVENTION . Details on design, patients, interventions, outcomes, and quality were extracted into standard forms. To increase nationwide implementation of SMBP plus clinical support, multiple issues must be addressed. All information these cookies collect is aggregated and therefore anonymous. 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. 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. Hello. Data Extraction: 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. Ann Intern Med. 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. We take your privacy seriously. 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. Federal government websites often end in .gov or .mil. 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. 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"" Please confirm that you would like to log out of Medscape. 2011 Aug 8. Take this form [PDF 105 KB]with you on your first blood pressure visit to record important blood pressure-related information. They help us to know which pages are the most and least popular and see how visitors move around the site. Purpose CDC twenty four seven. Murakami L, Rakotz M. Improving health outcomes: Blood pressure. 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. and transmitted securely. Thank you. Many studies were of moderate to poor quality and had short followup periods. Target: BP: Implement SMBP Progestogens for Prevention of Preterm Birth. 45. Federal government websites often end in .gov or .mil. Background Hypertension often requires lifelong treatment. European Associations Review Dietary Therapies for Obesity, AHA Statement Ranks 10 Popular Diets for Heart Health. 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. MeSH 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. Patients may require some instruction on how to use SMBP devices.30,31. 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)? Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners. 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. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Would you like email updates of new search results? This resource from the Public Health Informatics Institute provides a checklist of helpful characteristics for SMBP telemonitoring software. sharing sensitive information, make sure youre on a federal We also included longitudinal cohort studies in addressing adherence predictors. The site is secure. Resource title: Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension. In: Daniel D, Prall M, editors. Measuring your blood pressure is the only way to know whether you have high blood pressure. No studies of SMBP monitoring in children were identified. Content last reviewed March 2021. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. ECG Challenge: What's Causing This Woman's Slow Pulse? This 2012 AHRQ review examined the comparative effectiveness of SMBP alone, of SMBP plus additional clinical support, and of usual care. These evidence-based action steps and resources, assembled by Million Hearts, can help practices implement SMBP monitoring. You will be subject to the destination website's privacy policy when you follow the link. Please enable it to take advantage of the complete set of features! John M Eisenberg Center for Clinical Decisions and Communications Science. The current report evaluates ambulatory BP monitoring only as an outcome measurement tool, not as an intervention of interest. 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. 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. 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. The Forum convenes online quarterly. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. 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. A connected monitor is preprogrammed to regularly record BP, usually every 15 to 20 minutes while awake and every 20 to 30 minutes while asleep. pressure monitoring and refers to the regular use of a 293 0 obj <> endobj Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Clinical support includes regular one-on-one counseling, web-based or telephonic support tools, and educational classes. We included studies that used arm (not wrist) monitors for at least 8 weeks and excluded studies of pregnant women or people on hemodialysis. No studies evaluated children. SMBP differs from clinic-based and ambulatory blood . To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. The Correct Way to Measure Blood Pressure Many studies were of moderate to poor quality and had short followup periods. To determine predictors of adherence with SMBP monitoring. 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 Public Health Practitioners [PDF 1 MB] High blood pressure usually has no warning signs or symptoms, and many people do not know they have it. 12-EHC002-EF. Is immediate imaging important in managing low back pain? Rockville, MD 20857 To summarize evidence about the effectiveness of self-measured blood pressure (SMBP) monitoring in adults with hypertension. Very few trials evaluated objective clinical outcomes. Measurements can be read by a person or provided digitally by a device. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Aug. Report No. b W 35D43zi&J &lbP K 7X Centers for Disease Control and Prevention. 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.) 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. Content last reviewed March 2021. 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. An official website of the United States government. Measurements may interfere with a patient's activity or sleep. Purpose: 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. 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]. They can help you make a plan to manage high blood pressure. The review addressed SMBP monitoring performed by the patient or the patient's companion at home; it did not include monitoring done at the doctor's office, clinic, pharmacy, or health unit at work, nor did it include blood pressure (BP) monitoring done at home by nurses or other health care professionals. 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. The HOME BP intervention for SMBP is an integrated patient-practitioner online digital tool. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). FOIA Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care, Agency for Healthcare Research and Quality (US). With training, additional support and treatment algorithms, patients may be able to self adjust medications based on SMBP results. You will be subject to the destination website's privacy policy when you follow the link. 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. 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. FOIA 2012 Sep 21. An official website of the Department of Health & Human Services. 5600 Fishers Lane government site. This article outlines high-level SMBP barriers that federal/national partners have encountered and offers potential solutions to achieve widespread SMBP implementation. 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. 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. Home BP monitoring (HBPM) has been utilized for regular monitoring of BP at home to improve HTN control or regulate antihypertensive medications. 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. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. While patient self-participation in chronic disease management appears promising, the sustainability and clinical impact of SMBP remains uncertain. 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. Figure 2. Lozano P, Henrikson NB, Morrison CC, Dunn J, Nguyen M, Blasi P, Whitlock EP. 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. You will receive email when new content is published. Don't smoke, drink caffeinated beverages or exercise within 30 minutes before measuring your blood pressure. Technically, SMBP monitoring refers to regular measurement by the patient of his or her own BP. : 12-EHC002-EF. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. 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. 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. The actual BP measurement can be done either by the patient, or less frequently by a companion, who is usually not a medical professional. Addressing Barriers Beyond the Published Literature Whether or not to advise the use of an SMBP monitoring device for a patient with hypertension is a common clinical question for clinicians. Share this graphic with family and friends to show them the correct way to measure blood pressure. Taking Control of My Blood Pressure: DAngelos Story Comparative Effectiveness Review No. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. Million Hearts Science team, Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GeorgiaDisclosure: Allison Goldstein, MPH, has disclosed no relevant financial relationships. Blood Pressure Validated Device Listing (VDL), Self-Measurement: How Patients and Care Teams Are Bringing Blood Pressure to Control, An Economic Case for Self-Measured Blood Pressure (SMBP) Monitoring [PDF - 156 KB], Choosing-a-Home-BP-Monitor At-a-Glance-Comparison, Self-Measured Blood Pressure Monitoring: Key Findings from a National Health Information Technology Landscape Analysis, Tools to Establish a Self-Measured BP (SMBP) Monitoring Program, Self-Measured Blood Pressure Monitoring Program: Engaging Patients in Self-Measurement, Oscillometric Blood Pressure Devices Validated for Accuracy During Pregnancy, Target: BP: CME Course: Using SMBP to Diagnose and Manage High Blood Pressure, Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians, Collaborative Care Models for Improving Hypertension Control Through SMBP Monitoring, Accelerating Use of Self-measured Blood Pressure Monitoring (SMBP) Through Clinical-Community Care Models, Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners, Topline Findings: A National Analysis of Self-Measured Blood Pressure Monitoring Coverage and Reimbursement, CDCs 6|18 Initiative: Accelerating Evidence into Action, Release the Pressure Self-Measured Blood Pressure (SMBP) Training Video, How to Use Your Home Blood Pressure Monitor, Taking Control of My Blood Pressure: DAngelos Story, Taking Control of My Blood Pressure: Natalias Story, How to Measure Your Blood Pressure at Home, The Correct Way to Measure Blood Pressure, How Do We Jump-Start Self-measured Blood Pressure Monitoring in the United States?
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